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Koliopoulos P, Kayange N, Jensen C, Gröndahl B, Eichmann J, Daniel T, Huth F, Eckert T, Klamm N, Follmann M, Medina-Montaño GC, Hokororo A, Pretsch L, Klüber J, Schmidt C, Züchner A, Addo MM, Okamo B, Mshana SE, Gehring S. Challenges in Diagnosing and Treating Acutely Febrile Children with Suspected Malaria at Health Care Facilities in the Lake Mwanza Region of Tanzania. Am J Trop Med Hyg 2024; 110:202-208. [PMID: 38150741 PMCID: PMC10859794 DOI: 10.4269/ajtmh.23-0254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 09/20/2023] [Indexed: 12/29/2023] Open
Abstract
Acute febrile diseases transmitted by mosquitos are a diagnostic challenge for pediatricians working in sub-Saharan Africa. Misclassification due to the lack of rapid, reliable diagnostic tests leads to the overuse of antibiotics and antimalarials. Children presenting with acute fever and suspected of having malaria were examined at health care facilities in the Mwanza Region of Tanzania. The sensitivity and specificity of blood smear microscopy and malaria rapid diagnostic tests that targeted histidine-rich protein 2 and Plasmodium lactate dehydrogenase were compared with a multiplex reverse transcriptase-polymerase chain reaction (PCR)-ELISA. Six hundred ninety-eight children presented with acute fever and met the criteria for inclusion; 23% received antibiotics and 23% received antimalarials prior to admission. Subsequently, 20% were confirmed by PCR to have Plasmodium falciparum infection. Blood smear microscopy exhibited 33% sensitivity and 93% specificity. The malaria rapid test provided 87% sensitivity and 98% specificity in detecting acute malaria infections. Only 7% of malaria-negative children received antimalarials at Sengerema Designated District Hospital when treatment was guided by the results of rapid testing. In contrast, 75% of malaria-negative patients were treated with antimalarial drugs at health facilities that used blood smears as the standard diagnostic test. Misclassification and premedication of nonmalarial, febrile illnesses contribute to the emergence of antimalarial and antimicrobial resistance. The incorporation of malaria rapid diagnostic tests into the clinical routine translated into improved treatment and a significant reduction in antimalarial drug prescriptions.
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Affiliation(s)
- Philip Koliopoulos
- Center of Pediatric and Adolescent Medicine, University Medical Center, Mainz, Germany
| | - Neema Kayange
- Department of Pediatric and Adolescent Medicine, Bugando Medical Centre, Mwanza, Tanzania
| | - Christian Jensen
- Center of Pediatric and Adolescent Medicine, University Medical Center, Mainz, Germany
| | - Britta Gröndahl
- Center of Pediatric and Adolescent Medicine, University Medical Center, Mainz, Germany
| | - Jana Eichmann
- Department of Pediatric and Adolescent Medicine, St. Joseph Hospital, Berlin, Germany
| | - Tim Daniel
- Center of Pediatric and Adolescent Medicine, University Medical Center, Mainz, Germany
| | - Florian Huth
- Department of Visceral and Thoracic Surgery, Klinikum Worms, Worms, Germany
| | - Till Eckert
- Department of Internal Medicine, GeoMed Kreisklinik, Gerolzhofen, Germany
| | - Nele Klamm
- Center of Gynecology and Obstetrics, Augusta-Kranken-Anstalt, Bochum, Germany
| | - Marlene Follmann
- Department of Internal Medicine, Gesundheits- und Pflegezentrum, Rüsselsheim, Germany
| | | | - Adolfine Hokororo
- Department of Pediatric and Adolescent Medicine, Bugando Medical Centre, Mwanza, Tanzania
| | - Leah Pretsch
- Center of Pediatric and Adolescent Medicine, University Medical Center, Mainz, Germany
| | - Julia Klüber
- Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
| | - Christian Schmidt
- Department of Pediatric and Adolescent Medicine, St. Vinzenz-Hospital, Dinslaken, Germany
| | - Antke Züchner
- CCBRT Maternity and Newborn Hospital, Dar es Salaam, Tanzania
| | - Marylyn M. Addo
- Institute for Infection Research and Vaccine Development, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Bernard Okamo
- Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | | | - Stephan Gehring
- Center of Pediatric and Adolescent Medicine, University Medical Center, Mainz, Germany
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Traoré N, Singhal T, Millogo O, Sié A, Utzinger J, Vounatsou P. Relative effects of climate factors and malaria control interventions on changes of parasitaemia risk in Burkina Faso from 2014 to 2017/2018. BMC Infect Dis 2024; 24:166. [PMID: 38326750 PMCID: PMC10848559 DOI: 10.1186/s12879-024-08981-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 01/03/2024] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND In Burkina Faso, the prevalence of malaria has decreased over the past two decades, following the scale-up of control interventions. The successful development of malaria parasites depends on several climatic factors. Intervention gains may be reversed by changes in climatic factors. In this study, we investigated the role of malaria control interventions and climatic factors in influencing changes in the risk of malaria parasitaemia. METHODS Bayesian logistic geostatistical models were fitted on Malaria Indicator Survey data from Burkina Faso obtained in 2014 and 2017/2018 to estimate the effects of malaria control interventions and climatic factors on the temporal changes of malaria parasite prevalence. Additionally, intervention effects were assessed at regional level, using a spatially varying coefficients model. RESULTS Temperature showed a statistically important negative association with the geographic distribution of parasitaemia prevalence in both surveys; however, the effects of insecticide-treated nets (ITNs) use was negative and statistically important only in 2017/2018. Overall, the estimated number of infected children under the age of 5 years decreased from 704,202 in 2014 to 290,189 in 2017/2018. The use of ITNs was related to the decline at national and regional level, but coverage with artemisinin-based combination therapy only at regional level. CONCLUSION Interventions contributed more than climatic factors to the observed change of parasitaemia risk in Burkina Faso during the period of 2014 to 2017/2018. Intervention effects varied in space. Longer time series analyses are warranted to determine the differential effect of a changing climate on malaria parasitaemia risk.
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Affiliation(s)
- Nafissatou Traoré
- Swiss Tropical and Public Health Institute, Kreuzstrasse 2, CH-4123, Allschwil, Switzerland
- University of Basel, Petersplatz 1, CH-4001, Basel, Switzerland
- Nouna Health Research Centre, National Institute of Public Health, BP 02, Nouna, Burkina Faso
| | - Taru Singhal
- Swiss Tropical and Public Health Institute, Kreuzstrasse 2, CH-4123, Allschwil, Switzerland
- University of Basel, Petersplatz 1, CH-4001, Basel, Switzerland
| | - Ourohiré Millogo
- Nouna Health Research Centre, National Institute of Public Health, BP 02, Nouna, Burkina Faso
- Institut de Recherche en Sciences de la Santé/Centre National de Recherche Scientifique et Technologique, 01 BP, 2779, Bobo-Dioulasso, Burkina Faso
| | - Ali Sié
- Nouna Health Research Centre, National Institute of Public Health, BP 02, Nouna, Burkina Faso
| | - Jürg Utzinger
- Swiss Tropical and Public Health Institute, Kreuzstrasse 2, CH-4123, Allschwil, Switzerland
- University of Basel, Petersplatz 1, CH-4001, Basel, Switzerland
| | - Penelope Vounatsou
- Swiss Tropical and Public Health Institute, Kreuzstrasse 2, CH-4123, Allschwil, Switzerland.
- University of Basel, Petersplatz 1, CH-4001, Basel, Switzerland.
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Ribeiro GDJG, Rei Yan SL, Palmisano G, Wrenger C. Plant Extracts as a Source of Natural Products with Potential Antimalarial Effects: An Update from 2018 to 2022. Pharmaceutics 2023; 15:1638. [PMID: 37376086 DOI: 10.3390/pharmaceutics15061638] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 05/03/2023] [Accepted: 05/09/2023] [Indexed: 06/29/2023] Open
Abstract
Malaria kills more than 500,000 people yearly, mainly affecting Africa and Southeast Asia. The disease is caused by the protozoan parasite from the genus Plasmodium, with Plasmodium vivax and Plasmodium falciparum being the main species that cause the disease in humans. Although substantial progress has been observed in malaria research in the last years, the threat of the spread of Plasmodium parasites persists. Artemisinin-resistant strains of this parasite have been reported mainly in Southeast Asia, highlighting the urgent need to develop more effective and safe antimalarial drugs. In this context, natural sources, mainly from flora, remain underexplored antimalarial spaces. The present mini-review explores this space focusing on plant extracts and some of their isolated natural products with at least in vitro antiplasmodial effects reported in the literature comprising the last five years (2018-2022).
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Affiliation(s)
- Giovane de Jesus Gomes Ribeiro
- Unit for Drug Discovery, Department of Parasitology, Institute of Biomedical Sciences, University of São Paulo, São Paulo 05508-000, Brazil
| | - Sun Liu Rei Yan
- Unit for Drug Discovery, Department of Parasitology, Institute of Biomedical Sciences, University of São Paulo, São Paulo 05508-000, Brazil
| | - Giuseppe Palmisano
- GlycoProteomics Laboratory, Department of Parasitology, Institute of Biomedical Sciences, University of São Paulo, São Paulo 05508-000, Brazil
| | - Carsten Wrenger
- Unit for Drug Discovery, Department of Parasitology, Institute of Biomedical Sciences, University of São Paulo, São Paulo 05508-000, Brazil
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Funwei RI, Uyaiabasi GN, Hammed WA, Ojurongbe O, Walker O, Falade CO. High prevalence of persistent residual parasitemia on days 3 and 14 after artemether-lumefantrine or pyronaridine-artesunate treatment of uncomplicated Plasmodium falciparum malaria in Nigeria. Parasitol Res 2023; 122:519-526. [PMID: 36510009 DOI: 10.1007/s00436-022-07753-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 12/02/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Microscopic evaluation of parasite clearance is the gold standard in antimalarial drug efficacy trials. However, the presence of sub-microscopic residual parasitemia after artemisinin-based combination therapy (ACT) needs to be investigated. METHODS One hundred and twenty (AL: n = 60, PA: n = 60) days 3 and 14 dried blood spots, negative by microscopy were analysed for residual parasitemia using nested PCR. Isolates with residual parasitemia on days 3 and 14 were further genotyped with their corresponding day-0 isolates using merozoite surface proteins msp-1, msp-2, and glurp genes for allelic similarity. RESULTS Persistent PCR-determined sub-microscopic residual parasitemia at day 3 post ACT treatment was 83.3 (AL) and 88.3% (PA), respectively (ρ = 0.600), while 63.6 and 36.4% (ρ = 0.066) isolates were parasitemic at day 14 for AL and PA, respectively. Microscopy-confirmed gametocytemia persisted from days 0 to 7 and from days 0 to 21 for AL and PA. When the alleles of day 3 versus day 0 were compared according to base pair sizes, 59% of parasites shared identical alleles for glurp, 36% each for 3D7 and FC27, while K1 was 77%, RO33 64%, and MAD20 23%, respectively. Similarly, day 14 versus day 0 was 36% (glurp), 64% (3D7), and 32% (FC27), while 73% (K1), 77% (RO33), and 41% (MAD20), respectively. CONCLUSION The occurrence of residual parasitemia on days 3 and 14 following AL or PA treatment may be attributable to the presence of either viable asexual, gametocytes, or dead parasite DNAs, which requires further investigation.
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Affiliation(s)
- Roland I Funwei
- Department of Pharmacology, Babcock University, Ilishan-Remo, Ogun State, Nigeria. .,Center for Advanced Medical Research and Biotechnology (CAMRAB), Babcock University, Ilishan-Remo, Ogun State, Nigeria.
| | - Gabriel N Uyaiabasi
- Department of Pharmacology, Babcock University, Ilishan-Remo, Ogun State, Nigeria.,Center for Advanced Medical Research and Biotechnology (CAMRAB), Babcock University, Ilishan-Remo, Ogun State, Nigeria
| | - Wasiu A Hammed
- Center for Advanced Medical Research and Biotechnology (CAMRAB), Babcock University, Ilishan-Remo, Ogun State, Nigeria
| | - Olusola Ojurongbe
- Department of Medical Microbiology, Ladoke Akintola University of Technology, Ogbomosho, Oyo State, Nigeria.,Center for Emerging and Re-Emerging Infectious Diseases (CERID), Ladoke Akintola University of Technology, Ogbomosho, Oyo State, Nigeria
| | - Oladapo Walker
- Department of Pharmacology, Babcock University, Ilishan-Remo, Ogun State, Nigeria.,Center for Advanced Medical Research and Biotechnology (CAMRAB), Babcock University, Ilishan-Remo, Ogun State, Nigeria
| | - Catherine O Falade
- Department of Pharmacology and Therapeutics, University of Ibadan, Ibadan, Nigeria.,Institute for Advanced Medical Research and Training (IAMRAT), University of Ibadan, Ibadan, Nigeria
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Abstract
Since the year 2000, historic reductions in malaria incidence and mortality have been driven by the widespread distribution of bed nets, drugs, and insecticides for the prevention and treatment of malaria. Scale-up of these tools has been enabled by an increase in malaria financing compounded by price reductions, yet these trends are unlikely to continue at the same rate. Rapid population growth in high-endemic areas requires procurement of more of these tools just to maintain current coverage, even as prices are likely to increase as resistance to drugs and insecticides forces shifts to newer products. Further progress toward the long-term goal of malaria eradication requires a combination of greater funding, more cost-effective resource allocation, and fundamental changes to the global malaria control strategy.
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Affiliation(s)
| | - Fredros Okumu
- Environmental Health and Ecological Science Department, Ifakara Health Institute, Ifakara, Tanzania.,School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, UK.,School of Life Science and Bioengineering, Nelson Mandela African Institution of Science and Technology, Arusha, Tanzania
| | - Bruno Moonen
- Bill & Melinda Gates Foundation, Seattle, WA, USA
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Myers-Hansen JL, Abuaku B, Oyebola MK, Mensah BA, Ahorlu C, Wilson MD, Awandare G, Koram KA, Ngwa AA, Ghansah A. Assessment of antimalarial drug resistant markers in asymptomatic Plasmodium falciparum infections after 4 years of indoor residual spraying in Northern Ghana. PLoS One 2020; 15:e0233478. [PMID: 33284800 PMCID: PMC7721464 DOI: 10.1371/journal.pone.0233478] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 08/18/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Drug resistance remains a concern for malaria control and elimination. The effect of interventions on its prevalence needs to be monitored to pre-empt further selection. We assessed the prevalence of Plasmodium falciparum gene mutations associated with resistance to the antimalarial drugs: sulfadoxine-pyrimethamine (SP), chloroquine (CQ) and artemisinin combination therapy (ACTs) after the scale-up of a vector control activity that reduced transmission. METHODS A total of 400 P. falciparum isolates from children under five years were genotyped for seventeen single nucleotide polymorphisms (SNPs) in pfcrt, pfmdr1, pfdhfr, pfdhps and pfk13 genes using polymerase chain reaction (PCR) and high resolution melting (HRM) analysis. These included 80 isolates, each randomly selected from cross-sectional surveys of asymptomatic infections across 2010 (baseline), 2011, 2012, 2013 (midline: post-IRS) and 2014 (endline: post-IRS) during the peak transmission season, when IRS intervention was rolled out in Bunkpurugu Yunyoo (BY) District, Ghana. The proportions of isolates with drug resistant alleles were assessed over this period. RESULTS There were significant decreases in the prevalence of pfdhfr- I51R59N108 haplotype from 2010 to 2014, while the decline in pfdhfr/pfdhps- I51R59N108G437 during the same period was not significant. The prevalence of lumefantrine (LM), mefloquine (MQ) and amodiaquine (AQ) resistance-associated haplotypes pfmdr1-N86F184D1246 and pfmdr1-Y86Y184Y1246 showed decreasing trends (z = -2.86, P = 0.004 and z = -2.71, P = 0.007, respectively). Each of pfcrt-T76 and pfmdr1-Y86 mutant alleles also showed a declining trend in the asymptomatic reservoir, after the IRS rollout in 2014 (z = -2.87, P = 0.004 and z = -2.65, P = 0.008, respectively). Similarly, Pyrimethamine resistance mediating polymorphisms pfdhfr-N108, pfdhfr-I51 and pfdhfr-R59 also declined (z = -2.03, P = 0.042, z = -3.54, P<0.001 and z = -4.63, P<0.001, respectively), but not the sulphadoxine resistance mediating pfdhps-G437 and pfdhps-F436 (z = -0.36, P = 0.715 and z = 0.41, P = 0.684, respectively). No mutant pfk13-Y580 were detected during the study period. CONCLUSION The study demonstrated declining trends in the prevalence of drug resistant mutations in asymptomatic P. falciparum infections following transmission reduction after an enhanced IRS intervention in Northern Ghana.
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Affiliation(s)
| | - Benjamin Abuaku
- Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | - Muyiwa K. Oyebola
- West African Center for Cell Biology of Infectious Pathogens, University of Ghana, Legon, Ghana
| | - Benedicta A. Mensah
- Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | - Collins Ahorlu
- Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | - Michael D. Wilson
- Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | - Gordon Awandare
- West African Center for Cell Biology of Infectious Pathogens, University of Ghana, Legon, Ghana
| | - Kwadwo A. Koram
- Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | | | - Anita Ghansah
- Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
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Shekalaghe S, Mosha D, Hamad A, Mbaga TA, Mihayo M, Bousema T, Drakeley C, Abdulla S. Optimal timing of primaquine to reduce Plasmodium falciparum gametocyte carriage when co-administered with artemether-lumefantrine. Malar J 2020; 19:34. [PMID: 31964380 DOI: 10.1186/s12936-020-3121-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 01/13/2020] [Indexed: 01/13/2023] Open
Abstract
Background Primaquine is an important gametocytocidal drug that is combined with conventional malaria treatment for prevention of Plasmodium falciparum malaria transmission. Primaquine has been administered together on the first or the last day of conventional treatment but the impact of primaquine timing has never been examined. This study aimed to assess safety, efficacy and optimal timing of single full-dose (0.75 mg/kg) primaquine when added to a standard 6-dose regimen of artemether–lumefantrine (AL). Methods In an individual-level randomized controlled trial, enrolled participants who were G6PD normal and had uncomplicated P. falciparum malaria were randomly assigned to receive: AL only; AL and a single 0.75 mg/kg primaquine dose on the first day of AL (day 1); or AL and single 0.75 mg//kg primaquine on the last day of AL (day 3). On days 2, 3, 4, 8, 11 and 15, gametocytes were assessed and quantified by microscope and quantitative nuclear acid sequence based quantification (QT-NASBA). Results Overall, 111 participants aged between 3 and 17 years were randomly allocated to receive AL only (36) or combined with primaquine on day 1 (38), or primaquine on day 3 (37). Day 4 gametocyte prevalence in AL + day 1 primaquine was half the level seen in either AL + day 3 primaquine or AL only arm (11% [4/35] vs 26% [8/31] and 27% [8/30], respectively) albeit not statistically significant. A similar trend of lower gametocyte in the AL + day 1 primaquine verses AL + day 3 primaquine or AL only arm was observed in mean gametocyte density. Mean (sd) haemoglobin level in AL + day 3 primaquine arm recovered from -0.42(1.2) g/dl on day 2 to 0.35 (1.5) g/dl on day 15 of follow up. This was not the case in AL only and AL + day 1 primaquine arms during the same follow-up period, although the difference was not statistically significant (p = 318). No serious adverse events reported in the study. Across arms, 23% (26/111) of participants reported a total of 31 mild adverse events and the difference was not statistically significant (p = 0.477). Conclusion Primaquine administration on the first day of AL is well tolerated and as safe as later administration. Whilst the World Health Organization currently recommends a lower dose of primaquine (0.25 mg/kg), the findings are supportive of early primaquine administration when combined with artemisinin-combination therapy. ClinicalTrials.gov Registration NCT01906788
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Xue CC, Lyu Y. Accelerating the comprehensive and systematic evaluation of clinical evidence for Chinese medicine using a whole-evidence approach. Global Health Journal 2019. [DOI: 10.1016/j.glohj.2019.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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