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Zhou M, Xie J, Kawase O, Nishikawa Y, Ji S, Zhu S, Cao S, Xuan X. Characterization of anti-erythrocyte and anti-platelet antibodies in hemolytic anemia and thrombocytopenia induced by Plasmodium spp. and Babesiaspp. infection in mice. Front Cell Infect Microbiol 2023; 13:1143138. [PMID: 37124034 PMCID: PMC10140361 DOI: 10.3389/fcimb.2023.1143138] [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: 01/12/2023] [Accepted: 03/20/2023] [Indexed: 05/02/2023] Open
Abstract
Introduction Malaria and Babesiosis are acute zoonotic disease that caused by infection with the parasite in the phylum Apicomplexa. Severe anemia and thrombocytopenia are the most common hematological complication of malaria and babesiosis. However, the mechanisms involved have not been elucidated, and only a few researches focus on the possible role of anti-erythrocyte and anti-platelet antibodies. Methods In this study, the Plasmodium yoelii, P. chabaudi, Babesia microti and B. rodhaini infected SCID and ICR mice. The parasitemia, survival rate, platelet count, anti-platelet antibodies, and the level of IFN-γ and interleukin (IL) -10 was tested after infection. Furthermore, the P. yoelii, P. chabaudi, B. rodhaini and B. microti infected ICR mice were treated with artesunate and diminaze, the development of the anti-erythrocyte and anti-platelet antibodies in chronic stage were examined. At last, the murine red blood cell and platelet membrane proteins probed with auto-antibodies induced by P. yoelii, P. chabaudi, B. rodhaini, and B. microti infection were characterized by proteomic analysis. Results and discussion The high anti-platelet and anti-erythrocyte antibodies were detected in ICR mice after P. yoelii, P. chabaudi, B. rodhaini, and B. microti infection. Actin of murine erythrocyte and platelet is a common auto-antigen in Plasmodium and Babesia spp. infected mice. Our findings indicate that anti-erythrocyte and anti-platelet autoantibodies contribute to thrombocytopenia and anemia associated with Plasmodium spp. and Babesia spp. infection. This study will help to understand the mechanisms of malaria and babesiosis-related thrombocytopenia and hemolytic anemia.
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Affiliation(s)
- Mo Zhou
- National Research Center for Protozoan Diseases, Obihiro University of Agriculture and Veterinary Medicine, Obihiro, Hokkaido, Japan
- Jiangsu Key Laboratory for High-tech Research and Development of Veterinary Biopharmaceuticals, Jiangsu Agri-animal Husbandry Vocational College, Taizhou, China
- Engineering Technology Research Center for Modern Animal Science and Novel Veterinary Pharmaceutic Development, Jiangsu Agri-animal Husbandry Vocational College, Taizhou, China
| | - Jun Xie
- Jiangsu Key Laboratory for High-tech Research and Development of Veterinary Biopharmaceuticals, Jiangsu Agri-animal Husbandry Vocational College, Taizhou, China
- Engineering Technology Research Center for Modern Animal Science and Novel Veterinary Pharmaceutic Development, Jiangsu Agri-animal Husbandry Vocational College, Taizhou, China
| | - Osamu Kawase
- Department of Biology, Premedical Sciences, Dokkyo Medical University, Tochigi, Japan
| | - Yoshifumi Nishikawa
- National Research Center for Protozoan Diseases, Obihiro University of Agriculture and Veterinary Medicine, Obihiro, Hokkaido, Japan
| | - Shengwei Ji
- National Research Center for Protozoan Diseases, Obihiro University of Agriculture and Veterinary Medicine, Obihiro, Hokkaido, Japan
| | - Shanyuan Zhu
- Jiangsu Key Laboratory for High-tech Research and Development of Veterinary Biopharmaceuticals, Jiangsu Agri-animal Husbandry Vocational College, Taizhou, China
- Engineering Technology Research Center for Modern Animal Science and Novel Veterinary Pharmaceutic Development, Jiangsu Agri-animal Husbandry Vocational College, Taizhou, China
| | - Shinuo Cao
- National Research Center for Protozoan Diseases, Obihiro University of Agriculture and Veterinary Medicine, Obihiro, Hokkaido, Japan
- Jiangsu Key Laboratory for High-tech Research and Development of Veterinary Biopharmaceuticals, Jiangsu Agri-animal Husbandry Vocational College, Taizhou, China
- Engineering Technology Research Center for Modern Animal Science and Novel Veterinary Pharmaceutic Development, Jiangsu Agri-animal Husbandry Vocational College, Taizhou, China
- *Correspondence: Shinuo Cao, ; Xuenan Xuan,
| | - Xuenan Xuan
- National Research Center for Protozoan Diseases, Obihiro University of Agriculture and Veterinary Medicine, Obihiro, Hokkaido, Japan
- *Correspondence: Shinuo Cao, ; Xuenan Xuan,
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Severe thrombocytopaenia in patients with vivax malaria compared to falciparum malaria: a systematic review and meta-analysis. Infect Dis Poverty 2018; 7:10. [PMID: 29427995 PMCID: PMC5808388 DOI: 10.1186/s40249-018-0392-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 01/24/2018] [Indexed: 11/19/2022] Open
Abstract
Background Plasmodium vivax is the most geographically widespread species among human malaria parasites. Immunopathological studies have shown that platelets are an important component of the host innate immune response against malaria infections. The objectives of this study were to quantify thrombocytopaenia in P. vivax malaria patients and to determine the associated risks of severe thrombocytopaenia in patients with vivax malaria compared to patients with P. falciparum malaria. Main body A systematic review and meta-analysis of the available literature on thrombocytopaenia in P. vivax malaria patients was undertaken. Relevant studies in health-related electronic databases were identified and reviewed. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Fifty-eight observational studies (n = 29 664) were included in the current review. Severe thrombocytopaenia (< 50 000/mm3) to very severe thrombocytopaenia (< 20 000/mm3) was observed in 10.1% of patients with P. vivax infection. A meta-analysis of 11 observational studies showed an equal risk of developing severe/very severe thrombocytopaenia between the patients with P. vivax malaria and those with P. falciparum malaria (OR: 1.98, 95% CI: 0.92–4.25). This indicates that thrombocytopaenia is as equally a common manifestation in P. vivax and P. falciparum malaria patients. One study showed a higher risk of developing very severe thrombocytopaenia in children with severe P. vivax malaria than with severe P. falciparum malaria (OR: 2.80, 95% CI: 1.48–5.29). However, a pooled analysis of two studies showed an equal risk among adult severe cases (OR: 1.19, 95% CI: 0.51–2.77). This indicates that the risk of developing thrombocytopaenia in P. vivax malaria can vary with immune status in both children and adults. One study reported higher levels of urea and serum bilirubin in patients with P. vivax malaria and severe thrombocytopaenia compared with patients mild thrombocytopaenia or no thrombocytopaenia, (P < 0.001 in all comparisons). A pooled analysis of two other studies showed a similar proportion of bleeding episodes with thrombocytopaenia in severe P. vivax patients and severe P. falciparum patients (P = 0.09). This implied that both P. vivax and P. falciparum infections could present with bleeding episodes, if there had been a change in platelet counts in the infected patients. A pooled analysis of another two studies showed an equal risk of mortality with severe thrombocytopaenia in both P. vivax and P. falciparum malaria patients (OR: 1.16, 95% CI: 0.30–4.60). However, due to the low number of studies with small sample sizes within the subset of studies that provided clinically relevant information, our confidence in the estimates is limited. Conclusion The current review has provided some evidence of the clinical relevance of severe thrombocytopaenia in P. vivax malaria. To substantiate these findings, there is a need for well designed, large-scale, prospective studies among patients infected with P. vivax. These should include patients from different countries and epidemiological settings with various age and gender groups represented. Electronic supplementary material The online version of this article (10.1186/s40249-018-0392-9) contains supplementary material, which is available to authorized users.
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Ray S, Patel SK, Venkatesh A, Chatterjee G, Ansari NN, Gogtay NJ, Thatte UM, Gandhe P, Varma SG, Patankar S, Srivastava S. Quantitative Proteomics Analysis of Plasmodium vivax Induced Alterations in Human Serum during the Acute and Convalescent Phases of Infection. Sci Rep 2017; 7:4400. [PMID: 28667326 PMCID: PMC5493610 DOI: 10.1038/s41598-017-04447-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 05/15/2017] [Indexed: 12/23/2022] Open
Abstract
The radial distribution of Plasmodium vivax malaria burden has evoked enormous concern among the global research community. In this study, we have investigated the serum proteome alterations in non-severe vivax malaria patients before and during patient recuperation starting from the early febrile to the defervescence and convalescent stages of the infection. We have also performed an extensive quantitative proteomics analysis to compare the serum proteome profiles of vivax malaria patients with low (LPVM) and moderately-high (MPVM) parasitemia with healthy community controls. Interestingly, some of the serum proteins such as Serum amyloid A, Apolipoprotein A1, C-reactive protein, Titin and Haptoglobin, were found to be sequentially altered with respect to increased parasite counts. Analysis of a longitudinal cohort of malaria patients indicated reversible alterations in serum levels of some proteins such as Haptoglobin, Apolipoprotein E, Apolipoprotein A1, Carbonic anhydrase 1, and Hemoglobin subunit alpha upon treatment; however, the levels of a few other proteins did not return to the baseline even during the convalescent phase of the infection. Here we present the first comprehensive serum proteomics analysis of vivax malaria patients with different levels of parasitemia and during the acute and convalescent phases of the infection.
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Affiliation(s)
- Sandipan Ray
- Department of Biosciences and Bioengineering, Indian Institute of Technology Bombay, Powai, Mumbai, 400076, India.,Department of Clinical Biochemistry, Metabolic Research Laboratories, Wellcome Trust-Medical Research Council Institute of Metabolic Science, University of Cambridge, Addenbrooke's Hospital, Cambridge, CB2 0QQ, United Kingdom
| | - Sandip K Patel
- Department of Biosciences and Bioengineering, Indian Institute of Technology Bombay, Powai, Mumbai, 400076, India
| | - Apoorva Venkatesh
- Department of Biosciences and Bioengineering, Indian Institute of Technology Bombay, Powai, Mumbai, 400076, India
| | - Gangadhar Chatterjee
- Dept of Biochemistry, Grant Govt Medical College and Sir JJ Group of Hospitals, Byculla, Mumbai, 400008, India
| | - Naziya N Ansari
- Department of Biosciences and Bioengineering, Indian Institute of Technology Bombay, Powai, Mumbai, 400076, India
| | - Nithya J Gogtay
- Departments of Clinical Pharmacology, Seth GS Medical College & KEM Hospital, Parel, Mumbai, 400012, India
| | - Urmila M Thatte
- Departments of Clinical Pharmacology, Seth GS Medical College & KEM Hospital, Parel, Mumbai, 400012, India
| | - Prajakta Gandhe
- Departments of Clinical Pharmacology, Seth GS Medical College & KEM Hospital, Parel, Mumbai, 400012, India
| | - Santosh G Varma
- Dept of Biochemistry, Grant Govt Medical College and Sir JJ Group of Hospitals, Byculla, Mumbai, 400008, India
| | - Swati Patankar
- Department of Biosciences and Bioengineering, Indian Institute of Technology Bombay, Powai, Mumbai, 400076, India
| | - Sanjeeva Srivastava
- Department of Biosciences and Bioengineering, Indian Institute of Technology Bombay, Powai, Mumbai, 400076, India.
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Medina-Morales DA, Montoya-Franco E, Sanchez-Aristizabal VD, Machado-Alba JE, Rodríguez-Morales AJ. Severe and benign Plasmodium vivax malaria in Emberá (Amerindian) children and adolescents from an endemic municipality in Western Colombia. J Infect Public Health 2016; 9:172-80. [DOI: 10.1016/j.jiph.2015.09.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 07/21/2015] [Accepted: 09/07/2015] [Indexed: 11/16/2022] Open
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Rodríguez-Morales AJ, Orrego-Acevedo CA, Zambrano-Muñoz Y, García-Folleco FJ, Herrera-Giraldo AC, Lozada-Riascos CO. Mapping malaria in municipalities of the Coffee Triangle region of Colombia using Geographic Information Systems (GIS). J Infect Public Health 2015; 8:603-11. [PMID: 26106039 DOI: 10.1016/j.jiph.2015.05.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 04/06/2015] [Accepted: 05/02/2015] [Indexed: 11/24/2022] Open
Abstract
Geographical Information Systems (GIS) have been used extensively for the development of epidemiological maps of malaria but not in the Coffee Triangle region of Colombia, endemic for P. vivax, P. falciparum and P. malariae. Surveillance case data (2007-2011) were used to estimate annual incidence rates per Plasmodium spp. (cases/100,000 pop) to develop the first malaria maps in the 53 municipalities of this region (departments Caldas, Quindío, Risaralda). The GIS software used was Kosmo Desktop 3.0RC1(®). Thirty thematic maps were developed according to the municipalities, years, parasite etiology, and uncomplicated and complicated cases. A total of 6582 cases were reported (6478 uncomplicated and 104 complicated, 77.8% Risaralda), for a cumulated rate of 269.46 cases/100,000 pop. Among uncomplicated cases, 5722 corresponded to P. vivax (234.25 cases/100,000 pop), 475 to P. falciparum (19.45 cases/100,000 pop), 8 to P. malariae (0.33 cases/100,000 pop) and 273 mixed (P. falciparum/P. vivax) (11.18 cases/100,000 pop). The highest rate reported was in the more undeveloped and rural municipality of Risaralda (Pueblo Rico, 57.7 cases/1000 pop, 2009). The burden of disease was concentrated in one department (>75% of the region). The use of GIS-based epidemiological maps helps to guide decision-making for the prevention and control of this public health problem that still represents a significant issue in the region and the country, particularly in children.
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Affiliation(s)
- Alfonso J Rodríguez-Morales
- Research Group Public Health and Infection, Faculty of Health Sciences, Universidad Tecnológica de Pereira (UTP), Pereira, Risaralda, Colombia; Committee on Zoonoses and Hemorrhagic Fevers of the Colombian Association of Infectious Diseases (Asociación Colombiana de Infectología, ACIN), Bogotá, Colombia; School of Medicine, Faculty of Health Sciences, Universidad Tecnológica de Pereira (UTP), Pereira, Risaralda, Colombia.
| | - César A Orrego-Acevedo
- Research Group Public Health and Infection, Faculty of Health Sciences, Universidad Tecnológica de Pereira (UTP), Pereira, Risaralda, Colombia; School of Medicine, Faculty of Health Sciences, Universidad Tecnológica de Pereira (UTP), Pereira, Risaralda, Colombia
| | - Yazmin Zambrano-Muñoz
- School of Medicine, Faculty of Health Sciences, Universidad Tecnológica de Pereira (UTP), Pereira, Risaralda, Colombia
| | - Francisco J García-Folleco
- School of Medicine, Faculty of Health Sciences, Universidad Tecnológica de Pereira (UTP), Pereira, Risaralda, Colombia
| | - Albert C Herrera-Giraldo
- School of Medicine, Faculty of Health Sciences, Universidad Tecnológica de Pereira (UTP), Pereira, Risaralda, Colombia; Operative Direction of Public Health, Risaralda Department Secretary of Health, Pereira, Risaralda, Colombia
| | - Carlos O Lozada-Riascos
- Regional Information System, Universidad Tecnológica de Pereira (UTP), Pereira, Risaralda, Colombia
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O’Brien AT, Ramírez JF, Martínez SP. A descriptive study of 16 severe Plasmodium vivax cases from three municipalities of Colombia between 2009 and 2013. Malar J 2014; 13:404. [PMID: 25318617 PMCID: PMC4203896 DOI: 10.1186/1475-2875-13-404] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 10/10/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Plasmodium vivax, the most geographically distributed cause of malaria, accounts for more than 70% of cases in the Americas. In Colombia, P. vivax was responsible for 67.3% of cases in the last five years. Despite vivax malaria impact worldwide, historically it has been neglected and considered to be a benign disease. In the last decade medical literature reports have emerged countering this benign outlook. This study pretends to describe the clinical and paraclinical profile of severe vivax malaria cases hospitalized in Tumaco, Cali, Buenaventura between 2009 and 2013, to contribute to the knowledge regarding the behaviour and clinical expression of this disease. METHODS This is a descriptive, retrospective case-series study of 16 severe malaria vivax cases, hospitalized between 2009 and 2013, in Colombian municipalities of Tumaco, Buenaventura and Cali. Severe malaria vivax cases were defined using criteria adapted from the national guidelines. Descriptive analyses of reason for consultation, signs and symptoms, diagnosis, treatment, paraclinical characteristics, complications, and time hospitalized, were conducted. RESULTS Sixteen cases of severe P. vivax were analysed. Fever, chills and headache were shown to be the main admission symptoms. Elevation of total bilirubin levels in 18.75%, and severe thrombocytopaenia in 25% of cases were the main complications presented during hospitalization. All cases responded to treatment, there were no deaths. CONCLUSIONS The following questions derived from this study could be the basis for future research: 1) Does the time to consultation have an impact on the number of days hospitalized and how cases progress during hospitalization, 2) Are the severity criteria in WHO guidelines sensitive enough to be used in clinical practice compared to national guidelines, and 3) How does malnutrition contribute to anaemia in malaria-endemic regions.
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Affiliation(s)
- Anthony T O’Brien
- Fundación Santa Fe de Bogotá Centro de Estudios e Investigación en Salud - CEI, Carrera 7 B # 123-90, Piso 3, Bogotá, Colombia
| | - Jesica F Ramírez
- Fundación Santa Fe de Bogotá Centro de Estudios e Investigación en Salud - CEI, Carrera 7 B # 123-90, Piso 3, Bogotá, Colombia
| | - Sandra P Martínez
- Fundación Santa Fe de Bogotá Centro de Estudios e Investigación en Salud - CEI, Carrera 7 B # 123-90, Piso 3, Bogotá, Colombia
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Abstract
Splenic infarction is a rare complication of malaria. We report two recent cases of splenic infarction after Plasmodium vivax infection. No systematic review of malaria-induced splenic infarction was available, therefore we conducted a systematic review of the English, French, and Spanish literature in PubMed and KoreaMed for reports of malaria-associated splenic infarction from 1960 to 2012. Of the 40 cases collected on splenic infarction by Plasmodium species, 23 involved P. vivax, 11 Plasmodium falciparum, one Plasmodium ovale, and five a mixed infection of P. vivax and P. falciparum. Of the 40 cases, 2 (5.0%) involved splenectomy and 5 (12.5%) were accompanied by splenic rupture. The median time from symptom onset to diagnosis was 8.5 days (range, 3-90 days). Improved findings after treatment were observed in 8 (88.9%) of 9 patients with splenic infarction on follow-up by computed tomography or ultrasonography. All patients survived after treatment with the exception of one patient with cerebral malaria. Clinicians should consider the possibility of splenic infarction when malaria-infected patients have left upper quadrant pain.
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Affiliation(s)
- Jeong-Hwan Hwang
- Department of Internal Medicine, Chonbuk National University Medical School and Research Institute of Clinical Medicine of Chonbuk National University-Chonbuk National University Hospital, Jeonju, Republic of Korea
| | - Chang-Seop Lee
- Department of Internal Medicine, Chonbuk National University Medical School and Research Institute of Clinical Medicine of Chonbuk National University-Chonbuk National University Hospital, Jeonju, Republic of Korea
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Cohen R, Feghali K, Alemayehu S, Komisar J, Hang J, Weina PJ, Coggeshall P, Kamau E, Zapor M. Use of qPCR and genomic sequencing to diagnose Plasmodium ovale wallikeri malaria in a returned soldier in the setting of a negative rapid diagnostic assay. Am J Trop Med Hyg 2013; 89:501-6. [PMID: 23836567 DOI: 10.4269/ajtmh.12-0724] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Plasmodium ovale is one of several clinically relevant malaria species known to cause disease in humans. However, in contrast to Plasmodium falciparum and Plasmodium vivax, which are responsible for most cases of human malaria, P. ovale has a wide distribution but low prevalence in tropical regions. Here, we report the case of a soldier returning from Liberia with P. ovale wallikeri malaria. This case highlights the limitations of both microscopy and the malaria rapid diagnostic test for diagnosing infection with P. ovale and for distinguishing P. ovale wallikeri from P. ovale curtisi. To our knowledge, this is the first case report in which quantitative real-time polymerase chain reaction amplification using the Cytochrome B gene, coupled with genomic sequencing of the potra locus, was used for definitive diagnosis of P. ovale wallikeri malaria.
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Affiliation(s)
- Robert Cohen
- Infectious Disease Service, Walter Reed National Military Medical Center, Bethesda, MD, USA.
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Cytokine balance in human malaria: does Plasmodium vivax elicit more inflammatory responses than Plasmodium falciparum? PLoS One 2012; 7:e44394. [PMID: 22973442 PMCID: PMC3433413 DOI: 10.1371/journal.pone.0044394] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Accepted: 08/06/2012] [Indexed: 02/08/2023] Open
Abstract
Background The mechanisms by which humans regulate pro- and anti-inflammatory responses on exposure to different malaria parasites remains unclear. Although Plasmodium vivax usually causes a relatively benign disease, this parasite has been suggested to elicit more host inflammation per parasitized red blood cell than P. falciparum. Methodology/Principal Findings We measured plasma concentrations of seven cytokines and two soluble tumor necrosis factor (TNF)-α receptors, and evaluated clinical and laboratory outcomes, in Brazilians with acute uncomplicated infections with P. vivax (n = 85), P. falciparum (n = 30), or both species (n = 12), and in 45 asymptomatic carriers of low-density P. vivax infection. Symptomatic vivax malaria patients, compared to those infected with P. falciparum or both species, had more intense paroxysms, but they had no clear association with a pro-inflammatory imbalance. To the contrary, these patients had higher levels of the regulatory cytokine interleukin (IL)-10, which correlated positively with parasite density, and elevated IL-10/TNF-α, IL-10/interferon (IFN)-γ, IL-10/IL-6 and sTNFRII/TNF-α ratios, compared to falciparum or mixed-species malaria patient groups. Vivax malaria patients had the highest levels of circulating soluble TNF-α receptor sTNFRII. Levels of regulatory cytokines returned to normal values 28 days after P. vivax clearance following chemotherapy. Finally, asymptomatic carriers of low P. vivax parasitemias had substantially lower levels of both inflammatory and regulatory cytokines than did patients with clinical malaria due to either species. Conclusions Controlling fast-multiplying P. falciparum blood stages requires a strong inflammatory response to prevent fulminant infections, while reducing inflammation-related tissue damage with early regulatory cytokine responses may be a more cost-effective strategy in infections with the less virulent P. vivax parasite. The early induction of regulatory cytokines may be a critical mechanism protecting vivax malaria patients from severe clinical complications.
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Abstract
This retrospective study was conducted in order to determine the incidence of various complications of Plasmodium vivax malaria based on a review of case records in a tertiary care hospital in New Delhi, India. The case records of all confirmed cases of malaria over the period of one year were studied. Complete blood count, peripheral blood findings, liver and kidney functions were reviewed. There were 165 confirmed cases. Of these, 121 were due to P. vivax and 42 to P. falciparum. Two cases had mixed infection. The complications seen in the P. vivax cases were: thrombocytopenia; hepatic dysfunction; renal damage; and acute respiratory distress syndrome (ARDS). There were three deaths as a result of ARDS. This paper highlights the fact that P. vivax malaria, although considered to be a benign entity, can have a severe and complicated course, which is usually associated with P. falciparum malaria.
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Affiliation(s)
- Atul Gogia
- Department of Medicine, Sir Ganga Ram Hospital, New Delhi, India.
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Naha K, Dasari S, Prabhu M. Spectrum of complications associated with Plasmodium vivax infection in a tertiary hospital in South-Western India. ASIAN PAC J TROP MED 2012; 5:79-82. [PMID: 22182650 DOI: 10.1016/s1995-7645(11)60251-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2011] [Revised: 09/15/2011] [Accepted: 10/15/2011] [Indexed: 10/14/2022] Open
Abstract
OBJECTIVE To determine the range and incidence of complications associated with Plasmodium vivax (P. vivax) malaria. METHODS A retrospective analysis was performed of all patients of P. vivax malaria admitted in Kasturba Medical College, Manipal between January and December, 2010. Patients with mixed malarial infection were excluded by appropriate tests. Clinical presentation and laboratory parameters were studied. RESULTS Medical records of 213 individuals who satisfied the inclusion criteria were reviewed. Anaemia was seen in 65 (30.5%), leucopenia in 38 (17.8%) and thrombocytopenia in 184 (86.4%) patients. Aspartate and alanine aminotransferases were elevated in 86 (40.4%), and 89 (41.9%) patients respectively. Hypoalbuminemia was observed in 157 (73.6%) cases. Elevated serum creatinine was noted in in 59 (27.5%) patients. Creatine kinase was elevated in 30 out of 59 patients (50.8%). Overall, 107 (50.2%) patients fulfilled WHO criteria for severe malaria. None of the patients succumbed to the disease. CONCLUSIONS P. vivax malaria is a potentially severe disease, and the term "benign" tertian malaria is a misnomer. Despite significant morbidity, with timely and appropriate treatment P. vivax malaria has an excellent outcome.
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Affiliation(s)
- Kushal Naha
- Department of Medicine, Kasturba Hospital, Manipal, Karnataka, India
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Lacerda MVG, Mourão MPG, Coelho HCC, Santos JB. Thrombocytopenia in malaria: who cares? Mem Inst Oswaldo Cruz 2011; 106 Suppl 1:52-63. [DOI: 10.1590/s0074-02762011000900007] [Citation(s) in RCA: 119] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2011] [Accepted: 05/26/2011] [Indexed: 11/22/2022] Open
Affiliation(s)
| | - Maria Paula Gomes Mourão
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Brasil; Universidade do Estado do Amazonas, Brasil; Universidade Nilton Lins, Brasil
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Abstract
Plasmodium vivax usually causes an acute self-limiting febrile illness with fever spikes on every third day and no complications or death. Therefore the illness caused by this parasite was termed benign tertian malaria. However, many complications associated with Plasmodium falciparum have been seen with increasing frequency with Plasmodium vivax in recent times. The present study highlights the various complications associated with Plasmodium vivax malaria.
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Affiliation(s)
- Chanaveerappa Bammigatti
- Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Medicine, Puducherry, India.
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Singh H, Parakh A, Basu S, Rath B. Plasmodium vivax malaria: is it actually benign? J Infect Public Health 2011; 4:91-5. [PMID: 21663878 DOI: 10.1016/j.jiph.2011.03.002] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2010] [Revised: 03/07/2011] [Accepted: 03/09/2011] [Indexed: 11/24/2022] Open
Abstract
UNLABELLED Plasmodium vivax (Pv) malaria is being increasingly recognized as a cause of severe malaria in children. OBJECTIVES To describe the various severe manifestations associated with vivax malaria by retrospective analysis of records. METHODS Children between the ages of 0 and 18 years with a confirmed diagnosis of Pv malaria monoinfection done by peripheral blood film (PBF) and/or rapid diagnostic test (RDT) admitted between June and September 2009 were included. Their clinical, hematological and biochemical manifestations were analyzed. RESULTS Twenty-three patients of Pv malaria were retrospectively analyzed. Thrombocytopenia was present in 22 (96%) patients with counts less than 50,000/ μL in 9 patients. Severe anemia (hgb<5mg/dl) was present in 8 (34%) patients. Cerebral malaria was present in 3 patients. Liver enzymes were elevated (>3 times normal) in 4 (17.3%) patients while jaundice (bilirubin>2.5mg/dl) was present in 2 patients (total bilirubin 5.2mg/dl and 14.3mg/dl). Renal dysfunction (creatinine>3mg/dl) was present in 6 (26%) patients with 2 patients showing severely deranged renal functions (blood urea 168 mg/dl, 222 mg/dl and serum creatinine 5.0mg/dl, 5.6 mg/dl, respectively). Hypernatremia was present in one patient. One patient expired within 12h of presentation because of severely deranged hepatic and renal dysfunction. CONCLUSION Pv malaria can lead to unusual and fatal complications. All new guidelines should include "Severe Vivax malaria" as a clinical entity. Further research into the etiopathogenesis and treatment would be important.
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Affiliation(s)
- Harpal Singh
- Department of Pediatrics, Lady Hardinge Medical College and Kalawati Saran Children's Hospital, New Delhi, India. dr
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Rodriguez-Morales AJ, Herrera-Martínez AD, Herrera-Martínez Y. Imported cases of malaria admitted to a hospital in Western Venezuela, 1998–2009. Travel Med Infect Dis 2010; 8:269-71. [DOI: 10.1016/j.tmaid.2010.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2010] [Revised: 07/06/2010] [Accepted: 07/07/2010] [Indexed: 11/28/2022]
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Andrade BB, Reis-Filho A, Souza-Neto SM, Clarêncio J, Camargo LMA, Barral A, Barral-Netto M. Severe Plasmodium vivax malaria exhibits marked inflammatory imbalance. Malar J 2010; 9:13. [PMID: 20070895 PMCID: PMC2837053 DOI: 10.1186/1475-2875-9-13] [Citation(s) in RCA: 188] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2009] [Accepted: 01/13/2010] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Despite clinical descriptions of severe vivax malaria cases having been reported, data regarding immunological and inflammatory patterns are scarce. In this report, the inflammatory and immunological status of both mild and severe vivax malaria cases are compared in order to explore immunopathological events in this disease. METHODS AND RESULTS Active and passive malaria case detections were performed during 2007 in Buritis, Rondônia, in the Brazilian Amazon. A total of 219 participants enrolled the study. Study individuals were classified according to the presence of Plasmodium vivax infection within four groups: non-infected (n = 90), asymptomatic (n = 60), mild (n = 50) and severe vivax infection (n = 19). A diagnosis of malaria was made by microscopy and molecular assays. Since at present no clear criteria define severe vivax malaria, this study adapted the consensual criteria from falciparum malaria. Patients with severe P. vivax infection were younger, had lived for shorter time in the endemic area, and recalled having experienced less previous malaria episodes than individuals with no malaria infection and with mild or asymptomatic infection. Strong linear trends were identified regarding increasing plasma levels of C reactive protein (CRP), serum creatinine, bilirubins and the graduation of disease severity. Plasma levels of tumour necrosis factor (TNF), interferon-gamma(IFN-gamma) and also IFN-gamma/interleukin-10 ratios were increased and exhibited a linear trend with gradual augmentation of disease severity. Both laboratory parameters of organ dysfunction and inflammatory cytokines were reduced during anti-parasite therapy in those patients with severe disease. CONCLUSION Different clinical presentations of vivax malaria infection present strong association with activation of pro-inflammatory responses and cytokine imbalance. These findings are of utmost importance to improve current knowledge about physiopathological concepts of this serious widespread disease.
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Affiliation(s)
- Bruno B Andrade
- Centro de Pesquisas Gonçalo Moniz (CPqGM), Fundação Oswaldo Cruz (FIOCRUZ), Salvador, Bahia, Brazil
- Faculdade de Medicina da Bahia, Universidade Federal da Bahia (UFBA), Salvador, Bahia, Brazil
| | - Antonio Reis-Filho
- Centro de Pesquisas Gonçalo Moniz (CPqGM), Fundação Oswaldo Cruz (FIOCRUZ), Salvador, Bahia, Brazil
- Faculdade de Medicina da Bahia, Universidade Federal da Bahia (UFBA), Salvador, Bahia, Brazil
| | - Sebastião M Souza-Neto
- Centro de Pesquisas Gonçalo Moniz (CPqGM), Fundação Oswaldo Cruz (FIOCRUZ), Salvador, Bahia, Brazil
- Faculdade de Medicina da Bahia, Universidade Federal da Bahia (UFBA), Salvador, Bahia, Brazil
| | - Jorge Clarêncio
- Centro de Pesquisas Gonçalo Moniz (CPqGM), Fundação Oswaldo Cruz (FIOCRUZ), Salvador, Bahia, Brazil
- Faculdade de Medicina da Bahia, Universidade Federal da Bahia (UFBA), Salvador, Bahia, Brazil
| | - Luis MA Camargo
- Departamento de Parasitologia, Instituto de Ciências Biológicas, Universidade de São Paulo, Brazil
- Faculdade de Medicina, Faculdade São Lucas, Rondônia, Brazil
| | - Aldina Barral
- Centro de Pesquisas Gonçalo Moniz (CPqGM), Fundação Oswaldo Cruz (FIOCRUZ), Salvador, Bahia, Brazil
- Faculdade de Medicina da Bahia, Universidade Federal da Bahia (UFBA), Salvador, Bahia, Brazil
- Instituto de Investigação em Imunologia (iii), Instituto Nacional de Ciência e Tecnologia (INCT), São Paulo, Brazil
| | - Manoel Barral-Netto
- Centro de Pesquisas Gonçalo Moniz (CPqGM), Fundação Oswaldo Cruz (FIOCRUZ), Salvador, Bahia, Brazil
- Faculdade de Medicina da Bahia, Universidade Federal da Bahia (UFBA), Salvador, Bahia, Brazil
- Instituto de Investigação em Imunologia (iii), Instituto Nacional de Ciência e Tecnologia (INCT), São Paulo, Brazil
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Rodriguez-Morales AJ, Ferrer MV, Barrera MA, Pacheco M, Daza V, Franco-Paredes C. Imported cases of malaria admitted to two hospitals of Margarita Island, Venezuela, 1998-2005. Travel Med Infect Dis 2008; 7:44-8. [PMID: 19174301 DOI: 10.1016/j.tmaid.2008.09.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2008] [Revised: 09/13/2008] [Accepted: 09/22/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Imported cases of malaria constitute an important public health problem in many countries, even in those with autochthonous cases, where disease could be acquired in these areas and then seen in non-endemic regions. Non-immune populations are susceptible to complications due to malaria infection, particularly in malaria caused by Plasmodium falciparum. However, Plasmodium vivax the predominant Plasmodium spp. in Venezuela can also lead to severe malaria. METHODS We reviewed retrospectively cases of malaria to identify the clinical features of those imported cases diagnosed at two institutions in Margarita Island (a non-endemic area), Venezuela, in an 8-year period. We conducted a retrospective observational study to identify the clinical and epidemiological features among hospitalized patients at Hospital Central and Hospital Agustin Hernández with malaria acquired at malaria-endemic locations. RESULTS We identified eighteen imported cases of malaria confirmed by thin and thick peripheral blood smears at these two institutions over an 8-year period. The mean age of diagnosis was 27 years. P. vivax was responsible for the majority of cases. All patients presented with fever, 89% with malaise, 78% with chills, and 67% with myalgia, among others symptoms. Mean haemoglobin levels on admission were 8.1g/dL (100% <12g/dL); platelets: 79,283cells/mm(3) (89% had platelets below 150,000); and a mean total leukocyte count: 3.4x10(3)cells/mm(3) (78% had leukopenia). Thirty nine percent of patients required blood transfusions. Two fatalities were identified (CFR=11%), one associated to severe malaria due to P. falciparum and the other due to a complicated case of P. vivax malaria. DISCUSSION Imported cases of malaria due to P. vivax and P. falciparum in the studied population are associated with significant hematological complications. These findings illustrate the importance of educating non-immune populations about the malaria risk and prevention strategies; and from a pubic health perspective, the need to develop further malaria prevention strategies at a national level.
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Kim JS, Oh JS, Chang EA, Bae SY, Nam DH, Lee CH, Yang JH, Lee CK, Lee WJ, Kim HC, Klein TA, Lim CS, Kim YK. Alteration of platelet counts and lipid profiles after treatment of acute Plasmodium vivax. Acta Trop 2008; 106:39-43. [PMID: 18304498 DOI: 10.1016/j.actatropica.2008.01.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2007] [Revised: 10/12/2007] [Accepted: 01/13/2008] [Indexed: 12/13/2022]
Abstract
During malaria infections, thrombocytopenia and low cholesterol levels are frequently observed changes. We compared these changes in patients admitted with fevers and infected with Plasmodium vivax, patients admitted with fevers with respiratory/urinary infections and afebrile normal (control) non-infected volunteers. Changes in the platelet count and lipid parameters are reported for malaria patients after treatment with hydroxychloroquine and primaquine for acute P. vivax malaria. Of a total 141 participants, 55 patients were diagnosed with malaria (positive blood smear) prior to treatment. Compared to the normal (n=52) and non-malaria fever groups (n=34), there was a significant decrease in five hematologic indices (white blood cell, red blood cell, hemoglobin, hematocrit and platelet) and three lipid parameters (total cholesterol, HDL-c and LDL-c) in the vivax malaria group at day 0 (pre-treatment). Following treatment, the platelet counts returned to normal limits (P<0.05) from 91,058/microL on day 0 to 246,833/microL by day 17 after treatment. However, changes in the lipid parameters of malaria patients showed a slow recovery to normal limits compared to the platelet counts. The HDL-c and LDL-c remained low for 1 month after treatment but increased at 3 and 6 months post-treatment. At 12 months after treatment, the levels of two lipid parameters had fully recovered to the normal limits. Thus, special attention should be applied when interpreting laboratory blood profiles of malaria patients, especially platelet and lipid based tests, until full recovery after treatment.
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Rifakis PM, Hernandez O, Fernández CT, Rodriguez-Morales AJ, Von A, Franco-Paredes C. Atypical Plasmodium vivax malaria in a traveler: bilateral hydronephrosis, severe thrombocytopenia, and hypotension. J Travel Med 2008; 15:119-21. [PMID: 18346245 DOI: 10.1111/j.1708-8305.2007.00178.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We report a case of Plasmodium vivax infection manifested as severe thrombocytopenia, bilateral hydronephrosis, and hypotension in a returning traveler from a malaria-endemic area in Venezuela. While most of the efforts to prevent malaria in travelers focus on the life-threatening consequences of Plasmodium falciparum malaria, nonimmune travelers who encounter infection with P vivax may also develop serious complications. This case highlights the importance of preventing malaria cases among nonimmune or semi-immune individuals traveling to P vivax-endemic areas.
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Affiliation(s)
- Pedro M Rifakis
- Internal Medicine, Hosipital de Emergencia Pérez de León, Caracas, Venezuela
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Rodríguez-Morales AJ, Sánchez E, Arria M, Vargas M, Piccolo C, Colina R, Franco-Paredes C. Haemoglobin and haematocrit: the threefold conversion is also non valid for assessing anaemia in Plasmodium vivax malaria-endemic settings. Malar J 2007; 6:166. [PMID: 18086306 PMCID: PMC2222606 DOI: 10.1186/1475-2875-6-166] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2007] [Accepted: 12/17/2007] [Indexed: 11/23/2022] Open
Abstract
It has been recently reported that the standard threefold conversion from haematocrit to haemoglobin underestimates the prevalence of anaemia and low levels of haemoglobin in children living in areas endemic for Plasmodium falciparum malaria. The data presented herein describes the experience in a malaria-endemic zone in northeastern Venezuela (state of Sucre), where a similar bias between haematocrit and haemoglobin in patients with Plasmodium vivax infection was found. In summary, the relationship between haematocrit and haemoglobin needs to be specifically evaluated according to each particular region or epidemiological setting.
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Rodríguez-Morales AJ, Sánchez E, Vargas M, Piccolo C, Colina R, Arria M, Franco-Paredes C. Is anemia in Plasmodium vivax malaria more frequent and severe than in Plasmodium falciparum? Am J Med 2006; 119:e9-10. [PMID: 17071151 DOI: 10.1016/j.amjmed.2005.08.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2005] [Accepted: 08/15/2005] [Indexed: 11/22/2022]
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Antinori S, Galimberti L, Gianelli E, Morelli P, Radice A, Acquaviva V, Cigardi B. Thrombocytopenia and Plasmodium vivax malaria. Clin Infect Dis 2006; 41:1210-1; author reply 1211-2. [PMID: 16163645 DOI: 10.1086/444567] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Rodríguez-Morales AJ, Benitez JA, Franco-Paredes C. Acute respiratory distress syndrome in Plasmodium vivax malaria in traveler returning from Venezuela. J Travel Med 2006; 13:325-6; author reply 326. [PMID: 16987135 DOI: 10.1111/j.1708-8305.2006.0064_1.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Rodríguez-Morales AJ, Sánchez E, Arria M, Vargas M, Piccolo C, Colina R, Franco-Paredes C. White blood cell counts in Plasmodium vivax malaria. J Infect Dis 2006; 192:1675-6; author reply 1676-7. [PMID: 16206089 DOI: 10.1086/496993] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Rodriguez-Morales AJ, Sanchez E, Vargas M, Piccolo C, Colina R, Arria M, Franco-Paredes C. Reply to Antinori et al. Clin Infect Dis 2005. [DOI: 10.1086/444570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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