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Brito M, Rufatto R, Brito-Sousa JD, Murta F, Sampaio V, Balieiro P, Baía-Silva D, Castro V, Alves B, Alencar A, Duparc S, Grewal Daumerie P, Borghini-Fuhrer I, Jambert E, Peterka C, Edilson Lima F, Carvalho Maia L, Lucena Cruz C, Maciele B, Vasconcelos M, Machado M, Augusto Figueira E, Alcirley Balieiro A, Batista Pereira D, Lacerda M. Operational effectiveness of tafenoquine and primaquine for the prevention of Plasmodium vivax recurrence in Brazil: a retrospective observational study. Lancet Infect Dis 2024:S1473-3099(24)00074-4. [PMID: 38452779 DOI: 10.1016/s1473-3099(24)00074-4] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 01/15/2024] [Accepted: 01/25/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND Prevention of Plasmodium vivax malaria recurrence is essential for malaria elimination in Brazil. We evaluated the real-world effectiveness of an updated treatment algorithm for P vivax radical cure in the Brazilian Amazon. METHODS In this non-interventional observational study, we used retrospective data from the implementation of a P vivax treatment algorithm at 43 health facilities in Manaus and Porto Velho, Brazil. The treatment algorithm consisted of chloroquine (25 mg/kg over 3 days) and point-of-care quantitative glucose-6-phosphate dehydrogenase (G6PD) testing followed by single-dose tafenoquine 300 mg (G6PD normal, aged ≥16 years, not pregnant and not breastfeeding), 7-day primaquine 0·5 mg/kg per day (G6PD intermediate or normal, aged ≥6 months, not pregnant, and not breastfeeding or breastfeeding for >1 month), or primaquine 0·75 mg/kg per week for 8 weeks (G6PD deficient, aged ≥6 months, not pregnant, and not breastfeeding or breastfeeding for >1 month). P vivax recurrences were identified from probabilistic linkage of routine patient records from the Brazilian malaria epidemiological surveillance system. Recurrence-free effectiveness at day 90 and day 180 was estimated using Kaplan-Meier analysis and hazard ratios (HRs) by multivariate analysis. This clinical trial is registered with ClinicalTrials.gov, NCT05096702, and is completed. FINDINGS Records from Sept 9, 2021, to Aug 31, 2022, included 5554 patients with P vivax malaria. In all treated patients of any age and any G6PD status, recurrence-free effectiveness at day 180 was 75·8% (95% CI 74·0-77·6) with tafenoquine, 73·4% (71·9-75·0) with 7-day primaquine, and 82·1% (77·7-86·8) with weekly primaquine. In patients aged at least 16 years who were G6PD normal, recurrence-free effectiveness until day 90 was 88·6% (95% CI 87·2-89·9) in those who were treated with tafenoquine (n=2134) and 83·5% (79·8-87·4) in those treated with 7-day primaquine (n=370); after adjustment for confounding factors, the HR for recurrence following tafenoquine versus 7-day primaquine was 0·65 (95% CI 0·49-0·86; p=0·0031), with similar outcomes between the two treatments at day 180 (log-rank p=0·82). Over 180 days, median time to recurrence in patients aged at least 16 years who were G6PD normal was 92 days (IQR 76-120) in those treated with tafenoquine and 68 days (52-94) in those treated with 7-day primaquine. INTERPRETATION In this real-world setting, single-dose tafenoquine was more effective at preventing P vivax recurrence in patients aged at least 16 years who were G6PD normal compared with 7-day primaquine at day 90, while overall efficacy at 180 days was similar. The public health benefits of the P vivax radical cure treatment algorithm incorporating G6PD quantitative testing and tafenoquine support its implementation in Brazil and potentially across South America. FUNDING Brazilian Ministry of Health, Municipal and State Health Secretariats; Fiocruz; Medicines for Malaria Venture; Bill & Melinda Gates Foundation; Newcrest Mining; and the UK Government. TRANSLATION For the Portuguese translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Marcelo Brito
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Brazil
| | - Rosilene Rufatto
- Centro de Pesquisa em Medicina Tropical de Rondônia, Porto Velho, Brazil
| | | | - Felipe Murta
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Brazil
| | - Vanderson Sampaio
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Brazil
| | - Patrícia Balieiro
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Brazil
| | - Djane Baía-Silva
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Brazil
| | | | - Brenda Alves
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Brazil
| | - Aline Alencar
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Brazil
| | | | | | | | | | | | | | | | | | - Bruna Maciele
- Centro de Pesquisa em Medicina Tropical de Rondônia, Porto Velho, Brazil
| | | | | | | | | | | | - Marcus Lacerda
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Brazil; Instituto Leônidas & Maria Deane, Fiocruz, Manaus, Brazil; University of Texas Medical Branch, Galveston, TX, USA.
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Brito M, Rufatto R, Murta F, Sampaio V, Balieiro P, Baía-Silva D, Castro V, Alves B, Alencar A, Duparc S, Grewal Daumerie P, Borghini-Fuhrer I, Jambert E, Peterka C, Edilson Lima F, Carvalho Maia L, Lucena Cruz C, Maciele B, Vasconcelos M, Machado M, Augusto Figueira E, Alcirley Balieiro A, Menezes A, Ataídes R, Batista Pereira D, Lacerda M. Operational feasibility of Plasmodium vivax radical cure with tafenoquine or primaquine following point-of-care, quantitative glucose-6-phosphate dehydrogenase testing in the Brazilian Amazon: a real-life retrospective analysis. Lancet Glob Health 2024; 12:e467-e477. [PMID: 38365417 PMCID: PMC10882209 DOI: 10.1016/s2214-109x(23)00542-9] [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: 07/25/2023] [Revised: 11/07/2023] [Accepted: 11/10/2023] [Indexed: 02/18/2024]
Abstract
BACKGROUND To achieve malaria elimination, Brazil must implement Plasmodium vivax radical cure. We aimed to investigate the operational feasibility of point-of-care, quantitative, glucose-6-phosphate dehydrogenase (G6PD) testing followed by chloroquine plus tafenoquine or primaquine. METHODS This non-interventional, observational study was done at 43 health facilities in Manaus (Amazonas State) and Porto Velho (Rondônia State), Brazil, implementing a new P vivax treatment algorithm incorporating point-of-care quantitative G6PD testing to identify G6PD status and single-dose tafenoquine (G6PD normal, aged ≥16 years, and not pregnant or breastfeeding) or primaquine (intermediate or normal G6PD, aged ≥6 months, not pregnant, or breastfeeding >1 month). Following training of health-care providers, we collated routine patient records from the malaria epidemiological surveillance system (SIVEP-Malaria) retrospectively for all consenting patients aged at least 6 months with parasitologically confirmed P vivax malaria mono-infection or P vivax plus P falciparum mixed infection, presenting between Sept 9, 2021, and Aug 31, 2022. The primary endpoint was the proportion of patients aged at least 16 years with P vivax mono-infection treated or not treated appropriately with tafenoquine in accordance with their G6PD status. The trial is registered with ClinicalTrials.gov, NCT05096702, and is completed. FINDINGS Of 6075 patients enrolled, 6026 (99·2%) had P vivax mono-infection, 2685 (44·6%) of whom were administered tafenoquine. G6PD status was identified in 2685 (100%) of 2685 patients treated with tafenoquine. The proportion of patients aged at least 16 years with P vivax mono-infection who were treated or not treated appropriately with tafenoquine in accordance with their G6PD status was 99·7% (95% CI 99·4-99·8; 4664/4680). INTERPRETATION Quantitative G6PD testing before tafenoquine administration was operationally feasible, with high adherence to the treatment algorithm, supporting deployment throughout the Brazilian health system. FUNDING Brazilian Ministry of Health, Municipal and State Health Secretariats; Fiocruz; Medicines for Malaria Venture; Bill & Melinda Gates Foundation; Newcrest Mining; and the UK Government. TRANSLATION For the Portuguese translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Marcelo Brito
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Brazil
| | - Rosilene Rufatto
- Centro de Pesquisa em Medicina Tropical de Rondônia, Porto Velho, Brazil
| | - Felipe Murta
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Brazil
| | - Vanderson Sampaio
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Brazil
| | - Patrícia Balieiro
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Brazil
| | - Djane Baía-Silva
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Brazil; Universidade do Estado do Amazonas, Manaus, Brazil; Instituto Leônidas & Maria Deane, Fiocruz, Manaus, Brazil; Universidade Nilton Lins, Manaus, Brazil
| | | | - Brenda Alves
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Brazil
| | - Aline Alencar
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Brazil
| | | | | | | | | | | | | | | | | | - Bruna Maciele
- Centro de Pesquisa em Medicina Tropical de Rondônia, Porto Velho, Brazil
| | | | | | | | | | | | | | | | - Marcus Lacerda
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Brazil; Instituto Leônidas & Maria Deane, Fiocruz, Manaus, Brazil; University of Texas Medical Branch, Galveston, TX, USA.
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Kallás EG, Cintra MAT, Moreira JA, Patiño EG, Braga PE, Tenório JCV, Infante V, Palacios R, de Lacerda MVG, Batista Pereira D, da Fonseca AJ, Gurgel RQ, Coelho ICB, Fontes CJF, Marques ETA, Romero GAS, Teixeira MM, Siqueira AM, Barral AMP, Boaventura VS, Ramos F, Elias Júnior E, Cassio de Moraes J, Covas DT, Kalil J, Precioso AR, Whitehead SS, Esteves-Jaramillo A, Shekar T, Lee JJ, Macey J, Kelner SG, Coller BAG, Boulos FC, Nogueira ML. Live, Attenuated, Tetravalent Butantan-Dengue Vaccine in Children and Adults. N Engl J Med 2024; 390:397-408. [PMID: 38294972 DOI: 10.1056/nejmoa2301790] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Abstract
BACKGROUND Butantan-Dengue Vaccine (Butantan-DV) is an investigational, single-dose, live, attenuated, tetravalent vaccine against dengue disease, but data on its overall efficacy are needed. METHODS In an ongoing phase 3, double-blind trial in Brazil, we randomly assigned participants to receive Butantan-DV or placebo, with stratification according to age (2 to 6 years, 7 to 17 years, and 18 to 59 years); 5 years of follow-up is planned. The objectives of the trial were to evaluate overall vaccine efficacy against symptomatic, virologically confirmed dengue of any serotype occurring more than 28 days after vaccination (the primary efficacy end point), regardless of serostatus at baseline, and to describe safety up to day 21 (the primary safety end point). Here, vaccine efficacy was assessed on the basis of 2 years of follow-up for each participant, and safety as solicited vaccine-related adverse events reported up to day 21 after injection. Key secondary objectives were to assess vaccine efficacy among participants according to dengue serostatus at baseline and according to the dengue viral serotype; efficacy according to age was also assessed. RESULTS Over a 3-year enrollment period, 16,235 participants received either Butantan-DV (10,259 participants) or placebo (5976 participants). The overall 2-year vaccine efficacy was 79.6% (95% confidence interval [CI], 70.0 to 86.3) - 73.6% (95% CI, 57.6 to 83.7) among participants with no evidence of previous dengue exposure and 89.2% (95% CI, 77.6 to 95.6) among those with a history of exposure. Vaccine efficacy was 80.1% (95% CI, 66.0 to 88.4) among participants 2 to 6 years of age, 77.8% (95% CI, 55.6 to 89.6) among those 7 to 17 years of age, and 90.0% (95% CI, 68.2 to 97.5) among those 18 to 59 years of age. Efficacy against DENV-1 was 89.5% (95% CI, 78.7 to 95.0) and against DENV-2 was 69.6% (95% CI, 50.8 to 81.5). DENV-3 and DENV-4 were not detected during the follow-up period. Solicited systemic vaccine- or placebo-related adverse events within 21 days after injection were more common with Butantan-DV than with placebo (58.3% of participants, vs. 45.6%). CONCLUSIONS A single dose of Butantan-DV prevented symptomatic DENV-1 and DENV-2, regardless of dengue serostatus at baseline, through 2 years of follow-up. (Funded by Instituto Butantan and others; DEN-03-IB ClinicalTrials.gov number, NCT02406729, and WHO ICTRP number, U1111-1168-8679.).
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Affiliation(s)
- Esper G Kallás
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Monica A T Cintra
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - José A Moreira
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Elizabeth G Patiño
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Patricia Emilia Braga
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Juliana C V Tenório
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Vanessa Infante
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Ricardo Palacios
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Marcus Vínicius Guimarães de Lacerda
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Dhelio Batista Pereira
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Allex Jardim da Fonseca
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Ricardo Queiroz Gurgel
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Ivo Castelo-Branco Coelho
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Cor Jesus Fernandes Fontes
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Ernesto T A Marques
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Gustavo Adolfo Sierra Romero
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Mauro Martins Teixeira
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - André M Siqueira
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Aldina Maria Prado Barral
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Viviane Sampaio Boaventura
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Fabiano Ramos
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Erivaldo Elias Júnior
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - José Cassio de Moraes
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Dimas T Covas
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Jorge Kalil
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Alexander Roberto Precioso
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Stephen S Whitehead
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Alejandra Esteves-Jaramillo
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Tulin Shekar
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Jung-Jin Lee
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Julieta Macey
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Sabrina Gozlan Kelner
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Beth-Ann G Coller
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Fernanda Castro Boulos
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Mauricio L Nogueira
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
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4
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Pereira DB, Martins JG, Oliveira MS, Lima-Júnior RS, Rocha LC, Andrade SL, Procópio REL. Leishmanicidal activity of the venoms of the Scorpions Brotheas amazonicus and Tityus metuendus. BRAZ J BIOL 2023; 83:e276872. [PMID: 38055507 DOI: 10.1590/1519-6984.276872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 10/26/2023] [Indexed: 12/08/2023] Open
Abstract
Leishmaniasis is a vector-transmitted zoonosis caused by different species of the genus Leishmania, with a wide clinical spectrum. It is a public health problem aggravated by a series of limitations regarding treatment. In the search for new therapeutic alternatives, scorpion venoms are a source of multifunctional molecules that act against the natural resistance of pathogens. This work evaluated the antileishmanial potential of Brotheas amazonicus and Tityus metuendus venoms against the promastigote forms of Leishmania amazonensis e Leishmania guyanensis. The venoms of B. amazonicus and T. metuendus were evaluated for their constituents using Fourier Transform Infrared (FTIR). Growth inhibition and death of promastigotes were evaluated in the presence of diferente crude venom concentrations (100 µg/mL, 50 µg/mL, 10 µg/mL, 1 µg/mL) after one hour of incubation at 25 °C. The FTIR spectra of both venoms exhibited bands in approximate regions, revealing that both exhibit similar functional groups. Crude venom from both scorpion species showed similar or superior leishmanicidal effects to the standart drug N-methylglucamine antimoniate. At the highest concentration of 100 µg/mL, cultures of L. guyanensis treated with the venom of B. amazonicus showed the highest mortality percentages, above 28%, while T. metuendus venom showed the highest activity against L. amazonensis, with mortality above 7%. This preliminar study demonstrates that B. amazonicus and T. metuendus venoms can be important tools in the search for new drugs Against leishmaniasis. Next step involves evaluating the activity against the amastigote forms and purifying the venom proteins in order to identify the best anti-leishmania candidates.
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Affiliation(s)
- D B Pereira
- Universidade do Estado do Amazonas - UEA, Escola Superior de Ciências da Saúde - ESA, Manaus, AM, Brasil
| | - J G Martins
- Instituto Nacional de Pesquisas da Amazônia - INPA, Manaus, AM, Brasil
| | - M S Oliveira
- Universidade do Estado do Amazonas - UEA, Escola Superior de Ciências da Saúde - ESA, Manaus, AM, Brasil
| | - R S Lima-Júnior
- Universidade do Estado do Amazonas - UEA, Escola Normal Superior - ENS, Manaus, AM, Brasil
| | - L C Rocha
- Universidade do Estado do Amazonas - UEA, Escola Superior de Ciências da Saúde - ESA, Manaus, AM, Brasil
| | - S L Andrade
- Universidade do Estado do Amazonas - UEA, Escola Superior de Ciências da Saúde - ESA, Manaus, AM, Brasil
| | - R E L Procópio
- Universidade do Estado do Amazonas - UEA, Escola Superior de Ciências da Saúde - ESA, Manaus, AM, Brasil
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5
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da Silva Duarte G, Jones AD, de Goes Cavalcanti LP, de Melo Rêgo MJB, Ribeiro GS, Boyton RJ, Pereira DB, Croda JHR, Costa FTM, Duarte AP, Consolaro MEL, Stabeli RG, Negrão FJ, Proenca-Modena JL, Villalobos-Salcedo JM, da Rocha Castelar Pinheiro G, de Barros Albuquerque AP, de Almeida Barreto FK, Moreira J, Ferrari IC, Évora PM, da Silva VRS, Lacerda MVG, Altmann DM, Siqueira AM. Multicenter study of the natural history and therapeutic responses of patients with chikungunya, focusing on acute and chronic musculoskeletal manifestations - a study protocol from the clinical and applied research in Chikungunya (REPLICK network). BMC Infect Dis 2023; 23:499. [PMID: 37507666 PMCID: PMC10386654 DOI: 10.1186/s12879-023-08292-y] [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: 02/18/2023] [Accepted: 04/28/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Chikungunya is associated with high morbidity and the natural history of symptomatic infection has been divided into three phases (acute, post-acute, and chronic) according to the duration of musculoskeletal symptoms. Although this classification has been designed to help guide therapeutic decisions, it does not encompass the complexity of the clinical expression of the disease and does not assist in the evaluation of the prognosis of severity nor chronic disease. Thus, the current challenge is to identify and diagnose musculoskeletal disorders and to provide the optimal treatment in order to prevent perpetuation or progression to a potentially destructive disease course. METHODS The study is the first product of the Clinical and Applied Research Network in Chikungunya (REPLICK). This is a prospective, outpatient department-based, multicenter cohort study in Brazil. Four work packages were defined: i. Clinical research; ii) Translational Science - comprising immunology and virology streams; iii) Epidemiology and Economics; iv) Therapeutic Response and clinical trials design. Scheduled appointments on days 21 (D21) ± 7 after enrollment, D90 ± 15, D120 ± 30, D180 ± 30; D360 ± 30; D720 ± 60, and D1080 ± 60 days. On these visits a panel of blood tests are collected in addition to the clinical report forms to obtain data on socio-demographic, medical history, physical examination and questionnaires devoted to the evaluation of musculoskeletal manifestations and overall health are performed. Participants are asked to consent for their specimens to be maintained in a biobank. Aliquots of blood, serum, saliva, PAXgene, and when clinically indicated to be examined, synovial fluid, are stored at -80° C. The study protocol was submitted and approved to the National IRB and local IRB at each study site. DISCUSSION Standardized and harmonized patient cohorts are needed to provide better estimates of chronic arthralgia development, the clinical spectra of acute and chronic disease and investigation of associated risk factors. This study is the largest evaluation of the long-term sequelae of individuals infected with CHIKV in the Brazilian population focusing on musculoskeletal manifestations, mental health, quality of life, and chronic pain. This information will both define disease burden and costs associated with CHIKV infection, and better inform therapeutic guidelines.
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Affiliation(s)
- Giselle da Silva Duarte
- Laboratório de Pesquisa Clínica Em Doenças Febris Agudas, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Jose Moreira
- Laboratório de Pesquisa Clínica Em Doenças Febris Agudas, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | | | | | | | | | | | - André M Siqueira
- Laboratório de Pesquisa Clínica Em Doenças Febris Agudas, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
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6
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Ibrahim A, Manko E, Dombrowski JG, Campos M, Benavente ED, Nolder D, Sutherland CJ, Nosten F, Fernandez D, Vélez-Tobón G, Castaño AT, Aguiar ACC, Pereira DB, da Silva Santos S, Suarez-Mutis M, Di Santi SM, Regina de Souza Baptista A, Dantas Machado RL, Marinho CR, Clark TG, Campino S. Population-based genomic study of Plasmodium vivax malaria in seven Brazilian states and across South America. Lancet Reg Health Am 2023; 18:100420. [PMID: 36844008 PMCID: PMC9950661 DOI: 10.1016/j.lana.2022.100420] [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] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 12/06/2022] [Accepted: 12/06/2022] [Indexed: 01/03/2023]
Abstract
Background Brazil is a unique and understudied setting for malaria, with complex foci of transmission associated with human and environmental conditions. An understanding of the population genomic diversity of P. vivax parasites across Brazil can support malaria control strategies. Methods Through whole genome sequencing of P. vivax isolates across 7 Brazilian states, we use population genomic approaches to compare genetic diversity within country (n = 123), continent (6 countries, n = 315) and globally (26 countries, n = 885). Findings We confirm that South American isolates are distinct, have more ancestral populations than the other global regions, with differentiating mutations in genes under selective pressure linked to antimalarial drugs (pvmdr1, pvdhfr-ts) and mosquito vectors (pvcrmp3, pvP45/48, pvP47). We demonstrate Brazil as a distinct parasite population, with signals of selection including ABC transporter (PvABCI3) and PHIST exported proteins. Interpretation Brazil has a complex population structure, with evidence of P. simium infections and Amazonian parasites separating into multiple clusters. Overall, our work provides the first Brazil-wide analysis of P. vivax population structure and identifies important mutations, which can inform future research and control measures. Funding AI is funded by an MRC LiD PhD studentship. TGC is funded by the Medical Research Council (Grant no. MR/M01360X/1, MR/N010469/1, MR/R025576/1, MR/R020973/1 and MR/X005895/1). SC is funded by Medical Research Council UK grants (MR/M01360X/1, MR/R025576/1, MR/R020973/1 and MR/X005895/1) and Bloomsbury SET (ref. CCF17-7779). FN is funded by The Shloklo Malaria Research Unit - part of the Mahidol Oxford Research Unit, supported by the Wellcome Trust (Grant no. 220211). ARSB is funded by São Paulo Research Foundation - FAPESP (Grant no. 2002/09546-1). RLDM is funded by Brazilian National Council for Scientific and Technological Development - CNPq (Grant no. 302353/2003-8 and 471605/2011-5); CRFM is funded by FAPESP (Grant no. 2020/06747-4) and CNPq (Grant no. 302917/2019-5 and 408636/2018-1); JGD is funded by FAPESP fellowships (2016/13465-0 and 2019/12068-5) and CNPq (Grant no. 409216/2018-6).
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Affiliation(s)
- Amy Ibrahim
- Faculty of Infectious & Tropical Diseases, London School of Hygiene
& Tropical Medicine, London, UK
| | - Emilia Manko
- Faculty of Infectious & Tropical Diseases, London School of Hygiene
& Tropical Medicine, London, UK
| | - Jamille G. Dombrowski
- Department of Parasitology, Institute of Biomedical Sciences, University
of São Paulo, São Paulo, Brazil
| | - Mónica Campos
- Faculty of Infectious & Tropical Diseases, London School of Hygiene
& Tropical Medicine, London, UK
| | - Ernest Diez Benavente
- Faculty of Infectious & Tropical Diseases, London School of Hygiene
& Tropical Medicine, London, UK
| | - Debbie Nolder
- Faculty of Infectious & Tropical Diseases, London School of Hygiene
& Tropical Medicine, London, UK
- Public Health England Malaria Reference Laboratory, London School of
Hygiene & Tropical Medicine, London, UK
| | - Colin J. Sutherland
- Faculty of Infectious & Tropical Diseases, London School of Hygiene
& Tropical Medicine, London, UK
- Public Health England Malaria Reference Laboratory, London School of
Hygiene & Tropical Medicine, London, UK
| | - Francois Nosten
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research
Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Tak,
Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of
Clinical Medicine Research Building, University of Oxford Old Road Campus,
Oxford, UK
| | - Diana Fernandez
- Grupo Malaria, Facultad de Medicina, Universidad de Antioquia, Antioquia,
Colombia
| | - Gabriel Vélez-Tobón
- Grupo Malaria, Facultad de Medicina, Universidad de Antioquia, Antioquia,
Colombia
| | | | | | | | - Simone da Silva Santos
- Laboratório de Doenças Parasitárias, Institute Oswaldo Cruz - Fiocruz-
Rio de Janeiro, Brazil
| | - Martha Suarez-Mutis
- Laboratório de Doenças Parasitárias, Institute Oswaldo Cruz - Fiocruz-
Rio de Janeiro, Brazil
| | | | - Andrea Regina de Souza Baptista
- Centro de Investigação de Microrganismos – CIM, Departamento de
Microbiologia e Parasitologia, Universidade Federal Fluminense,
Brazil
| | - Ricardo Luiz Dantas Machado
- Centro de Investigação de Microrganismos – CIM, Departamento de
Microbiologia e Parasitologia, Universidade Federal Fluminense,
Brazil
| | - Claudio R.F. Marinho
- Department of Parasitology, Institute of Biomedical Sciences, University
of São Paulo, São Paulo, Brazil
| | - Taane G. Clark
- Faculty of Infectious & Tropical Diseases, London School of Hygiene
& Tropical Medicine, London, UK
- Faculty of Epidemiology & Population Health, London School of Hygiene
& Tropical Medicine, London, UK
| | - Susana Campino
- Faculty of Infectious & Tropical Diseases, London School of Hygiene
& Tropical Medicine, London, UK
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7
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Adam I, Alam MS, Alemu S, Amaratunga C, Amato R, Andrianaranjaka V, Anstey NM, Aseffa A, Ashley E, Assefa A, Auburn S, Barber BE, Barry A, Batista Pereira D, Cao J, Chau NH, Chotivanich K, Chu C, Dondorp AM, Drury E, Echeverry DF, Erko B, Espino F, Fairhurst R, Faiz A, Fernanda Villegas M, Gao Q, Golassa L, Goncalves S, Grigg MJ, Hamedi Y, Hien TT, Htut Y, Johnson KJ, Karunaweera N, Khan W, Krudsood S, Kwiatkowski DP, Lacerda M, Ley B, Lim P, Liu Y, Llanos-Cuentas A, Lon C, Lopera-Mesa T, Marfurt J, Michon P, Miotto O, Mohammed R, Mueller I, Namaik-larp C, Newton PN, Nguyen TN, Nosten F, Noviyanti R, Pava Z, Pearson RD, Petros B, Phyo AP, Price RN, Pukrittayakamee S, Rahim AG, Randrianarivelojosia M, Rayner JC, Rumaseb A, Siegel SV, Simpson VJ, Thriemer K, Tobon-Castano A, Trimarsanto H, Urbano Ferreira M, Vélez ID, Wangchuk S, Wellems TE, White NJ, William T, Yasnot MF, Yilma D. An open dataset of Plasmodium vivax genome variation in 1,895 worldwide samples. Wellcome Open Res 2022; 7:136. [PMID: 35651694 PMCID: PMC9127374 DOI: 10.12688/wellcomeopenres.17795.1] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2022] [Indexed: 01/13/2023] Open
Abstract
This report describes the MalariaGEN Pv4 dataset, a new release of curated genome variation data on 1,895 samples of Plasmodium vivax collected at 88 worldwide locations between 2001 and 2017. It includes 1,370 new samples contributed by MalariaGEN and VivaxGEN partner studies in addition to previously published samples from these and other sources. We provide genotype calls at over 4.5 million variable positions including over 3 million single nucleotide polymorphisms (SNPs), as well as short indels and tandem duplications. This enlarged dataset highlights major compartments of parasite population structure, with clear differentiation between Africa, Latin America, Oceania, Western Asia and different parts of Southeast Asia. Each sample has been classified for drug resistance to sulfadoxine, pyrimethamine and mefloquine based on known markers at the dhfr, dhps and mdr1 loci. The prevalence of all of these resistance markers was much higher in Southeast Asia and Oceania than elsewhere. This open resource of analysis-ready genome variation data from the MalariaGEN and VivaxGEN networks is driven by our collective goal to advance research into the complex biology of P. vivax and to accelerate genomic surveillance for malaria control and elimination.
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Affiliation(s)
| | - Ishag Adam
- Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | - Mohammad Shafiul Alam
- Infectious Diseases Division, International Centre for Diarrheal Diseases Research, Bangladesh (ICDDR,B), Dhaka, Bangladesh
| | - Sisay Alemu
- Armauer Hansen Research Unit (AHRI), Addis Ababa, Ethiopia,Addis Ababa University, Addis Ababa, Ethiopia,MilliporeSigma (Bioreliance), Rockville, USA
| | - Chanaki Amaratunga
- National Institute of Allergy and Infectious Diseases (NIAID), NIH, Bethesda, USA
| | | | | | - Nicholas M Anstey
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia
| | - Abraham Aseffa
- Armauer Hansen Research Unit (AHRI), Addis Ababa, Ethiopia
| | - Elizabeth Ashley
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao People's Democratic Republic,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | | | - Sarah Auburn
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK,Mahidol‐Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
| | - Bridget E Barber
- Menzies School of Health Research, Darwin, Australia,QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Alyssa Barry
- Walter and Eliza Hall Institute, Parkville, Australia,Deakin University, Geelong, Australia,Burnet Institute, Melbourne, Australia
| | | | - Jun Cao
- National Health Commission Key Laboratory of Parasitic Disease Control and Prevention, Jiangsu Provincial Key Laboratory on Parasite and Vector Control Technology, Jiangsu Institute of Parasitic Diseases, Wuxi, China,Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Nguyen Hoang Chau
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | | | - Cindy Chu
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Arjen M. Dondorp
- Mahidol‐Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
| | | | - Diego F. Echeverry
- Departamento de Microbiologia, Facultad de Salud, Universidad del Valle, Cali, Colombia
| | - Berhanu Erko
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Fe Espino
- Research Institute for Tropical Medicine, Department of Health, Manila, Philippines
| | | | | | | | - Qi Gao
- National Health Commission Key Laboratory of Parasitic Disease Control and Prevention, Jiangsu Provincial Key Laboratory on Parasite and Vector Control Technology, Jiangsu Institute of Parasitic Diseases, Wuxi, China
| | - Lemu Golassa
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Matthew J Grigg
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia
| | - Yaghoob Hamedi
- Infectious and Tropical Diseases Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Tran Tinh Hien
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Ye Htut
- Department of Medical Research, Yangon, Myanmar
| | | | - Nadira Karunaweera
- University of Colombo, Colombo, Sri Lanka,School of Public Health, Harvard University, Boston, USA
| | - Wasif Khan
- Infectious Diseases Division, International Centre for Diarrheal Diseases Research, Bangladesh (ICDDR,B), Dhaka, Bangladesh
| | | | | | - Marcus Lacerda
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Brazil,Instituto Leônidas & Maria Deane, Fundação Oswaldo Cruz, Manaus, Brazil
| | - Benedikt Ley
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia
| | - Pharath Lim
- National Institute of Allergy and Infectious Diseases (NIAID), NIH, Bethesda, USA,Parsons Corporation, Walter Reed Army Institute of Research (WRAIR), Silver Spring, USA
| | - Yaobao Liu
- National Health Commission Key Laboratory of Parasitic Disease Control and Prevention, Jiangsu Provincial Key Laboratory on Parasite and Vector Control Technology, Jiangsu Institute of Parasitic Diseases, Wuxi, China,Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
| | | | - Chanthap Lon
- National Institute of Allergy and Infectious Diseases, Phnom Penh, Cambodia
| | | | - Jutta Marfurt
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia
| | | | - Olivo Miotto
- Wellcome Sanger Institute, Hinxton, UK,Mahidol‐Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
| | - Rezika Mohammed
- Department of Internal Medicine, University of Gondar, Gondar, Ethiopia
| | - Ivo Mueller
- Walter and Eliza Hall Institute, Parkville, Australia
| | | | - Paul N Newton
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao People's Democratic Republic,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Thuy-Nhien Nguyen
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK,Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Francois Nosten
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK,Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | | | - Zuleima Pava
- Centro Internacionale de Entrenamiento e Investigaciones Medicas, Cali, Colombia
| | | | | | - Aung P Phyo
- Mahidol‐Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand,Shoklo Malaria Research Unit, Bangkok, Thailand
| | - Ric N Price
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK,Mahidol‐Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
| | | | - Awab Ghulam Rahim
- Nangarhar Medical Faculty, Nangarhar University, Ministry of Higher Education, Jalalabad, Afghanistan
| | - Milijaona Randrianarivelojosia
- Institut Pasteur de Madagascar, Antananarivo, Madagascar,Universités d'Antananarivo et de Mahajanga, Antananarivo, Madagascar
| | - Julian C Rayner
- Cambridge Institute for Medical Research, University of Cambridge, Cambridge, UK
| | - Angela Rumaseb
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia
| | | | | | - Kamala Thriemer
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia
| | | | | | - Marcelo Urbano Ferreira
- Universidade de São Paulo, São Paulo, Brazil,Institute of Hygiene and Tropical Medicine, NOVA University of Lisbon, Lisbon, Portugal
| | | | - Sonam Wangchuk
- Royal Center for Disease Control, Department of Public Health, Ministry of Health, Thimphu, Bhutan
| | - Thomas E Wellems
- National Institute of Allergy and Infectious Diseases (NIAID), NIH, Bethesda, USA
| | - Nicholas J White
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK,Mahidol‐Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
| | - Timothy William
- Clinical Research Centre, Queen Elizabeth Hospital, Sabah, Malaysia,Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit, Kota Kinabalu, Sabah, Malaysia
| | - Maria F Yasnot
- Grupo de Investigaciones Microbiológicas y Biomédicas de Córdoba-GIMBIC, Universidad de Córdoba, Monteria, Colombia
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8
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Benavente ED, Manko E, Phelan J, Campos M, Nolder D, Fernandez D, Velez-Tobon G, Castaño AT, Dombrowski JG, Marinho CRF, Aguiar ACC, Pereira DB, Sriprawat K, Nosten F, Moon R, Sutherland CJ, Campino S, Clark TG. Distinctive genetic structure and selection patterns in Plasmodium vivax from South Asia and East Africa. Nat Commun 2021; 12:3160. [PMID: 34039976 PMCID: PMC8154914 DOI: 10.1038/s41467-021-23422-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 04/28/2021] [Indexed: 12/30/2022] Open
Abstract
Despite the high burden of Plasmodium vivax malaria in South Asian countries, the genetic diversity of circulating parasite populations is not well described. Determinants of antimalarial drug susceptibility for P. vivax in the region have not been characterised. Our genomic analysis of global P. vivax (n = 558) establishes South Asian isolates (n = 92) as a distinct subpopulation, which shares ancestry with some East African and South East Asian parasites. Signals of positive selection are linked to drug resistance-associated loci including pvkelch10, pvmrp1, pvdhfr and pvdhps, and two loci linked to P. vivax invasion of reticulocytes, pvrbp1a and pvrbp1b. Significant identity-by-descent was found in extended chromosome regions common to P. vivax from India and Ethiopia, including the pvdbp gene associated with Duffy blood group binding. Our investigation provides new understanding of global P. vivax population structure and genomic diversity, and genetic evidence of recent directional selection in this important human pathogen.
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Affiliation(s)
- Ernest Diez Benavente
- Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Emilia Manko
- Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Jody Phelan
- Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Monica Campos
- Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Debbie Nolder
- Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
- Public Health England Malaria Reference Laboratory, London School of Hygiene & Tropical Medicine, London, UK
| | - Diana Fernandez
- Grupo Malaria, Facultad de Medicina, Universidad de Antioquia, Antioquia, Colombia
| | - Gabriel Velez-Tobon
- Grupo Malaria, Facultad de Medicina, Universidad de Antioquia, Antioquia, Colombia
| | | | - Jamille G Dombrowski
- Department of Parasitology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Claudio R F Marinho
- Department of Parasitology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Anna Caroline C Aguiar
- Department of Parasitology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | | | - Kanlaya Sriprawat
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Tak, Thailand
| | - Francois Nosten
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Tak, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine Research Building, University of Oxford Old Road Campus, Oxford, UK
| | - Robert Moon
- Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Colin J Sutherland
- Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
- Public Health England Malaria Reference Laboratory, London School of Hygiene & Tropical Medicine, London, UK
| | - Susana Campino
- Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK.
| | - Taane G Clark
- Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK.
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK.
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9
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Queiroz JADS, Botelho-Souza LF, Nogueira-Lima FS, Rampazzo RDCP, Krieger MA, Zambenedetti MR, Marchini FK, Borghetti IA, Pereira DB, Salcedo JMV, Vieira DS, dos Santos ADO. Phylogenetic Characterization of Arboviruses in Patients Suffering from Acute Fever in Rondônia, Brazil. Viruses 2020; 12:v12080889. [PMID: 32823806 PMCID: PMC7472125 DOI: 10.3390/v12080889] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 07/31/2020] [Accepted: 08/02/2020] [Indexed: 12/13/2022] Open
Abstract
The purpose of the study was to classify, through phylogenetic analyses, the main arboviruses that have been isolated in the metropolitan region of Porto Velho, Rondônia, Brazil. Serum samples from patients with symptoms suggesting arboviruses were collected and tested by One Step RT-qPCR for Zika, Dengue (serotypes 1–4), Chikungunya, Mayaro and Oropouche viruses. Positive samples were amplified by conventional PCR and sequenced utilizing the Sanger method. The obtained sequences were aligned, and an evolutionary analysis was carried out using Bayesian inference. A total of 308 samples were tested. Of this total, 20 had a detectable viral load for Dengue, being detected DENV1 (18/20), co-infection DENV1 and DENV2 (1/20) and DENV4 (1/20). For Dengue serotype 3 and for the CHIKV, ZIKV, MAYV and OROV viruses, no individuals with a detectable viral load were found. A total of 9 of these samples were magnified by conventional PCR for sequencing. Of these, 6 were successfully sequenced and, according to the evolutionary profile, 5 corresponded to serotype DENV-1 genotype V, and 1 to serotype DENV-4 genotype II. In the study, we demonstrate co-circulation of the DENV-1 genotype V and the DENV-4 genotype II. Co-circulation of several DENV serotypes in the same city poses a risk to the population and is correlated with the increase of the most severe forms of the disease. Similarly, co-circulation of genetically distinct DENV and the occurrence of simultaneous infections can affect recombination events and lead to the emergence of more virulent isolates.
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Affiliation(s)
- Jackson Alves da Silva Queiroz
- Oswaldo Cruz Foundation of Rondônia—FIOCRUZ/RO, Porto Velho RO 76812 245, Rondônia, Brazil; (J.A.d.S.Q.); (L.F.B.-S.); (F.S.N.-L.); (J.M.V.S.); (D.S.V.)
- Postgraduate Program in Experimental Biology of Federal University of Rondônia—PGBIOEXP, Porto Velho RO 76801 059, Rondônia, Brazil
- National Institute of Epidemiology of Western Amazonia—INCT EpiAmO, Porto Velho RO 76812 245, Rondônia, Brazil
| | - Luan Felipo Botelho-Souza
- Oswaldo Cruz Foundation of Rondônia—FIOCRUZ/RO, Porto Velho RO 76812 245, Rondônia, Brazil; (J.A.d.S.Q.); (L.F.B.-S.); (F.S.N.-L.); (J.M.V.S.); (D.S.V.)
- National Institute of Epidemiology of Western Amazonia—INCT EpiAmO, Porto Velho RO 76812 245, Rondônia, Brazil
- Aparício Carvalho University Center, Porto Velho RO 76811-678, Rondônia, Brazil
| | - Felipe Souza Nogueira-Lima
- Oswaldo Cruz Foundation of Rondônia—FIOCRUZ/RO, Porto Velho RO 76812 245, Rondônia, Brazil; (J.A.d.S.Q.); (L.F.B.-S.); (F.S.N.-L.); (J.M.V.S.); (D.S.V.)
- Postgraduate Program in Experimental Biology of Federal University of Rondônia—PGBIOEXP, Porto Velho RO 76801 059, Rondônia, Brazil
- National Institute of Epidemiology of Western Amazonia—INCT EpiAmO, Porto Velho RO 76812 245, Rondônia, Brazil
| | - Rita de Cássia Pontello Rampazzo
- Institute of Molecular Biology of Paraná -IBMP, Curitiba PR 81350-010, Rondônia, Brazil; (R.d.C.P.R.); (M.A.K.); (M.R.Z.); (F.K.M.); (I.A.B.)
| | - Marco Aurélio Krieger
- Institute of Molecular Biology of Paraná -IBMP, Curitiba PR 81350-010, Rondônia, Brazil; (R.d.C.P.R.); (M.A.K.); (M.R.Z.); (F.K.M.); (I.A.B.)
| | - Miriam Ribas Zambenedetti
- Institute of Molecular Biology of Paraná -IBMP, Curitiba PR 81350-010, Rondônia, Brazil; (R.d.C.P.R.); (M.A.K.); (M.R.Z.); (F.K.M.); (I.A.B.)
| | - Fabricio Klerinton Marchini
- Institute of Molecular Biology of Paraná -IBMP, Curitiba PR 81350-010, Rondônia, Brazil; (R.d.C.P.R.); (M.A.K.); (M.R.Z.); (F.K.M.); (I.A.B.)
| | - Ivo Alberto Borghetti
- Institute of Molecular Biology of Paraná -IBMP, Curitiba PR 81350-010, Rondônia, Brazil; (R.d.C.P.R.); (M.A.K.); (M.R.Z.); (F.K.M.); (I.A.B.)
| | - Dhelio Batista Pereira
- Tropical Medicine of Rondônia Center Research—CEPEM/RO, Porto Velho RO 76812 329, Rondônia, Brazil;
| | - Juan Miguel Vilalobos Salcedo
- Oswaldo Cruz Foundation of Rondônia—FIOCRUZ/RO, Porto Velho RO 76812 245, Rondônia, Brazil; (J.A.d.S.Q.); (L.F.B.-S.); (F.S.N.-L.); (J.M.V.S.); (D.S.V.)
- National Institute of Epidemiology of Western Amazonia—INCT EpiAmO, Porto Velho RO 76812 245, Rondônia, Brazil
- Tropical Medicine of Rondônia Center Research—CEPEM/RO, Porto Velho RO 76812 329, Rondônia, Brazil;
| | - Deusilene Souza Vieira
- Oswaldo Cruz Foundation of Rondônia—FIOCRUZ/RO, Porto Velho RO 76812 245, Rondônia, Brazil; (J.A.d.S.Q.); (L.F.B.-S.); (F.S.N.-L.); (J.M.V.S.); (D.S.V.)
- Postgraduate Program in Experimental Biology of Federal University of Rondônia—PGBIOEXP, Porto Velho RO 76801 059, Rondônia, Brazil
- National Institute of Epidemiology of Western Amazonia—INCT EpiAmO, Porto Velho RO 76812 245, Rondônia, Brazil
| | - Alcione de Oliveira dos Santos
- Oswaldo Cruz Foundation of Rondônia—FIOCRUZ/RO, Porto Velho RO 76812 245, Rondônia, Brazil; (J.A.d.S.Q.); (L.F.B.-S.); (F.S.N.-L.); (J.M.V.S.); (D.S.V.)
- National Institute of Epidemiology of Western Amazonia—INCT EpiAmO, Porto Velho RO 76812 245, Rondônia, Brazil
- Correspondence:
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10
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Tentokam BCN, Amaratunga C, Alani NAH, MacDonald NJ, Narum DL, Salinas ND, Kwan JL, Suon S, Sreng S, Pereira DB, Tolia NH, Fujiwara RT, Bueno LL, Duffy PE, Coelho CH. Naturally Acquired Antibody Response to Malaria Transmission Blocking Vaccine Candidate Pvs230 Domain 1. Front Immunol 2019; 10:2295. [PMID: 31636633 PMCID: PMC6788386 DOI: 10.3389/fimmu.2019.02295] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 09/11/2019] [Indexed: 01/27/2023] Open
Abstract
Plasmodium vivax malaria incidence has increased in Latin America and Asia and is responsible for nearly 74.1% of malaria cases in Latin America. Immune responses to P. vivax are less well characterized than those to P. falciparum, partly because P. vivax is more difficult to cultivate in the laboratory. While antibodies are known to play an important role in P. vivax disease control, few studies have evaluated responses to P. vivax sexual stage antigens. We collected sera or plasma samples from P. vivax-infected subjects from Brazil (n = 70) and Cambodia (n = 79) to assess antibody responses to domain 1 of the gametocyte/gamete stage protein Pvs230 (Pvs230D1M). We found that 27.1% (19/70) and 26.6% (21/79) of subjects from Brazil and Cambodia, respectively, presented with detectable antibody responses to Pvs230D1M antigen. The most frequent subclasses elicited in response to Pvs230D1M were IgG1 and IgG3. Although age did not correlate significantly with Pvs230D1M antibody levels overall, we observed significant differences between age strata. Hemoglobin concentration inversely correlated with Pvs230D1M antibody levels in Brazil, but not in Cambodia. Additionally, we analyzed the antibody response against Pfs230D1M, the P. falciparum ortholog of Pvs230D1M. We detected antibodies to Pfs230D1M in 7.2 and 16.5% of Brazilian and Cambodian P. vivax-infected subjects. Depletion of Pvs230D1M IgG did not impair the response to Pfs230D1M, suggesting pre-exposure to P. falciparum, or co-infection. We also analyzed IgG responses to sporozoite protein PvCSP (11.4 and 41.8% in Brazil and Cambodia, respectively) and to merozoite protein PvDBP-RII (67.1 and 48.1% in Brazil and Cambodia, respectively), whose titers also inversely correlated with hemoglobin concentration only in Brazil. These data establish patterns of seroreactivity to sexual stage Pvs230D1M and show similar antibody responses among P. vivax-infected subjects from regions of differing transmission intensity in Brazil and Cambodia.
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Affiliation(s)
- Bergeline C Nguemwo Tentokam
- Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, National Institutes of Health (NIH), Bethesda, MD, United States
| | - Chanaki Amaratunga
- Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health (NIH), Rockville, MD, United States
| | - Nada A H Alani
- Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, National Institutes of Health (NIH), Bethesda, MD, United States
| | - Nicholas J MacDonald
- Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, National Institutes of Health (NIH), Bethesda, MD, United States
| | - David L Narum
- Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, National Institutes of Health (NIH), Bethesda, MD, United States
| | - Nichole D Salinas
- Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, National Institutes of Health (NIH), Bethesda, MD, United States
| | - Jennifer L Kwan
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health (NIH), Bethesda, MD, United States
| | - Seila Suon
- National Center for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia
| | - Sokunthea Sreng
- National Center for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia
| | | | - Niraj H Tolia
- Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, National Institutes of Health (NIH), Bethesda, MD, United States
| | - Ricardo T Fujiwara
- Department of Parasitology, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Lilian L Bueno
- Department of Parasitology, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Patrick E Duffy
- Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, National Institutes of Health (NIH), Bethesda, MD, United States
| | - Camila H Coelho
- Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, National Institutes of Health (NIH), Bethesda, MD, United States
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11
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Vieira DS, Zambenedetti MR, Requião L, Borghetti IA, Luna LKDS, Santos ADOD, Taborda RLM, Pereira DB, Krieger MA, Salcedo JMV, Rampazzo RDCP. Epidemiological profile of Zika, Dengue and Chikungunya virus infections identified by medical and molecular evaluations in Rondonia, Brazil. Rev Inst Med Trop Sao Paulo 2019; 61:e40. [PMID: 31432989 PMCID: PMC6710006 DOI: 10.1590/s1678-9946201961040] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 07/05/2019] [Indexed: 11/25/2022] Open
Abstract
Several arboviruses have emerged and/or re-emerged in North, Central and
South-American countries. Viruses from some regions of Africa and Asia, such as
the Zika and Chikungunya virus have been introduced in new continents causing
major public health problems. The aim of this study was to investigate the
presence of RNA from Zika, Dengue and Chikungunya viruses in symptomatic
patients from Rondonia, where the epidemiological profile is still little known,
by one-step real-time RT-PCR. The main clinical signs and symtoms were fever
(51.2%), headache (78%), chills (6.1%), pruritus (12.2%), exanthema (20.1%),
arthralgia (35.3%), myalgia (26.8%) and retro-orbital pain (19.5%). Serum from
164 symptomatic patients were collected and tested for RNA of Zika, Dengue types
1 to 4 and Chikungunya viruses, in addition to antibodies against Dengue NS1
antigen. Direct microscopy for Malaria was also performed. Only ZIKV RNA was
detected in 4.3% of the patients, and in the remaining 95.7% of the patients RNA
for Zika, Dengue and Chikungunya viruses were not detected. This finding is
intriguing as the region has been endemic for Dengue for a long time and more
recently for Chikungunya virus as well. The results indicated that medical and
molecular parameters obtained were suitable to describe the first report of
symptomatic Zika infections in this region. Furthermore, the low rate of
detection, compared to clinical signs and symptoms as the solely diagnosis
criteria, suggests that molecular assays for detection of viruses or other
pathogens that cause similar symptoms should be used and the corresponding
diseases could be included in the compulsory notification list.
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Affiliation(s)
- Deusilene Souza Vieira
- Fundação Oswaldo Cruz Rondônia, Porto Velho, Rondônia, Brazil.,Universidade Federal de Rondônia, Programa de Pós-Graduação em Biologia Experimental, Porto Velho, Rondônia, Brazil.,Centro de Pesquisa em Medicina Tropical, Porto Velho, Rondônia, Brazil
| | | | - Luciana Requião
- Instituto de Biologia Molecular do Paraná, Curitiba, Paraná, Brazil
| | - Ivo Alberto Borghetti
- Instituto de Biologia Molecular do Paraná, Curitiba, Paraná, Brazil.,Universidade Federal do Paraná, Departamento de Engenharia de Bioprocessos e Biotecnologia, Curitiba, Paraná, Brazil
| | | | - Alcione de Oliveira Dos Santos
- Fundação Oswaldo Cruz Rondônia, Porto Velho, Rondônia, Brazil.,Centro de Pesquisa em Medicina Tropical, Porto Velho, Rondônia, Brazil
| | | | | | - Marco Aurélio Krieger
- Instituto de Biologia Molecular do Paraná, Curitiba, Paraná, Brazil.,Instituto Carlos Chagas, Curitiba, Paraná, Brazil
| | - Juan Miguel Villalobos Salcedo
- Fundação Oswaldo Cruz Rondônia, Porto Velho, Rondônia, Brazil.,Centro de Pesquisa em Medicina Tropical, Porto Velho, Rondônia, Brazil
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12
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Amaral LC, Robortella DR, Guimarães LFF, Limongi JE, Fontes CJF, Pereira DB, de Brito CFA, Kano FS, de Sousa TN, Carvalho LH. Ribosomal and non-ribosomal PCR targets for the detection of low-density and mixed malaria infections. Malar J 2019; 18:154. [PMID: 31039781 PMCID: PMC6492410 DOI: 10.1186/s12936-019-2781-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 04/13/2019] [Indexed: 01/01/2023] Open
Abstract
Background The unexpected high proportion of submicroscopic malaria infections in areas with low transmission intensity challenges the control and elimination of malaria in the Americas. The current PCR-based assays present limitations as most protocols still rely on amplification of few-copies target gene. Here, the hypothesis was that amplification of different plasmodial targets—ribosomal (18S rRNA) and non-ribosomal multi-copy sequences (Pvr47 for Plasmodium vivax and Pfr364 for Plasmodium falciparum)—could increase the chances of detecting submicroscopic malaria infection. Methods A non-ribosomal real-time PCR assay targeting Pvr47/Pfr364 (NR-qPCR) was established and compared with three additional PCR protocols, two of them based on 18S rRNA gene amplification (Nested-PCR and R-qPCR) and one based on Pvr47/Pfr364 targets (NR-cPCR). The limit of detection of each PCR protocol, at single and artificial mixed P. vivax/P. falciparum infections, was determined by end-point titration curves. Field samples from clinical (n = 110) and subclinical (n = 324) malaria infections were used to evaluate the impact of using multiple molecular targets to detect malaria infections. Results The results demonstrated that an association of ribosomal and non-ribosomal targets did not increase sensitivity to detect submicroscopic malaria infections. Despite of that, artificial mixed-malaria infections demonstrated that the NR-qPCR was the most sensitive protocol to detect low-levels of P. vivax/P. falciparum co-infections. Field studies confirmed that submicroscopic malaria represented a large proportion (up to 77%) of infections among asymptomatic Amazonian residents, with a high proportion of infections (~ 20%) identified only by the NR-qPCR. Conclusions This study presents a new species-specific non-ribosomal PCR assay with potential to identify low-density P. vivax and P. falciparum infections. As the majority of subclinical infections was caused by P. vivax, the commonest form of malaria in the Amazon area, future studies should investigate the potential of Pvr47/Pfr364 to detect mixed-malaria infections in the field. Electronic supplementary material The online version of this article (10.1186/s12936-019-2781-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lara Cotta Amaral
- Instituto René Rachou, Fundação Oswaldo Cruz, FIOCRUZ-MINAS, Belo Horizonte, MG, Brazil
| | - Daniela Rocha Robortella
- Instituto René Rachou, Fundação Oswaldo Cruz, FIOCRUZ-MINAS, Belo Horizonte, MG, Brazil.,Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | | | | | | | - Dhelio Batista Pereira
- Centro de Pesquisas em Medicina Tropical de Rondônia (CEPEM), Porto Velho, Rondônia, Brazil
| | | | - Flora Satiko Kano
- Instituto René Rachou, Fundação Oswaldo Cruz, FIOCRUZ-MINAS, Belo Horizonte, MG, Brazil
| | - Taís Nóbrega de Sousa
- Instituto René Rachou, Fundação Oswaldo Cruz, FIOCRUZ-MINAS, Belo Horizonte, MG, Brazil.
| | - Luzia Helena Carvalho
- Instituto René Rachou, Fundação Oswaldo Cruz, FIOCRUZ-MINAS, Belo Horizonte, MG, Brazil. .,Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
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Lacerda MVG, Llanos-Cuentas A, Krudsood S, Lon C, Saunders DL, Mohammed R, Yilma D, Batista Pereira D, Espino FEJ, Mia RZ, Chuquiyauri R, Val F, Casapía M, Monteiro WM, Brito MAM, Costa MRF, Buathong N, Noedl H, Diro E, Getie S, Wubie KM, Abdissa A, Zeynudin A, Abebe C, Tada MS, Brand F, Beck HP, Angus B, Duparc S, Kleim JP, Kellam LM, Rousell VM, Jones SW, Hardaker E, Mohamed K, Clover DD, Fletcher K, Breton JJ, Ugwuegbulam CO, Green JA, Koh GCKW. Single-Dose Tafenoquine to Prevent Relapse of Plasmodium vivax Malaria. N Engl J Med 2019; 380:215-228. [PMID: 30650322 PMCID: PMC6657226 DOI: 10.1056/nejmoa1710775] [Citation(s) in RCA: 159] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Treatment of Plasmodium vivax malaria requires the clearing of asexual parasites, but relapse can be prevented only if dormant hypnozoites are cleared from the liver (a treatment termed "radical cure"). Tafenoquine is a single-dose 8-aminoquinoline that has recently been registered for the radical cure of P. vivax. METHODS This multicenter, double-blind, double-dummy, parallel group, randomized, placebo-controlled trial was conducted in Ethiopia, Peru, Brazil, Cambodia, Thailand, and the Philippines. We enrolled 522 patients with microscopically confirmed P. vivax infection (>100 to <100,000 parasites per microliter) and normal glucose-6-phosphate dehydrogenase (G6PD) activity (with normal activity defined as ≥70% of the median value determined at each trial site among 36 healthy male volunteers who were otherwise not involved in the trial). All patients received a 3-day course of chloroquine (total dose of 1500 mg). In addition, patients were assigned to receive a single 300-mg dose of tafenoquine on day 1 or 2 (260 patients), placebo (133 patients), or a 15-mg dose of primaquine once daily for 14 days (129 patients). The primary outcome was the Kaplan-Meier estimated percentage of patients who were free from recurrence at 6 months, defined as P. vivax clearance without recurrent parasitemia. RESULTS In the intention-to-treat population, the percentage of patients who were free from recurrence at 6 months was 62.4% in the tafenoquine group (95% confidence interval [CI], 54.9 to 69.0), 27.7% in the placebo group (95% CI, 19.6 to 36.6), and 69.6% in the primaquine group (95% CI, 60.2 to 77.1). The hazard ratio for the risk of recurrence was 0.30 (95% CI, 0.22 to 0.40) with tafenoquine as compared with placebo (P<0.001) and 0.26 (95% CI, 0.18 to 0.39) with primaquine as compared with placebo (P<0.001). Tafenoquine was associated with asymptomatic declines in hemoglobin levels, which resolved without intervention. CONCLUSIONS Single-dose tafenoquine resulted in a significantly lower risk of P. vivax recurrence than placebo in patients with phenotypically normal G6PD activity. (Funded by GlaxoSmithKline and Medicines for Malaria Venture; DETECTIVE ClinicalTrials.gov number, NCT01376167 .).
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Affiliation(s)
- Marcus V G Lacerda
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
| | - Alejandro Llanos-Cuentas
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
| | - Srivicha Krudsood
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
| | - Chanthap Lon
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
| | - David L Saunders
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
| | - Rezika Mohammed
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
| | - Daniel Yilma
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
| | - Dhelio Batista Pereira
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
| | - Fe E J Espino
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
| | - Reginaldo Z Mia
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
| | - Raul Chuquiyauri
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
| | - Fernando Val
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
| | - Martín Casapía
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
| | - Wuelton M Monteiro
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
| | - Marcelo A M Brito
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
| | - Mônica R F Costa
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
| | - Nillawan Buathong
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
| | - Harald Noedl
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
| | - Ermias Diro
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
| | - Sisay Getie
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
| | - Kalehiwot M Wubie
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
| | - Alemseged Abdissa
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
| | - Ahmed Zeynudin
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
| | - Cherinet Abebe
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
| | - Mauro S Tada
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
| | - Françoise Brand
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
| | - Hans-Peter Beck
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
| | - Brian Angus
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
| | - Stephan Duparc
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
| | - Jörg-Peter Kleim
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
| | - Lynda M Kellam
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
| | - Victoria M Rousell
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
| | - Siôn W Jones
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
| | - Elizabeth Hardaker
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
| | - Khadeeja Mohamed
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
| | - Donna D Clover
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
| | - Kim Fletcher
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
| | - John J Breton
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
| | - Cletus O Ugwuegbulam
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
| | - Justin A Green
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
| | - Gavin C K W Koh
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
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14
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Figueiredo MM, Costa PAC, Diniz SQ, Henriques PM, Kano FS, Tada MS, Pereira DB, Soares IS, Martins-Filho OA, Jankovic D, Gazzinelli RT, Antonelli LRDV. T follicular helper cells regulate the activation of B lymphocytes and antibody production during Plasmodium vivax infection. PLoS Pathog 2017; 13:e1006484. [PMID: 28700710 PMCID: PMC5519210 DOI: 10.1371/journal.ppat.1006484] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 07/20/2017] [Accepted: 06/21/2017] [Indexed: 01/24/2023] Open
Abstract
Although the importance of humoral immunity to malaria has been established, factors that control antibody production are poorly understood. Follicular helper T cells (Tfh cells) are pivotal for generating high-affinity, long-lived antibody responses. While it has been proposed that expansion of antigen-specific Tfh cells, interleukin (IL) 21 production and robust germinal center formation are associated with protection against malaria in mice, whether Tfh cells are found during Plasmodium vivax (P. vivax) infection and if they play a role during disease remains unknown. Our goal was to define the role of Tfh cells during P. vivax malaria. We demonstrate that P. vivax infection triggers IL-21 production and an increase in Tfh cells (PD-1+ICOS+CXCR5+CD45RO+CD4+CD3+). As expected, FACS-sorted Tfh cells, the primary source of IL-21, induced immunoglobulin production by purified naïve B cells. Furthermore, we found that P. vivax infection alters the B cell compartment and these alterations were dependent on the number of previous infections. First exposure leads to increased proportions of activated and atypical memory B cells and decreased frequencies of classical memory B cells, whereas patients that experienced multiple episodes displayed lower proportions of atypical B cells and higher frequencies of classical memory B cells. Despite the limited sample size, but consistent with the latter finding, the data suggest that patients who had more than five infections harbored more Tfh cells and produce more specific antibodies. P. vivax infection triggers IL-21 production by Tfh that impact B cell responses in humans. Plasmodium vivax is the most widely spread malaria parasite species and represents a significant impediment to social and economic development in endemic countries. Our goal was to assess the importance of T follicular helper cells in the development of the immune response during malaria. We found that P. vivax infection promotes expansion of circulating Tfh cells that secrete IL-21 to boost immunoglobulin production by B-cells. Accordingly, malaria infection led to marked changes in B cell subpopulations, including expansion of plasma cells and increased production of antigen-specific IgG1 and IgG3. Re-exposure to P. vivax led to amplified Tfh cells cell responses that were concomitantly associated with increased frequencies of classical memory B cells. Thus, Tfh cells that are induced during P. vivax infection could impact the efficiency of humoral immune responses that underlie protective immunity.
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Affiliation(s)
- Maria Marta Figueiredo
- Laboratório de Biologia e Imunologia de Doenças Infecciosas e Parasitárias, Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brazil.,Laboratório de Imunopatologia, Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brazil
| | - Pedro Augusto Carvalho Costa
- Laboratório de Biologia e Imunologia de Doenças Infecciosas e Parasitárias, Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brazil
| | - Suelen Queiroz Diniz
- Laboratório de Biologia e Imunologia de Doenças Infecciosas e Parasitárias, Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brazil.,Departamento de Bioquímica e Imunologia, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Priscilla Miranda Henriques
- Laboratório de Biologia e Imunologia de Doenças Infecciosas e Parasitárias, Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brazil
| | - Flora Satiko Kano
- Laboratório de Malária, Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brazil
| | - Mauro Sugiro Tada
- Centro de Pesquisas em Medicina Tropical de Rondônia, Porto Velho, Rondônia, Brazil
| | | | - Irene Silva Soares
- Departamento de Análises Clínicas e Toxicológicas, Faculdade de Ciências Farmacêuticas, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Olindo Assis Martins-Filho
- Laboratório de Biomarcadores de Diagnóstico e Monitoração, Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brazil
| | - Dragana Jankovic
- Immunobiology Section, Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Ricardo Tostes Gazzinelli
- Laboratório de Imunopatologia, Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brazil.,Departamento de Bioquímica e Imunologia, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Lis Ribeiro do Valle Antonelli
- Laboratório de Biologia e Imunologia de Doenças Infecciosas e Parasitárias, Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brazil
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15
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Hojo-Souza NS, Pereira DB, de Souza FSH, de Oliveira Mendes TA, Cardoso MS, Tada MS, Zanini GM, Bartholomeu DC, Fujiwara RT, Bueno LL. On the cytokine/chemokine network during Plasmodium vivax malaria: new insights to understand the disease. Malar J 2017; 16:42. [PMID: 28118834 PMCID: PMC5260126 DOI: 10.1186/s12936-017-1683-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 01/05/2017] [Indexed: 11/10/2022] Open
Abstract
Background The clinical outcome of malaria depends on the delicate balance between pro-inflammatory and immunomodulatory cytokine responses triggered during infection. Despite the numerous reports on characterization of plasma levels of cytokines/chemokines, there is no consensus on the profile of these mediators during blood stage malaria. The identification of acute phase biomarkers might contribute to a better understanding of the disease, allowing the use of more effective therapeutic approaches to prevent the progression towards severe disease. In the present study, the plasma levels of cytokines and chemokines and their association with parasitaemia and number of previous malaria episodes were evaluated in Plasmodium vivax-infected patients during acute and convalescence phase, as well as in healthy donors. Methods Samples of plasma were obtained from peripheral blood samples from four different groups: P. vivax-infected, P. vivax-treated, endemic control and malaria-naïve control. The cytokine (IL-6, IL-10, IL-17, IL-27, TGF-β, IFN-γ and TNF) and chemokine (MCP-1/CCL2, IP-10/CXCL10 and RANTES/CCL5) plasma levels were measured by CBA or ELISA. The network analysis was performed using Spearman correlation coefficient. Results Plasmodium vivax infection induced a pro-inflammatory response driven by IL-6 and IL-17 associated with an immunomodulatory profile mediated by IL-10 and TGF-β. In addition, a reduction was observed of IFN-γ plasma levels in P. vivax group. A lower level of IL-27 was observed in endemic control group in comparison to malaria-naïve control group. No significant results were found for IL-12p40 and TNF. It was also observed that P. vivax infection promoted higher levels of MCP-1/CCL2 and IP-10/CXCL10 and lower levels of RANTES/CCL5. The plasma level of IL-10 was elevated in patients with high parasitaemia and with more than five previous malaria episodes. Furthermore, association profile between cytokine and chemokine levels were observed by correlation network analysis indicating signature patterns associated with different parasitaemia levels. Conclusions The P. vivax infection triggers a balanced immune response mediated by IL-6 and MCP-1/CCL2, which is modulated by IL-10. In addition, the results indicated that IL-10 plasma levels are influenced by parasitaemia and number of previous malaria episodes.
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Affiliation(s)
- Natália Satchiko Hojo-Souza
- Departamento de Parasitologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | - Fernanda Sumika Hojo de Souza
- Departamento de Ciência da Computação, Universidade Federal de São João del-Rei, São João del-Rei, Minas Gerais, Brazil
| | | | - Mariana Santos Cardoso
- Departamento de Parasitologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | - Graziela Maria Zanini
- Instituto de Pesquisa Clínica Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Daniella Castanheira Bartholomeu
- Departamento de Parasitologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Ricardo Toshio Fujiwara
- Departamento de Parasitologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Lilian Lacerda Bueno
- Departamento de Parasitologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
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Hojo-Souza NS, Pereira DB, Passos LSA, Gazzinelli-Guimarães PH, Cardoso MS, Tada MS, Zanini GM, Bartholomeu DC, Fujiwara RT, Bueno LL. Phenotypic profiling of CD8(+) T cells during Plasmodium vivax blood-stage infection. BMC Infect Dis 2015; 15:35. [PMID: 25636730 PMCID: PMC4329216 DOI: 10.1186/s12879-015-0762-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 01/15/2015] [Indexed: 12/27/2022] Open
Abstract
Background For a long time, the role of CD8+ T cells in blood-stage malaria was not considered important because erythrocytes do not express major histocompatibility complex (MHC) class I proteins. While recent evidences suggest that CD8+ T cells may play an important role during the erythrocytic phase of infection by eliminating parasites, CD8+ T cells might also contribute to modulate the host response through production of regulatory cytokines. Thus, the role of CD8+ T cells during blood-stage malaria is unclear. Here, we report the phenotypic profiling of CD8+ T cells subsets from patients with uncomplicated symptomatic P. vivax malaria. Methods Blood samples were collected from 20 Plasmodium vivax-infected individuals and 12 healthy individuals. Immunophenotyping was conducted by flow cytometry. Plasma levels of IFN-γ, TNF-α and IL-10 were determined by ELISA/CBA. Unpaired t-test or Mann–Whitney test was used depending on the data distribution. Results P. vivax-infected subjects had lower percentages and absolute numbers of CD8+CD45RA+ and CD8+CD45RO+ T cells when compared to uninfected individuals (p ≤ 0.0002). A significantly lower absolute number of circulating CD8+CD45+CCR7+ cells (p = 0.002) was observed in P. vivax-infected individuals indicating that infection reduces the number of central memory T cells. Cytokine expression was significantly reduced in the naïve T cells from infected individuals compared with negative controls, as shown by lower numbers of IFN-γ+ (p = 0.001), TNF-α+ (p < 0.0001) and IL-10+ (p < 0.0001) CD8+ T cells. Despite the reduction in the number of CD8+ memory T cells producing IFN-γ (p < 0.0001), P. vivax-infected individuals demonstrated a significant increase in memory CD8+TNF-α+ (p = 0.016) and CD8+IL-10+ (p = 0.004) cells. Positive correlations were observed between absolute numbers of CD8+IL-10+ and numbers of CD8+IFN-γ+ (p < 0.001) and CD8+TNF-α+ T cells (p ≤ 0.0001). Finally, an increase in the plasma levels of TNF-α (p = 0.017) and IL-10 (p = 0.006) and a decrease in the IFN-γ plasma level (p <0.0001) were observed in the P. vivax-infected individuals. Conclusions P. vivax infection reduces the numbers of different subsets of CD8+ T cells, particularly the memory cells, during blood-stage of infection and enhances the number of CD8+ memory T cells expressing IL-10, which positively correlates with the number of cells expressing TNF-α and IFN-γ. Electronic supplementary material The online version of this article (doi:10.1186/s12879-015-0762-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Natália Satchiko Hojo-Souza
- Departamento de Parasitologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Av. Antônio Carlos 6627, 31270-901, Belo Horizonte, Minas Gerais, Brazil.
| | | | - Lívia Silva Araújo Passos
- Departamento de Parasitologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Av. Antônio Carlos 6627, 31270-901, Belo Horizonte, Minas Gerais, Brazil.
| | - Pedro Henrique Gazzinelli-Guimarães
- Departamento de Parasitologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Av. Antônio Carlos 6627, 31270-901, Belo Horizonte, Minas Gerais, Brazil.
| | - Mariana Santos Cardoso
- Departamento de Parasitologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Av. Antônio Carlos 6627, 31270-901, Belo Horizonte, Minas Gerais, Brazil.
| | | | - Graziela Maria Zanini
- Instituto de Pesquisa Clínica Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Rio de Janeiro, Brazil.
| | - Daniella Castanheira Bartholomeu
- Departamento de Parasitologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Av. Antônio Carlos 6627, 31270-901, Belo Horizonte, Minas Gerais, Brazil.
| | - Ricardo Toshio Fujiwara
- Departamento de Parasitologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Av. Antônio Carlos 6627, 31270-901, Belo Horizonte, Minas Gerais, Brazil.
| | - Lilian Lacerda Bueno
- Departamento de Parasitologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Av. Antônio Carlos 6627, 31270-901, Belo Horizonte, Minas Gerais, Brazil.
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Leoratti FMDS, Trevelin SC, Cunha FQ, Rocha BC, Costa PAC, Gravina HD, Tada MS, Pereira DB, Golenbock DT, do Valle Antonelli LR, Gazzinelli RT. Neutrophil paralysis in Plasmodium vivax malaria. PLoS Negl Trop Dis 2012; 6:e1710. [PMID: 22745844 PMCID: PMC3383745 DOI: 10.1371/journal.pntd.0001710] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2012] [Accepted: 05/13/2012] [Indexed: 12/03/2022] Open
Abstract
Background The activation of innate immune responses by Plasmodium vivax results in activation of effector cells and an excessive production of pro-inflammatory cytokines that may culminate in deleterious effects. Here, we examined the activation and function of neutrophils during acute episodes of malaria. Materials and Methods Blood samples were collected from P. vivax-infected patients at admission (day 0) and 30–45 days after treatment with chloroquine and primaquine. Expression of activation markers and cytokine levels produced by highly purified monocytes and neutrophils were measured by the Cytometric Bead Assay. Phagocytic activity, superoxide production, chemotaxis and the presence of G protein-coupled receptor (GRK2) were also evaluated in neutrophils from malaria patients. Principal Findings Both monocytes and neutrophils from P. vivax-infected patients were highly activated. While monocytes were found to be the main source of cytokines in response to TLR ligands, neutrophils showed enhanced phagocytic activity and superoxide production. Interestingly, neutrophils from the malaria patients expressed high levels of GRK2, low levels of CXCR2, and displayed impaired chemotaxis towards IL-8 (CXCL8). Conclusion Activated neutrophils from malaria patients are a poor source of pro-inflammatory cytokines and display reduced chemotactic activity, suggesting a possible mechanism for an enhanced susceptibility to secondary bacterial infection during malaria. Plasmodium vivax is responsible for approximately 60–80% of the malaria cases in the world, and contributes to significant social and economic instability in the developing countries of Latin America and Asia. The pathogenesis of P. vivax malaria is a consequence of host derived inflammatory mediators. Hence, a better understanding of the mechanisms involved in induction of systemic inflammation during P. vivax malaria is critical for the clinical management and prevention of severe disease. The innate immune receptors recognize Plasmodium sp. and initiate a broad spectrum of host defense mechanisms that mediate resistance to infection. However, the innate immune response is the classic “two-edged sword”, and clinical malaria is associated with high levels of circulating pro-inflammatory cytokines. Our findings show that both monocytes and neutrophils are highly activated during malaria. Monocytes produced high levels of IL-1β, IL-6 and TNF-α during acute malaria. On the other hand, neutrophils were a poor source of cytokines, but displayed an enhanced phagocytic activity and superoxide production. Unexpectedly, we noticed an impaired chemotaxis of neutrophils towards an IL-8 (CXCL8) gradient. We proposed that neutrophil paralysis is in part responsible for the enhanced susceptibility to bacterial infection observed in malaria patients.
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Affiliation(s)
| | - Silvia Cellone Trevelin
- Departamento de Farmacologia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Fernando Queiroz Cunha
- Departamento de Farmacologia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Bruno Coelho Rocha
- Laboratório de Imunopatologia, Centro de Pesquisas René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brazil
- Departamento de Bioquímica e Imunologia, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Pedro Augusto Carvalho Costa
- Laboratório de Imunopatologia, Centro de Pesquisas René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brazil
| | - Humberto Doriguêtto Gravina
- Laboratório de Imunopatologia, Centro de Pesquisas René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brazil
- Departamento de Bioquímica e Imunologia, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Mauro Shugiro Tada
- Centro de Pesquisas em Medicina Tropical de Rondônia, Porto Velho, Rondônia, Brazil
| | | | - Douglas Taylor Golenbock
- Division of Infectious Diseases and Immunology, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America
| | - Lis Ribeiro do Valle Antonelli
- Laboratório de Imunopatologia, Centro de Pesquisas René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brazil
| | - Ricardo T. Gazzinelli
- Laboratório de Imunopatologia, Centro de Pesquisas René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brazil
- Departamento de Bioquímica e Imunologia, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Division of Infectious Diseases and Immunology, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America
- * E-mail:
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Lucena LTD, Aguiar LO, Bogoevich ACA, Azevedo FSD, Santos ACPD, Vale DBAPD, Pereira DB, Villalobos-Salcedo JM. Dengue na Amazônia: aspectos epidemiológicos no Estado de Rondônia, Brasil, de 1999 a 2010. ACTA ACUST UNITED AC 2011. [DOI: 10.5123/s2176-62232011000300003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Pereira DB, Pereira ML, Gasparetto EL. Nonalcoholic Wernicke encephalopathy with extensive cortical involvement: cortical laminar necrosis and hemorrhage demonstrated with susceptibility-weighted MR phase images. AJNR Am J Neuroradiol 2011; 32:E37-8. [PMID: 21233235 DOI: 10.3174/ajnr.a2359] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Pereira DB, Gasparetto EL, Marcondes de Souza J, Chimelli L. Choroid plexus papilloma with osseous metaplasia as a differential diagnosis of calcifying pseudoneoplasms of the neuraxis. AJNR Am J Neuroradiol 2010; 31:E51-2; author reply E53. [PMID: 20395381 DOI: 10.3174/ajnr.a2096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Pereira DB, Carvalho AP, Duarte CB. Non-specific effects of the MEK inhibitors PD098,059 and U0126 on glutamate release from hippocampal synaptosomes. Neuropharmacology 2002; 42:9-19. [PMID: 11750912 DOI: 10.1016/s0028-3908(01)00162-9] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
In order to investigate a role for the extracellular-signal-regulated kinases 1 and 2 (ERK1/2) on hippocampal neurotransmitter release, we studied the effect of commonly used MEK (mitogen-activated protein kinase [MAPK]/ERK kinase) inhibitors, PD098,059 and U0126, on depolarization-induced glutamate release. PD098,059 inhibited glutamate release from hippocampal synaptosomes stimulated with 15 mM KCl in a concentration-dependent manner. At the same range of concentrations, PD098,059 inhibited basal and KCl-stimulated ERK1/2 phosphorylation. U0126, however, did not significantly affect KCl-evoked glutamate release at concentrations shown to inhibit ERK activity. Nonetheless, U0126 unspecifically potentiated depolarization-induced Ca2+-independent glutamate release, which masked a small dose-dependent inhibitory effect on the Ca2+-dependent release. PD098,059 reduced the [Ca2+]i response to KCl by partially inhibiting Ca2+ entry through N- and P-/Q-type voltage-gated Ca2+ channels, whereas U0126 did not affect depolarization-induced Ca2+ influx. To overcome the unspecific effect of PD098,059 on Ca2+ entry, we studied the effect of both MEK inhibitors on glutamate release stimulated by a Ca2+ ionophore. PD098,029 and U0126 showed a small dose-dependent inhibitory effect on ionomycin-induced glutamate release, at concentrations shown to inhibit ionomycin-stimulated ERK phosphorylation. These findings uncover new unspecific actions for both MEK inhibitors and suggest a minor role for ERK in modulating glutamate release in the hippocampus.
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Affiliation(s)
- D B Pereira
- Center for Neuroscience of Coimbra, University of Coimbra, 3004-517, Coimbra, Portugal
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Abstract
Attempts were made to reproduce bovine lechiguana, a disease associated with Dermatobia hominis and Pasteurella granulomatis infections. Suspensions of Pasteurella granulomatis were mixed with each of the following: saponin, oil adjuvant, ground Dermatobia hominis, or 5% mucin. Each preparation was inoculated into 6 cattle. Twelve more cattle, 6 of which received dexamethasone, were inoculated with bacterial suspension alone. Abscesses but no lechiguana was produced in all 36 cattle. After abscess regression, 12 cattle were reinoculated with a suspension of mouse-passed P. granulomatis. Only abscesses were produced. The intralymphatic inoculation of P. granulomatis in 6 cattle did not produce the disease. Eleven cattle infected naturally with D. hominis had lesions containing dead larvae. These lesions were inoculated with P. granulomatis. Nine cattle were experimentally infected with larvae of D. hominis that had been contaminated with the bacteria. No lechiguana lesions were produced in these 20 cattle. Six cattle with severe natural D. hominis infection were inoculated in the larval lesions with P. granulomatis. One developed lesions indistinguishable from those of natural lechiguana. The lesions regressed after treatment with chloramphenicol. D. hominis larvae and exudate from lesions caused by the fly were collected from 7 cattle on 3 farms and examined bacteriologically. P. granulomatis was isolated from the larvae and the exudate of a healthy calf from a farm where lechiguana had never been observed. These results suggest that P. granulomatis has a causal role in lechiguana, and that D. hominis may be a carrier of the bacterium. These observations suggest that lechiguana occurs when severe D. hominis lesions are infected with P. granulomatis. The apparent long incubation period, the negative results obtained in the other experiments, and also the infrequent occurrence of the natural disease suggest that lechiguana is a disease for which Koch's postulates are not easily fulfilled.
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Affiliation(s)
- S L Ladeira
- Regional Diagnostic Laboratory Faculty of Veterinary Medicine, University of Pelotas, Brazil
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Pereira DB. [Utilization of the Kato-Katz-method (thick-smear technique) the diagnosis of Isospora (author's transl)]. Rev Bras Pesqui Med Biol 1979; 12:351-2. [PMID: 394228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Performing 10475 stool examination using the KATO-KATZ, HOFFMAN-PONS-JANER and direct examination (after agitation) methods, the author showed the best results with KATO-KATZ method for the diagnosis of Isospora hominis and Isospora belli. Among the 10475 stools examined 392 (3.74%) were positive for I. hominis and 55 (0.52%) for I. belli with the KATO-KATZ method; with the use of the others methods only 28 (0.26%) were positive for I. hominis and 6 (0.06% for I. belli.
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