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Abstract
Malaria is resurging in many African and South American countries, exacerbated by COVID-19-related health service disruption. In 2021, there were an estimated 247 million malaria cases and 619 000 deaths in 84 endemic countries. Plasmodium falciparum strains partly resistant to artemisinins are entrenched in the Greater Mekong region and have emerged in Africa, while Anopheles mosquito vectors continue to evolve physiological and behavioural resistance to insecticides. Elimination of Plasmodium vivax malaria is hindered by impractical and potentially toxic antirelapse regimens. Parasitological diagnosis and treatment with oral or parenteral artemisinin-based therapy is the mainstay of patient management. Timely blood transfusion, renal replacement therapy, and restrictive fluid therapy can improve survival in severe malaria. Rigorous use of intermittent preventive treatment in pregnancy and infancy and seasonal chemoprevention, potentially combined with pre-erythrocytic vaccines endorsed by WHO in 2021 and 2023, can substantially reduce malaria morbidity. Improved surveillance, better access to effective treatment, more labour-efficient vector control, continued drug development, targeted mass drug administration, and sustained political commitment are required to achieve targets for malaria reduction by the end of this decade.
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Affiliation(s)
- Jeanne Rini Poespoprodjo
- Centre for Child Health and Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia; Timika Malaria Research Facility, Papuan Health and Community Development Foundation, Timika, Indonesia; Mimika District Hospital and District Health Authority, Timika, Indonesia; Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia.
| | - Nicholas M Douglas
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia; Department of Infectious Diseases, Christchurch Hospital, Te Whatu Ora Waitaha, Christchurch, New Zealand; Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Daniel Ansong
- School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Steven Kho
- Timika Malaria Research Facility, Papuan Health and Community Development Foundation, Timika, Indonesia; Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Nicholas M Anstey
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia; Department of Infectious Diseases, Royal Darwin Hospital, Darwin, NT, Australia
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Yilma D, Groves ES, Brito-Sousa JD, Monteiro WM, Chu C, Thriemer K, Commons RJ, Lacerda MVG, Price RN, Douglas NM. Severe Hemolysis during Primaquine Radical Cure of Plasmodium vivax Malaria: Two Systematic Reviews and Individual Patient Data Descriptive Analyses. Am J Trop Med Hyg 2023; 109:761-769. [PMID: 37604475 PMCID: PMC10551063 DOI: 10.4269/ajtmh.23-0280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 06/11/2023] [Indexed: 08/23/2023] Open
Abstract
Primaquine (PQ) kills Plasmodium vivax hypnozoites but can cause severe hemolysis in patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency. We conducted two systematic reviews. The first used data from clinical trials to determine the variety of definitions and frequency of hematological serious adverse events (SAEs) related to PQ treatment of vivax malaria. The second used data from prospective studies and case reports to describe the clinical presentation, management, and outcome of severe PQ-associated hemolysis necessitating hospitalization. In the first review, SAEs were reported in 70 of 249 clinical trials. There were 34 hematological SAEs among 9,824 patients with P. vivax malaria treated with PQ, nine of which necessitated hospitalization or blood transfusion. Criteria used to define SAEs were diverse. In the second review, 21 of 8,487 articles screened reported 163 patients hospitalized after PQ radical cure; 79.9% of whom (123 of 154) were prescribed PQ at ≥ 0.5 mg/kg/day. Overall, 101 patients were categorized as having probable or possible severe PQ-associated hemolysis, 96.8% of whom were G6PD deficient (< 30% activity). The first symptoms of hemolysis were reported primarily on day 2 or 3 (45.5%), and all patients were hospitalized within 7 days of PQ commencement. A total of 57.9% of patients (77 of 133) had blood transfusion. Seven patients (6.9%) with probable or possible hemolysis died. Even when G6PD testing is available, enhanced monitoring for hemolysis is warranted after PQ treatment. Clinical review within the first 5 days of treatment may facilitate early detection and management of hemolysis. More robust definitions of severe PQ-associated hemolysis are required.
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Affiliation(s)
- Daniel Yilma
- Jimma University Clinical Trial Unit, Department of Internal Medicine, Jimma University, Jimma, Ethiopia
- WorldWide Antimalarial Resistance Network, Oxford, United Kingdom
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Emily S. Groves
- Division of Global and Tropical Health, Menzies School of Health Research and Charles Darwin University, Darwin, Casuarina, Northern Territory, Australia
| | - Jose Diego Brito-Sousa
- Instituto de Pesquisa Clínica Carlos Borborema, Fundacão de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
- Escola Superior de Ciências da Saude, Universidade do Estado do Amazonas, Manaus, Brazil
| | - Wuelton M. Monteiro
- Instituto de Pesquisa Clínica Carlos Borborema, Fundacão de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
- Escola Superior de Ciências da Saude, Universidade do Estado do Amazonas, Manaus, Brazil
| | - Cindy Chu
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medical Research Unit, Faculty of Tropical Medicine, Mahidol University, MaeSot, Tak, Thailand
| | - Kamala Thriemer
- Division of Global and Tropical Health, Menzies School of Health Research and Charles Darwin University, Darwin, Casuarina, Northern Territory, Australia
| | - Robert J. Commons
- Division of Global and Tropical Health, Menzies School of Health Research and Charles Darwin University, Darwin, Casuarina, Northern Territory, Australia
- General and Subspecialty Medicine, Grampians Health, Ballarat, Victoria, Australia
| | - Marcus V. G. Lacerda
- Instituto de Pesquisa Clínica Carlos Borborema, Fundacão de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
- Instituto Leônidas & Maria Deane, Fundacão Oswaldo Cruz, Manaus, Brazil
| | - Ric N. Price
- Division of Global and Tropical Health, Menzies School of Health Research and Charles Darwin University, Darwin, Casuarina, Northern Territory, Australia
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, United Kingdom
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Nicholas M. Douglas
- Division of Global and Tropical Health, Menzies School of Health Research and Charles Darwin University, Darwin, Casuarina, Northern Territory, Australia
- Department of Medicine, University of Otago, Christchurch, New Zealand
- Department of Infectious Diseases, Christchurch Hospital, Christchurch, New Zealand
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3
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Fan D, Fisher C, Douglas NM, Hurrell MA, Freeman JT, Jardine DL. A rare case of Streptococcus oralis meningitis in New Zealand. Intern Med J 2023; 53:1931-1933. [PMID: 37859542 DOI: 10.1111/imj.16237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 08/23/2023] [Indexed: 10/21/2023]
Affiliation(s)
- Dali Fan
- Department of General Medicine, Christchurch Hospital, Te Whatu Ora Waitaha, Canterbury, New Zealand
| | - Calum Fisher
- Department of General Medicine, Christchurch Hospital, Te Whatu Ora Waitaha, Canterbury, New Zealand
| | - Nicholas M Douglas
- Department of Infectious Diseases, Christchurch Hospital, Te Whatu Ora Waitaha, Canterbury, New Zealand
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Michael A Hurrell
- Department of Radiology, Christchurch Hospital, Te Whatu Ora Waitaha, Canterbury, New Zealand
| | - Joshua T Freeman
- Department of Microbiology, Christchurch Hospital, Te Whatu Ora Waitaha, Canterbury, New Zealand
| | - David L Jardine
- Department of General Medicine, Christchurch Hospital, Te Whatu Ora Waitaha, Canterbury, New Zealand
- Department of Medicine, University of Otago, Christchurch, New Zealand
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Campbell PO, Gallagher K, Dalton SC, Metcalf SCL, Douglas NM, Chambers ST. Safety and clinical outcomes of outpatient parenteral antibiotic therapy for infective endocarditis in Christchurch, New Zealand: A retrospective cohort study. Int J Infect Dis 2023; 134:172-176. [PMID: 37331565 DOI: 10.1016/j.ijid.2023.06.008] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/06/2023] [Accepted: 06/09/2023] [Indexed: 06/20/2023] Open
Abstract
OBJECTIVES We examined the safety and clinical outcomes of outpatient parenteral antibiotic therapy (OPAT) for patients with infective endocarditis (IE) in Christchurch, New Zealand. METHODS Demographic and clinical data were collected from all adult patients treated for IE over 5 years. Outcomes were stratified by receipt of at least partial OPAT vs entirely hospital-based parenteral therapy. RESULTS There were 172 episodes of IE between 2014 and 2018. OPAT was administered in 115 cases (67%) for a median of 27 days after a median of 12 days of inpatient treatment. In the OPAT cohort, viridans group streptococci were the commonest causative pathogens (35%) followed by Staphylococcus aureus (25%) and Enterococcus faecalis (11%). There were six (5%) antibiotic-related adverse events and 26 (23%) readmissions in the OPAT treatment group. Mortality in OPAT patients was 6% (7/115) at 6 months and 10% (11/114) at 1 year and for patients receiving wholly inpatient parenteral therapy was 56% (31/56) and 58% (33/56), respectively. Three patients (3%) in the OPAT group had a relapse of IE during the 1-year follow-up period. CONCLUSION OPAT can be used safely in patients with IE, even in selected cases with complicated or difficult-to-treat infections.
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Affiliation(s)
- Patrick O Campbell
- Department of Infectious Diseases, Christchurch Hospital, Te Whatu Ora Waitaha Canterbury, New Zealand.
| | - Kate Gallagher
- Department of Infectious Diseases, Christchurch Hospital, Te Whatu Ora Waitaha Canterbury, New Zealand
| | - Simon C Dalton
- Department of Infectious Diseases, Christchurch Hospital, Te Whatu Ora Waitaha Canterbury, New Zealand
| | - Sarah C L Metcalf
- Department of Infectious Diseases, Christchurch Hospital, Te Whatu Ora Waitaha Canterbury, New Zealand
| | - Nicholas M Douglas
- Department of Infectious Diseases, Christchurch Hospital, Te Whatu Ora Waitaha Canterbury, New Zealand; Division of Medicine, University of Otago, Christchurch, New Zealand; Division of Global and Tropical Health, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Stephen T Chambers
- Department of Infectious Diseases, Christchurch Hospital, Te Whatu Ora Waitaha Canterbury, New Zealand; Department of Pathology and Biomedical Science, University of Otago, Christchurch, New Zealand
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Coleman M, Hill J, Timeon E, Rimon E, Bauro T, Ioteba N, Cunanan A, Douglas NM, Islam T, Tomlinson J, Campbell PO, Williman J, Priest P, Marais BJ, Britton WJ, Chambers ST. Effectiveness of population-wide screening and mass drug administration for leprosy control in Kiribati: the COMBINE protocol. BMJ Open 2023; 13:e065369. [PMID: 37385746 PMCID: PMC10314446 DOI: 10.1136/bmjopen-2022-065369] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 06/16/2023] [Indexed: 07/01/2023] Open
Abstract
INTRODUCTION Progress towards leprosy elimination is threatened by increasing incidence in 'hot-spot' areas where more effective control strategies are urgently required. In these areas, active case finding and leprosy prevention limited to known contacts is insufficient for control. Population-wide active case-finding together with universal prevention through mass drug administration (MDA) has been shown to be effective in 'hot-spot' areas, but is logistically challenging and expensive. Combining leprosy screening and MDA with other population-wide screening activities such as for tuberculosis may increase programme efficiency. There has been limited evaluation of the feasibility and effectiveness of combined screening and MDA interventions. The COMBINE study aims to bridge this knowledge gap. METHODS AND ANALYSIS This implementation study will assess the feasibility and effectiveness of active leprosy case-finding and treatment, combined with MDA using either single-dose rifampicin or rifamycin-containing tuberculosis preventive or curative treatment, for reducing leprosy incidence in Kiribati. The leprosy programme will run over 2022-2025 in concert with population-wide tuberculosis screening-and-treatment in South Tarawa. The primary research question is to what extent the intervention reduces the annual leprosy new case detection rate (NCDR) in adults and children compared with routine screening and postexposure prophylaxis (PEP) among close contacts (baseline leprosy control activities). Comparisons will be made with (1) the preintervention NCDR separably among adults and children in South Tarawa (before-after study) and (2) the corresponding NCDRs in the rest of the country. Additionally, the postintervention prevalence of leprosy obtained from a survey of a 'hot-spot' sub-population will be compared with prevalence documented during the intervention. The intervention will be implemented in collaboration with the Kiribati National Leprosy Programme. ETHICS AND DISSEMINATION Approval has been obtained from the Kiribati Ministry of Health and Medical Services (MHMS), the University of Otago (H22/111) and the University of Sydney (2021/127) Human Research Ethics Committees. Findings will be shared with the MHMS, local communities and internationally through publication.
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Affiliation(s)
- Mikaela Coleman
- Sydney Infectious Diseases Institute (Sydney ID), The University of Sydney, Sydney, New South Wales, Australia
- Tuberculosis Research Program, The Centenary Institute at the University of Sydney, Sydney, New South Wales, Australia
| | - Jeremy Hill
- Sydney Infectious Diseases Institute (Sydney ID), The University of Sydney, Sydney, New South Wales, Australia
- Tuberculosis Research Program, The Centenary Institute at the University of Sydney, Sydney, New South Wales, Australia
| | - Eretii Timeon
- Government of the Republic of Kiribati Ministry of Health and Medical Services, Tarawa, Kiribati
| | - Erei Rimon
- Government of the Republic of Kiribati Ministry of Health and Medical Services, Tarawa, Kiribati
| | - Temea Bauro
- Government of the Republic of Kiribati Ministry of Health and Medical Services, Tarawa, Kiribati
| | - Nabura Ioteba
- Pasifika Futures Ltd, Christchurch, New Zealand
- Pacific Leprosy Foundation, Christchurch, New Zealand
| | - Arturo Cunanan
- Pacific Leprosy Foundation, Christchurch, New Zealand
- Department of Health, Culion Sanatorium and General Hospital, Culion, Philippines
| | - Nicholas M Douglas
- Department of Infectious Diseases, Christchurch Hospital, Christchurch, New Zealand
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Tauhid Islam
- Division of Programmes for Disease Control, Manila, Philippines
| | | | - Patrick O Campbell
- Department of Infectious Diseases, Christchurch Hospital, Christchurch, New Zealand
| | - Jonathan Williman
- Biostatistics and Computation Biology Unit, University of Otago, Christchurch, New Zealand
| | | | - Ben J Marais
- Sydney Infectious Diseases Institute (Sydney ID), The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Warwick J Britton
- Tuberculosis Research Program, The Centenary Institute at the University of Sydney, Sydney, New South Wales, Australia
- Department of Clinical Immunology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Stephen T Chambers
- Pacific Leprosy Foundation, Christchurch, New Zealand
- Department of Pathology and Biomedical Science, University of Otago, Christchurch, New Zealand
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Alamri Y, Chua I, Douglas NM. A case of purpura fulminans attributed to trimethoprim-sulfamethoxazole. N Z Med J 2023; 136:72-76. [PMID: 36726322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Yassar Alamri
- Department of Intensive Care, Christchurch Hospital, Te Whatu Ora - Health New Zealand, New Zealand; Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Ignatius Chua
- Department of Immunology and Rheumatology, Christchurch Hospital, Te Whatu Ora - Health New Zealand, New Zealand
| | - Nicholas M Douglas
- Department of Medicine, University of Otago, Christchurch, New Zealand; Department of Infectious Diseases, Christchurch Hospital, Te Whatu Ora - Health New Zealand, New Zealand
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Douglas NM, Piera KA, Rumaseb A, Ley B, Anstey NM, Price RN. Primaquine-induced Severe Hemolysis in the Absence of Concomitant Malaria: Effects on G6PD Activity and Renal Function. Am J Trop Med Hyg 2023; 108:76-80. [PMID: 36509054 PMCID: PMC9833077 DOI: 10.4269/ajtmh.21-0834] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 08/29/2022] [Indexed: 12/15/2022] Open
Abstract
Primaquine prevents relapses of Plasmodium vivax malaria but can cause severe hemolysis in patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency. The clinical and laboratory features of this outcome are usually confounded by the clinical and hemolytic effects of concomitant malaria. We describe a case of severe hemolysis occurring after a total dose of 2.04 mg/kg of primaquine used for prophylaxis in a young, G6PD-deficient (Kaiping variant), Australian man without malaria. During acute hemolysis, he had markedly elevated urinary beta-2-microglobulin, suggestive of renal tubular injury (a well-recognized complication of primaquine-induced hemolysis). He also had albuminuria and significantly increased excretion of glycocalyx metabolites, suggestive of glomerular glycocalyx degradation and injury. We show that regularly dosed paracetamol given for its putative renoprotective effect is safe in the context of severe oxidative hemolysis. Acute drug-induced hemolysis transiently increases G6PD activity. Cases such as this improve our understanding of primaquine-induced hemolysis and ultimately will help facilitate widespread safe and effective use of this critically important drug.
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Affiliation(s)
- Nicholas M. Douglas
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia
- Department of Infectious Diseases, Christchurch Hospital, Canterbury District Health Board, Christchurch, New Zealand
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Kim A. Piera
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia
| | - Angela Rumaseb
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia
| | - Benedikt Ley
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia
| | - Nicholas M. Anstey
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia
- Division of Infectious Diseases, Royal Darwin Hospital, Darwin, Australia
| | - Ric N. Price
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia
- Division of Infectious Diseases, Royal Darwin Hospital, Darwin, Australia
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
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8
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Affiliation(s)
- Nicholas M Douglas
- Department of Medicine, University of Otago, Christchurch, New Zealand.,Division of Global and Tropical Health, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,Department of Infectious Diseases, Christchurch Hospital, Christchurch, New Zealand
| | - Thomas R Burkot
- Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, QLD, Australia
| | - Ric N Price
- Division of Global and Tropical Health, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
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9
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Mansoor R, Commons RJ, Douglas NM, Abuaku B, Achan J, Adam I, Adjei GO, Adjuik M, Alemayehu BH, Allan R, Allen EN, Anvikar AR, Arinaitwe E, Ashley EA, Ashurst H, Asih PBS, Bakyaita N, Barennes H, Barnes KI, Basco L, Bassat Q, Baudin E, Bell DJ, Bethell D, Bjorkman A, Boulton C, Bousema T, Brasseur P, Bukirwa H, Burrow R, Carrara VI, Cot M, D’Alessandro U, Das D, Das S, Davis TME, Desai M, Djimde AA, Dondorp AM, Dorsey G, Drakeley CJ, Duparc S, Espié E, Etard JF, Falade C, Faucher JF, Filler S, Fogg C, Fukuda M, Gaye O, Genton B, Ghulam Rahim A, Gilayeneh J, Gonzalez R, Grais RF, Grandesso F, Greenwood B, Grivoyannis A, Hatz C, Hodel EM, Humphreys GS, Hwang J, Ishengoma D, Juma E, Kachur SP, Kager PA, Kamugisha E, Kamya MR, Karema C, Kayentao K, Kazienga A, Kiechel JR, Kofoed PE, Koram K, Kremsner PG, Lalloo DG, Laman M, Lee SJ, Lell B, Maiga AW, Mårtensson A, Mayxay M, Mbacham W, McGready R, Menan H, Ménard D, Mockenhaupt F, Moore BR, Müller O, Nahum A, Ndiaye JL, Newton PN, Ngasala BE, Nikiema F, Nji AM, Noedl H, Nosten F, Ogutu BR, Ojurongbe O, Osorio L, Ouédraogo JB, Owusu-Agyei S, Pareek A, Penali LK, Piola P, Plucinski M, Premji Z, Ramharter M, Richmond CL, Rombo L, Roper C, Rosenthal PJ, Salman S, Same-Ekobo A, Sibley C, Sirima SB, Smithuis FM, Somé FA, Staedke SG, Starzengruber P, Strub-Wourgaft N, Sutanto I, Swarthout TD, Syafruddin D, Talisuna AO, Taylor WR, Temu EA, Thwing JI, Tinto H, Tjitra E, Touré OA, Tran TH, Ursing J, Valea I, Valentini G, van Vugt M, von Seidlein L, Ward SA, Were V, White NJ, Woodrow CJ, Yavo W, Yeka A, Zongo I, Simpson JA, Guerin PJ, Stepniewska K, Price RN. Haematological consequences of acute uncomplicated falciparum malaria: a WorldWide Antimalarial Resistance Network pooled analysis of individual patient data. BMC Med 2022; 20:85. [PMID: 35249546 PMCID: PMC8900374 DOI: 10.1186/s12916-022-02265-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 01/18/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Plasmodium falciparum malaria is associated with anaemia-related morbidity, attributable to host, parasite and drug factors. We quantified the haematological response following treatment of uncomplicated P. falciparum malaria to identify the factors associated with malarial anaemia. METHODS Individual patient data from eligible antimalarial efficacy studies of uncomplicated P. falciparum malaria, available through the WorldWide Antimalarial Resistance Network data repository prior to August 2015, were pooled using standardised methodology. The haematological response over time was quantified using a multivariable linear mixed effects model with nonlinear terms for time, and the model was then used to estimate the mean haemoglobin at day of nadir and day 7. Multivariable logistic regression quantified risk factors for moderately severe anaemia (haemoglobin < 7 g/dL) at day 0, day 3 and day 7 as well as a fractional fall ≥ 25% at day 3 and day 7. RESULTS A total of 70,226 patients, recruited into 200 studies between 1991 and 2013, were included in the analysis: 50,859 (72.4%) enrolled in Africa, 18,451 (26.3%) in Asia and 916 (1.3%) in South America. The median haemoglobin concentration at presentation was 9.9 g/dL (range 5.0-19.7 g/dL) in Africa, 11.6 g/dL (range 5.0-20.0 g/dL) in Asia and 12.3 g/dL (range 6.9-17.9 g/dL) in South America. Moderately severe anaemia (Hb < 7g/dl) was present in 8.4% (4284/50,859) of patients from Africa, 3.3% (606/18,451) from Asia and 0.1% (1/916) from South America. The nadir haemoglobin occurred on day 2 post treatment with a mean fall from baseline of 0.57 g/dL in Africa and 1.13 g/dL in Asia. Independent risk factors for moderately severe anaemia on day 7, in both Africa and Asia, included moderately severe anaemia at baseline (adjusted odds ratio (AOR) = 16.10 and AOR = 23.00, respectively), young age (age < 1 compared to ≥ 12 years AOR = 12.81 and AOR = 6.79, respectively), high parasitaemia (AOR = 1.78 and AOR = 1.58, respectively) and delayed parasite clearance (AOR = 2.44 and AOR = 2.59, respectively). In Asia, patients treated with an artemisinin-based regimen were at significantly greater risk of moderately severe anaemia on day 7 compared to those treated with a non-artemisinin-based regimen (AOR = 2.06 [95%CI 1.39-3.05], p < 0.001). CONCLUSIONS In patients with uncomplicated P. falciparum malaria, the nadir haemoglobin occurs 2 days after starting treatment. Although artemisinin-based treatments increase the rate of parasite clearance, in Asia they are associated with a greater risk of anaemia during recovery.
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Gardiner SJ, Duffy EJ, Chambers ST, Thomas MG, Addidle M, Arnold B, Arroll B, Balm MN, Perales CB, Berger S, Best E, Betty B, Birch M, Blackmore TK, Bloomfield M, Briggs S, Bupha-Intr O, Burns A, Campbell C, Chin PK, Dalton SC, Davies N, Douglas NM, Plessis TD, Elvy J, Everts R, Green J, Grimwade K, Handy R, Hardie MG, Henderson E, Holland DJ, Howard J, Hudson B, Huggan P, Isenman H, Issa M, Kelly MJ, Li C, Lim AG, Lim J, Maze M, Metcalf SC, McCall C, Murdoch D, McRae G, Nisbet M, Pithie A, Raymond N, Read K, Restrepo D, Ritchie S, Robertson B, Ussher JE, Voss L, Walls T, Sen Yew H. Antimicrobial stewardship in human healthcare in Aotearoa New Zealand: urgent call for national leadership and co-ordinated efforts to preserve antimicrobial effectiveness. N Z Med J 2021; 134:113-128. [PMID: 34695098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- Sharon J Gardiner
- Antimicrobial Stewardship Pharmacist, Canterbury District Health Board, Christchurch; Co-lead of the New Zealand Antimicrobial Stewardship/Infection Pharmacist Expert Group
| | - Eamon J Duffy
- Lead Antimicrobial Stewardship/Infectious Diseases Pharmacist, Auckland District Health Board, Auckland; Co-lead of the NZ Antimicrobial Stewardship/Infection Pharmacist Expert Group
| | | | - Mark G Thomas
- Infectious Diseases Physician, Auckland District Health Board, Auckland
| | - Michael Addidle
- Clinical Microbiologist, Pathlab, Tauranga, and The Institute of Environmental Science and Research NZ
| | - Brendan Arnold
- Infectious Diseases Physician, Southern District Health Board, Dunedin
| | - Bruce Arroll
- Head of Department, Department of General Practice and Primary Health Care, University of Auckland, Auckland
| | - Michelle Nd Balm
- Infectious Diseases Physician and Clinical Microbiologist, Capital and Coast District Health Board, Wellington
| | | | - Sarah Berger
- Nursing Director, Infection Prevention and Control Service, Canterbury District Health Board, Christchurch
| | - Emma Best
- Senior Lecturer, Department of Paediatrics, University of Auckland; Paediatric Infectious Diseases Physician, Starship Children's Health, Auckland District Health Board, Auckland
| | - Bryan Betty
- Medical Director, Royal New Zealand College of General Practitioners, Wellington
| | - Mark Birch
- Infectious Diseases Physician, Canterbury District Health Board, Christchurch
| | - Timothy K Blackmore
- Infectious Diseases Physician and Microbiologist, Capital and Coast District Health Board and Wellington Southern Community Laboratories, Wellington
| | - Max Bloomfield
- Infectious Diseases Physician, Capital and Coast District Health Board, Wellington
| | - Simon Briggs
- Infectious Diseases Physician, Auckland District Health Board, Auckland
| | - Olivia Bupha-Intr
- Infectious Diseases Physician, Capital and Coast District Health Board, Wellington
| | - Andrew Burns
- Infectious Diseases Physician, Hawke's Bay District Health Board, Hastings
| | - Chloë Campbell
- Professional Practice Pharmacist, Pharmaceutical Society of New Zealand Incorporated, Wellington
| | - Paul Kl Chin
- Clinical Pharmacologist, Department of Medicine, University of Otago, Christchurch
| | - Simon C Dalton
- Infectious Diseases Physician, Canterbury District Health Board, Christchurch
| | - Nicola Davies
- Antimicrobial Stewardship Pharmacist, Waitemata District Health Board, Auckland
| | - Nicholas M Douglas
- Infectious Diseases Physician, Canterbury District Health Board, Christchurch
| | - Tanya du Plessis
- Antimicrobial Stewardship/Infectious Diseases Pharmacist, Counties Manukau District Health Board, Auckland
| | - Juliet Elvy
- Clinical Microbiologist, Wellington Southern Community Laboratories, Wellington and Medlab South, Nelson/Marlborough
| | - Richard Everts
- Infectious Diseases Physician, Nelson Marlborough District Health Board, Nelson
| | - Jared Green
- Infectious Diseases Physician, General and Acute Care Medicine Physician, and Rural Generalist, Waikato District Health Board, Hamilton
| | - Kate Grimwade
- Infectious Diseases Physician, Bay of Plenty District Health Board, Tauranga
| | - Rupert Handy
- Infectious Diseases Physician, Auckland District Health Board, Auckland
| | - Mariam G Hardie
- Antimicrobial Stewardship Pharmacist, Waitemata District Health Board, Auckland
| | - Emma Henderson
- Antimicrobial Pharmacist, Hutt Valley District Health Board, Lower Hutt
| | - David J Holland
- Infectious Diseases Physician, Counties Manukau District Health Board, Auckland
| | - Julia Howard
- Clinical Microbiologist, Waikato District Health Board, Hamilton
| | - Ben Hudson
- Senior Lecturer, Department of General Practice, University of Otago, Christchurch
| | - Paul Huggan
- Infectious Diseases Physician, Waikato District Health Board, Hamilton
| | - Heather Isenman
- Infectious Diseases Physician, Canterbury District Health Board, Christchurch
| | - Mohammed Issa
- Antimicrobial Stewardship/Infectious Diseases Pharmacist, Waikato District Health Board, Hamilton
| | - Matthew J Kelly
- Infectious Diseases Physician, Hutt Valley District Health Board, Lower Hutt
| | - Cat Li
- Antimicrobial Stewardship Pharmacist, Capital and Coast District Health Board, Wellington
| | - Anecita G Lim
- Senior Lecturer, School of Nursing, University of Auckland, Auckland
| | - Joyce Lim
- Antimicrobial Stewardship Pharmacist, Southern District Health Board, Dunedin
| | - Michael Maze
- Infectious Diseases and Respiratory Medicine Physician, Department of Medicine, University of Otago, Christchurch
| | - Sarah Cl Metcalf
- Infectious Diseases Physician, Canterbury District Health Board, Christchurch
| | - Cate McCall
- Lecturer, Centre for Post Graduate Nursing Studies, University of Otago, Christchurch
| | - David Murdoch
- Dean and Head of Campus, University of Otago, Christchurch
| | - Grant McRae
- Senior Clinical Pharmacist, MidCentral District Health Board, Palmerston North
| | - Mitzi Nisbet
- Infectious Diseases and Respiratory Physician, Auckland District Health Board, Auckland
| | - Alan Pithie
- Infectious Diseases Physician, Canterbury District Health Board, Christchurch
| | - Nigel Raymond
- Infectious Diseases Physician, Capital and Coast District Health Board, Wellington
| | - Kerry Read
- Infectious Diseases Physician, Waitemata District Health Board, Auckland
| | - Dalilah Restrepo
- Infectious Diseases Physician, MidCentral District Health Board, Palmerston North
| | - Stephen Ritchie
- Infectious Diseases Physician, Auckland District Health Board and University of Auckland, Auckland
| | - Ben Robertson
- Antimicrobial Stewardship Pharmacist, Hawke's Bay District Health Board, Hastings
| | - James E Ussher
- Clinical Microbiologist, Southern Community Laboratories, Dunedin, and Associate Professor, Department of Microbiology and Immunology, University of Otago, Dunedin
| | - Lesley Voss
- Paediatric Infectious Diseases Physician, Starship Children's Health, Auckland District Health Board, Auckland
| | - Tony Walls
- Paediatric Infectious Diseases Physician, University of Otago, Christchurch
| | - Haur Sen Yew
- Infectious Diseases Physician, Canterbury District Health Board, Christchurch
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11
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Walker LJ, Codreanu TA, Armstrong PK, Goodwin S, Trewin A, Spencer E, Colquhoun SM, Stephens DM, Baird RW, Douglas NM, Cribb D, Owen R, Kelly P, Kirk MD. SARS-CoV-2 infections among Australian passengers on the Diamond Princess cruise ship: A retrospective cohort study. PLoS One 2021; 16:e0255401. [PMID: 34492022 PMCID: PMC8423262 DOI: 10.1371/journal.pone.0255401] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 07/16/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Prolonged periods of confined living on a cruise ship increase the risk for respiratory disease transmission. We describe the epidemiology and clinical characteristics of a SARS-CoV-2 outbreak in Australian passengers on the Diamond Princess cruise ship and provide recommendations to mitigate future cruise ship outbreaks. METHODS We conducted a retrospective cohort study of Australian passengers who travelled on the Diamond Princess from 20 January until 4 February 2020 and were either hospitalised, remained in Japan or repatriated. The main outcome measures included an epidemic curve, demographics, symptoms, clinical and radiological signs, risk factors and length of time to clear infection. RESULTS Among 223 Australian passengers, 56 were confirmed SARS-CoV-2 positive. Forty-nine cases had data available and of these over 70% had symptoms consistent with COVID-19. Of symptomatic cases, 17% showed signs and symptoms before the ship implemented quarantine and a further two-thirds had symptoms within one incubation period of quarantine commencing. Prior to ship-based quarantine, exposure to a close contact or cabin mate later confirmed SARS-CoV-2 positive was associated with a 3.78 fold (95% CI, 2.24-6.37) higher risk of COVID-19 acquisition compared to non-exposed passengers. Exposure to a positive cabin mate during the ship's quarantine carried a relative risk of 6.18 (95% CI, 1.96-19.46) of developing COVID-19. Persistently asymptomatic cases represented 29% of total cases. The median time to the first of two consecutive negative PCR-based SARS-CoV-2 assays was 13 days for asymptomatic cases and 19 days for symptomatic cases (p = 0.002). CONCLUSION Ship based quarantine was effective at reducing transmission of SARS-CoV-2 amongst Australian passengers, but the risk of infection was higher if an individual shared a cabin or was a close contact of a confirmed case. Managing COVID-19 in cruise ship passengers is challenging and requires enhanced health measures and access to onshore quarantine and isolation facilities.
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Affiliation(s)
- Liz J. Walker
- Australian Government Department of Health, Canberra, Australian Capital Territory, Australia
- National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Tudor A. Codreanu
- National Critical Care and Trauma Response Centre, Darwin, Northern Territory, Australia
- Western Australian Department of Health, Perth, Western Australia, Australia
| | - Paul K. Armstrong
- National Critical Care and Trauma Response Centre, Darwin, Northern Territory, Australia
- Western Australian Department of Health, Perth, Western Australia, Australia
| | - Sam Goodwin
- National Critical Care and Trauma Response Centre, Darwin, Northern Territory, Australia
- Northern Territory Department of Health, Darwin, Northern Territory, Australia
| | - Abigail Trewin
- Western Australian Department of Health, Perth, Western Australia, Australia
| | - Emma Spencer
- Northern Territory Department of Health, Darwin, Northern Territory, Australia
| | - Samantha M. Colquhoun
- National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Dianne M. Stephens
- National Critical Care and Trauma Response Centre, Darwin, Northern Territory, Australia
- Northern Territory Department of Health, Darwin, Northern Territory, Australia
| | - Rob W. Baird
- Territory Pathology, Department of Health, Darwin, Northern Territory, Australia
| | - Nicholas M. Douglas
- Territory Pathology, Department of Health, Darwin, Northern Territory, Australia
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Danielle Cribb
- Australian Government Department of Health, Canberra, Australian Capital Territory, Australia
| | - Rhonda Owen
- Australian Government Department of Health, Canberra, Australian Capital Territory, Australia
| | - Paul Kelly
- Australian Government Department of Health, Canberra, Australian Capital Territory, Australia
- National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Martyn D. Kirk
- Australian Government Department of Health, Canberra, Australian Capital Territory, Australia
- National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australian Capital Territory, Australia
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12
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Thriemer K, Poespoprodjo JR, Kenangalem E, Douglas NM, Sugiarto P, Anstey NM, Simpson JA, Price RN. The risk of adverse clinical outcomes following treatment of Plasmodium vivax malaria with and without primaquine in Papua, Indonesia. PLoS Negl Trop Dis 2020; 14:e0008838. [PMID: 33175835 PMCID: PMC7657498 DOI: 10.1371/journal.pntd.0008838] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 09/24/2020] [Indexed: 01/12/2023] Open
Abstract
The widespread use of primaquine (PQ) radical cure for P. vivax, is constrained by concerns over its safety. We used routinely collected patient data to compare the overall morbidity and mortality in patients treated with and without PQ without prior testing of Glucose-6-Phosphate-Dehydrogenase (G6PD) deficiency in Papua, Indonesia, where there is a low prevalence of G6PD deficiency. Records were collated from patients older than 1 year, with P. vivax infection, who were treated with an artemisinin combination therapy (ACT). The risks of re-presentation, hospitalization, major fall in haemoglobin and death within 30 days were quantified and compared between patients treated with and without PQ using a Cox regression model. In total 26,216 patients with P. vivax malaria presented to the hospital with malaria during the study period. Overall 27.56% (95% Confidence Interval (95%CI): 26.96-28.16) of 21,344 patients treated with PQ re-presented with any illness within 30 days and 1.69% (1.51-1.88) required admission to hospital. The corresponding risks were higher in the 4,872 patients not treated with PQ; Adjusted Hazard Ratio (AHR) = 0.84 (0.79-0.91; p<0.001) and 0.54 (0.41-0.70; p<0.001) respectively. By day 30, 14.15% (12.45-16.05) of patients who had received PQ had a fall in haemoglobin (Hb) below 7g/dl compared to 20.43% (16.67-24.89) of patients treated without PQ; AHR = 0.66 (0.45-0.97; p = 0.033). A total of 75 (0.3%) patients died within 30 days of treatment with a mortality risk of 0.27% (0.21-0.35) in patients treated with PQ, compared to 0.38% (0.24-0.60) without PQ; AHR = 0.79 (0.43-1.45; p = 0.448). In Papua, Indonesia routine administration of PQ radical cure without prior G6PD testing, was associated with lower risk of all cause hospitalization and other serious adverse clinical outcomes. In areas where G6PD testing is not available or cannot be delivered reliably, the risks of drug induced haemolysis should be balanced against the potential benefits of reducing recurrent P. vivax malaria and its associated morbidity and mortality.
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Affiliation(s)
- Kamala Thriemer
- Global Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia
- * E-mail:
| | - Jeanne-Rini Poespoprodjo
- Centre for Child Health and Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
- Timika Malaria Research Programme, Papuan Health and Community Development Foundation, Timika, Papua, Indonesia
- Mimika District Hospital, Timika, Papua, Indonesia
| | - Enny Kenangalem
- Timika Malaria Research Programme, Papuan Health and Community Development Foundation, Timika, Papua, Indonesia
- Mimika District Hospital, Timika, Papua, Indonesia
| | - Nicholas M. Douglas
- Global Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia
- Division of Medicine, Royal Darwin Hospital, Darwin, Australia
| | | | - Nicholas M. Anstey
- Global Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia
| | - Julie Anne Simpson
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Ric N. Price
- Global Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
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13
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Hossain MS, Commons RJ, Douglas NM, Thriemer K, Alemayehu BH, Amaratunga C, Anvikar AR, Ashley EA, Asih PBS, Carrara VI, Lon C, D’Alessandro U, Davis TME, Dondorp AM, Edstein MD, Fairhurst RM, Ferreira MU, Hwang J, Janssens B, Karunajeewa H, Kiechel JR, Ladeia-Andrade S, Laman M, Mayxay M, McGready R, Moore BR, Mueller I, Newton PN, Thuy-Nhien NT, Noedl H, Nosten F, Phyo AP, Poespoprodjo JR, Saunders DL, Smithuis F, Spring MD, Stepniewska K, Suon S, Suputtamongkol Y, Syafruddin D, Tran HT, Valecha N, Van Herp M, Van Vugt M, White NJ, Guerin PJ, Simpson JA, Price RN. The risk of Plasmodium vivax parasitaemia after P. falciparum malaria: An individual patient data meta-analysis from the WorldWide Antimalarial Resistance Network. PLoS Med 2020; 17:e1003393. [PMID: 33211712 PMCID: PMC7676739 DOI: 10.1371/journal.pmed.1003393] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 09/25/2020] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND There is a high risk of Plasmodium vivax parasitaemia following treatment of falciparum malaria. Our study aimed to quantify this risk and the associated determinants using an individual patient data meta-analysis in order to identify populations in which a policy of universal radical cure, combining artemisinin-based combination therapy (ACT) with a hypnozoitocidal antimalarial drug, would be beneficial. METHODS AND FINDINGS A systematic review of Medline, Embase, Web of Science, and the Cochrane Database of Systematic Reviews identified efficacy studies of uncomplicated falciparum malaria treated with ACT that were undertaken in regions coendemic for P. vivax between 1 January 1960 and 5 January 2018. Data from eligible studies were pooled using standardised methodology. The risk of P. vivax parasitaemia at days 42 and 63 and associated risk factors were investigated by multivariable Cox regression analyses. Study quality was assessed using a tool developed by the Joanna Briggs Institute. The study was registered in the International Prospective Register of Systematic Reviews (PROSPERO: CRD42018097400). In total, 42 studies enrolling 15,341 patients were included in the analysis, including 30 randomised controlled trials and 12 cohort studies. Overall, 14,146 (92.2%) patients had P. falciparum monoinfection and 1,195 (7.8%) mixed infection with P. falciparum and P. vivax. The median age was 17.0 years (interquartile range [IQR] = 9.0-29.0 years; range = 0-80 years), with 1,584 (10.3%) patients younger than 5 years. 2,711 (17.7%) patients were treated with artemether-lumefantrine (AL, 13 studies), 651 (4.2%) with artesunate-amodiaquine (AA, 6 studies), 7,340 (47.8%) with artesunate-mefloquine (AM, 25 studies), and 4,639 (30.2%) with dihydroartemisinin-piperaquine (DP, 16 studies). 14,537 patients (94.8%) were enrolled from the Asia-Pacific region, 684 (4.5%) from the Americas, and 120 (0.8%) from Africa. At day 42, the cumulative risk of vivax parasitaemia following treatment of P. falciparum was 31.1% (95% CI 28.9-33.4) after AL, 14.1% (95% CI 10.8-18.3) after AA, 7.4% (95% CI 6.7-8.1) after AM, and 4.5% (95% CI 3.9-5.3) after DP. By day 63, the risks had risen to 39.9% (95% CI 36.6-43.3), 42.4% (95% CI 34.7-51.2), 22.8% (95% CI 21.2-24.4), and 12.8% (95% CI 11.4-14.5), respectively. In multivariable analyses, the highest rate of P. vivax parasitaemia over 42 days of follow-up was in patients residing in areas of short relapse periodicity (adjusted hazard ratio [AHR] = 6.2, 95% CI 2.0-19.5; p = 0.002); patients treated with AL (AHR = 6.2, 95% CI 4.6-8.5; p < 0.001), AA (AHR = 2.3, 95% CI 1.4-3.7; p = 0.001), or AM (AHR = 1.4, 95% CI 1.0-1.9; p = 0.028) compared with DP; and patients who did not clear their initial parasitaemia within 2 days (AHR = 1.8, 95% CI 1.4-2.3; p < 0.001). The analysis was limited by heterogeneity between study populations and lack of data from very low transmission settings. Study quality was high. CONCLUSIONS In this meta-analysis, we found a high risk of P. vivax parasitaemia after treatment of P. falciparum malaria that varied significantly between studies. These P. vivax infections are likely attributable to relapses that could be prevented with radical cure including a hypnozoitocidal agent; however, the benefits of such a novel strategy will vary considerably between geographical areas.
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Affiliation(s)
- Mohammad S. Hossain
- WorldWide Antimalarial Resistance Network (WWARN), Oxford, United Kingdom
- Global Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- International Centre for Diarrheal Diseases and Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Robert J. Commons
- WorldWide Antimalarial Resistance Network (WWARN), Oxford, United Kingdom
- Global Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia
- Internal Medical Services, Ballarat Health Services, Ballarat, Victoria, Australia
| | - Nicholas M. Douglas
- Global Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Kamala Thriemer
- Global Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia
| | - Bereket H. Alemayehu
- ICAP at Mailman School of Public Health, Columbia University, New York, New York, United States of America
| | - Chanaki Amaratunga
- Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland, United States of America
| | | | - Elizabeth A. Ashley
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR
| | | | - Verena I. Carrara
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Chanthap Lon
- Department of Bacterial and Parasitic Diseases, Armed Forces Research Institute of Medical Sciences (AFRIMS), Bangkok, Thailand
- Armed Forces Research Institute of Medical Sciences, Phnom Penh, Cambodia
| | | | - Timothy M. E. Davis
- Medical School, University of Western Australia, Fremantle Hospital, Fremantle, Australia
| | - Arjen M. Dondorp
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Michael D. Edstein
- Australian Defence Force Malaria and Infectious Disease Institute, Enoggera, Brisbane, Australia
| | - Rick M. Fairhurst
- Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland, United States of America
| | - Marcelo U. Ferreira
- Department of Parasitology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Jimee Hwang
- US President's Malaria Initiative, Malaria Branch, US Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Global Health Group, University of California San Francisco, San Francisco, California, United States of America
| | | | - Harin Karunajeewa
- Melbourne Medical School–Western Health, The University of Melbourne, Melbourne, Australia
- Western Health Chronic Disease Alliance, Sunshine Hospital, St Albans, Melbourne, Australia
| | - Jean R. Kiechel
- Drugs for Neglected Diseases initiative (DNDi), Geneva, Switzerland
| | - Simone Ladeia-Andrade
- Laboratory of Parasitic Diseases, Oswaldo Cruz Institute/Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, Brazil
- Amazonian Malaria Initiative/Amazon Network for the Surveillance of Antimalarial Drug Resistance, Ministry of Health of Brazil, Cruzeiro do Sul, Brazil
| | - Moses Laman
- Medical School, University of Western Australia, Fremantle Hospital, Fremantle, Australia
- Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea
| | - Mayfong Mayxay
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR
- Institute of Research and Education Development (IRED), University of Health Sciences, Ministry of Health, Vientiane, Lao PDR
| | - Rose McGready
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Brioni R. Moore
- Medical School, University of Western Australia, Fremantle Hospital, Fremantle, Australia
- School of Pharmacy and Biomedical Sciences, Curtin University, Perth, Australia
| | - Ivo Mueller
- Division of Population Health and Immunity, The Walter & Eliza Hall Institute of Medical Research, Melbourne, Australia
- Department of Medical Biology, University of Melbourne, Melbourne, Australia
- Parasites and Insect Vectors Department, Institut Pasteur, Paris, France
| | - Paul N. Newton
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | | | - Harald Noedl
- MARIB—Malaria Research Initiative Bandarban, Vienna, Austria
| | - Francois Nosten
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Aung P. Phyo
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
- Myanmar Oxford Clinical Research Unit, Yangon, Myanmar
| | - Jeanne R. Poespoprodjo
- Mimika District Hospital, Timika, Indonesia
- Timika Malaria Research Programme, Papuan Health and Community Development Foundation, Timika, Indonesia
- Paediatric Research Office, Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - David L. Saunders
- Division of Medicine, United States Army Research Institute of Infectious Diseases, Ft. Detrick, Maryland, United States of America
| | - Frank Smithuis
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
- Myanmar Oxford Clinical Research Unit, Yangon, Myanmar
- Medical Action Myanmar, Yangon, Myanmar
| | - Michele D. Spring
- Department of Bacterial and Parasitic Diseases, Armed Forces Research Institute of Medical Sciences (AFRIMS), Bangkok, Thailand
| | - Kasia Stepniewska
- WorldWide Antimalarial Resistance Network (WWARN), Oxford, United Kingdom
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
| | - Seila Suon
- National Center for Parasitology, Entomology, and Malaria Control, Phnom Penh, Cambodia
| | - Yupin Suputtamongkol
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Din Syafruddin
- Eijkman Institute for Molecular Biology, Jakarta, Indonesia
- Department of Parasitology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Hien T. Tran
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
- Oxford University Clinical Research Unit (OUCRU), Ho Chi Minh City, Vietnam
| | - Neena Valecha
- National Institute of Malaria Research, Dwarka, New Delhi, India
| | | | - Michele Van Vugt
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Academic Medical Centre, Department of Internal Medicine, Slotervaart Hospital, Amsterdam, The Netherlands
| | - Nicholas J. White
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Philippe J. Guerin
- WorldWide Antimalarial Resistance Network (WWARN), Oxford, United Kingdom
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
| | - Julie A. Simpson
- WorldWide Antimalarial Resistance Network (WWARN), Oxford, United Kingdom
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Ric N. Price
- WorldWide Antimalarial Resistance Network (WWARN), Oxford, United Kingdom
- Global Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- * E-mail:
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14
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Douglas NM, Meumann EM, Krause VL, Davies J. Successful containment to date of SARS-CoV-2 transmission in the Northern Territory. Med J Aust 2020; 214:218-219. [PMID: 33111312 PMCID: PMC7984294 DOI: 10.5694/mja2.50840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 09/21/2020] [Indexed: 11/17/2022]
Affiliation(s)
- Nicholas M Douglas
- Royal Darwin Hospital, Darwin, NT.,Menzies School of Health Research, Charles Darwin University, Darwin, NT
| | - Ella M Meumann
- Royal Darwin Hospital, Darwin, NT.,Menzies School of Health Research, Charles Darwin University, Darwin, NT
| | - Vicki L Krause
- Northern Territory Centre for Disease Control, Department of Health, Darwin, NT
| | - Jane Davies
- Royal Darwin Hospital, Darwin, NT.,Menzies School of Health Research, Charles Darwin University, Darwin, NT
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15
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Douglas NM, Hennessy JN, Currie BJ, Baird RW. Trends in Bacteremia Over 2 Decades in the Top End of the Northern Territory of Australia. Open Forum Infect Dis 2020; 7:ofaa472. [PMID: 33204758 PMCID: PMC7651056 DOI: 10.1093/ofid/ofaa472] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 07/28/2020] [Accepted: 10/01/2020] [Indexed: 11/14/2022] Open
Abstract
Background Information on the local distribution of bloodstream pathogens helps to guide empiric antibiotic selection and can generate hypotheses regarding the effectiveness of infection prevention practices. We assessed trends in bacterial blood culture isolates at Royal Darwin Hospital (RDH) in the Northern Territory of Australia between 1999 and 2019. Methods Species identification was extracted for all blood cultures first registered at RDH. Thirteen organisms were selected for focused analysis. Trends were examined graphically and using univariable linear regression. Results Between 1999 and 2019, 189 577 blood cultures from 65 276 patients were processed at RDH. Overall, 6.72% (12 747/189 577) of blood cultures contained a bacterial pathogen. Staphylococcus aureus was the most common cause of bacteremia during the first decade, with an estimated incidence of 96.6 episodes per 100 000 person-years (py; 95% CI, 72.2-121/100 000 py) in 1999. Since 2009, S. aureus bacteremia has declined markedly, whereas there has been an inexorable rise in Escherichia coli bacteremia (30.1 to 74.7/100 000 py between 1999 and 2019; P < .001), particularly in older adults. Since 2017, E. coli has been more common than S. aureus. Rates of Streptococcus pneumoniae bacteremia have reduced dramatically in children, while Burkholderia pseudomallei remained the fourth most common bloodstream isolate overall. Conclusions The incidence of S. aureus bacteremia, though high by international standards, is declining at RDH, possibly in part due to a sustained focus on both community and hospital infection prevention practices. Gram-negative bacteremia, particularly due to E. coli, is becoming more common, and the trend will likely continue given our aging population.
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Affiliation(s)
- Nicholas M Douglas
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,Territory Pathology, Royal Darwin Hospital, Darwin, Northern Territory, Australia.,Department of Infectious Diseases, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Jann N Hennessy
- Territory Pathology, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Bart J Currie
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,Department of Infectious Diseases, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Rob W Baird
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,Territory Pathology, Royal Darwin Hospital, Darwin, Northern Territory, Australia.,Department of Infectious Diseases, Royal Darwin Hospital, Darwin, Northern Territory, Australia
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Douglas NM, Baird RW, Currie BJ. Use of a rapid faeces multiplex PCR assay for diagnosis of amoebic liver abscess. Pathology 2020; 52:725-727. [PMID: 32814622 PMCID: PMC7428710 DOI: 10.1016/j.pathol.2020.06.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 06/01/2020] [Accepted: 06/09/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Nicholas M Douglas
- Division of Infectious Diseases, Royal Darwin Hospital, Darwin, NT, Australia; Department of Microbiology, Territory Pathology, Royal Darwin Hospital, Darwin, NT, Australia.
| | - Robert W Baird
- Division of Infectious Diseases, Royal Darwin Hospital, Darwin, NT, Australia; Department of Microbiology, Territory Pathology, Royal Darwin Hospital, Darwin, NT, Australia
| | - Bart J Currie
- Division of Infectious Diseases, Royal Darwin Hospital, Darwin, NT, Australia; Global and Tropical Health Division, Menzies School of Health Research, Darwin, NT, Australia
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Dini S, Douglas NM, Poespoprodjo JR, Kenangalem E, Sugiarto P, Plumb ID, Price RN, Simpson JA. The risk of morbidity and mortality following recurrent malaria in Papua, Indonesia: a retrospective cohort study. BMC Med 2020; 18:28. [PMID: 32075649 PMCID: PMC7031957 DOI: 10.1186/s12916-020-1497-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 01/15/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND An acute episode of malaria can be followed by multiple recurrent episodes either due to re-infection, recrudescence of a partially treated parasite or, in the case of Plasmodium vivax or P. ovale, relapse from the dormant liver stage of the parasite. The aim of this study was to quantify the impact of recurrent malaria episodes on morbidity and mortality in Papua, Indonesia. METHODS We undertook a retrospective analysis of routinely collected data from malaria patients attending the primary referral hospital in Papua, Indonesia, between April 2004 and December 2013. Multi-state modelling was used to estimate the effect of recurring malaria episodes on re-presentation and admission to hospital and death. The risks of early (≤ 14 days) and late (15 to 365 days) hospital admission and death were estimated separately in our study to distinguish between the direct and indirect effects of malaria recurrence on adverse outcomes. RESULTS A total of 68,361 patients were included in the analysis, of whom 37,168 (54.4%) presented initially with P. falciparum, 22,209 (32.5%) with P. vivax, and 8984 (13.1%) with other species. During 12 months of follow-up after each of the first four malaria episodes, 10,868 (15.9%) patients were admitted to hospital and 897 (1.3%) died. The risk of re-presenting to the hospital with malaria increased from 34.7% (95% CI 34.4%, 35.1%) at first episode to 58.6% (57.5%, 59.6%) following the third episode of malaria. After adjusting for co-factors, infection with P. vivax was a significant risk factor for re-presentation (hazard ratio (HR) = 1.48 (95% CI 1.44, 1.51)) and late admission to hospital (HR = 1.17 (1.11, 1.22)). Patients infected with P. falciparum had a greater overall rate of mortality within 14 days (HR = 1.54 (1.25, 1.92)), but after multiple episodes of malaria, there was a trend towards a higher rate of early death in patients infected with P. vivax compared to P. falciparum (HR = 1.91 (0.73, 4.97)). CONCLUSIONS Compared to patients initially infected with P. falciparum, those infected with P. vivax had significantly more re-presentations to hospital with malaria, and this contributed to a high risk of inpatient admission and death. These findings highlight the importance of radical cure of P. vivax to eliminate the dormant liver stages that trigger relapses.
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Affiliation(s)
- Saber Dini
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Nicholas M Douglas
- Global Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Northern Territory, Australia.,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Jeanne Rini Poespoprodjo
- Timika Malaria Research Program, Papuan Health and Community Development Foundation, Timika, Papua, Indonesia.,Department of Child Health, Faculty of Medicine, University Gadjah Mada, Yogyakarta, Indonesia
| | - Enny Kenangalem
- Timika Malaria Research Program, Papuan Health and Community Development Foundation, Timika, Papua, Indonesia.,Mimika District Health Authority, Timika, Papua, Indonesia
| | | | - Ian D Plumb
- Global Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Northern Territory, Australia
| | - Ric N Price
- Global Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Northern Territory, Australia.,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK.,Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Julie A Simpson
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia.
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Douglas NM, Kenangalem E, Hasanuddin A, Anstey NM, Sugiarto P, Price RN, Poespoprodjo JR. Malaria-related hospitalization during childhood in Papua, Indonesia: A retrospective cohort study. PLoS One 2020; 15:e0228018. [PMID: 31995581 PMCID: PMC6988973 DOI: 10.1371/journal.pone.0228018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 01/05/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND In endemic regions, the age distribution of malaria varies according to the infecting Plasmodium species. We aimed to delineate the pattern of malaria-related hospitalization from birth in Timika, Papua-an area co-endemic for P. falciparum and P. vivax. METHODS Between April 2004 and December 2013, infants born at Mitra Masyarakat Hospital, or presenting within the first 7 days of life, were enrolled retrospectively into a cohort study and followed passively using routinely-collected hospital surveillance data. Outcomes were stratified by the presence or absence of Plasmodium parasitemia and included re-presentation to hospital, requirement for hospital admission and death. RESULTS Overall, 11,408 infants were enrolled into the cohort. Median follow-up was 4.3 (maximum 9.7) years. In total, 7,847 (68.9%) infants made 90,766 re-presentations to hospital, 18,105 (19.9%) of which were associated with Plasmodium parasitemia. The incidence of re-presentations with malaria during the first year of life was 213 per 1,000 person-years (py) for P. vivax and 79 per 1,000py for P. falciparum (Incidence Rate Ratio (IRR) = 2.69, 95% Confidence Interval (95%CI): 2.48-2.92). After the age of 5 years, the incidence of P. vivax had fallen to 77/1,000py and the incidence of P. falciparum had risen to 95/1,000py (IRR = 0.80, 95%CI: 0.73-0.88). Overall, 79.7% (14,431/18,105) of malaria re-presentations were recurrences rather than initial infections. Malaria accounted for 31.7% (2,126/3,120) of all hospital admissions. The infant mortality rate in this study was 52 deaths per 1,000 live births. Beyond the early neonatal period, 13.4% of deaths were associated with Plasmodium parasitemia. CONCLUSIONS In Papua, Indonesia, malaria is a major cause of hospital presentation and admission in early life. The initial predominance of P. vivax over P. falciparum inverts after five years of age. Malaria is directly associated with nearly one in seven deaths after the early neonatal period.
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Affiliation(s)
- Nicholas M. Douglas
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
- Division of Infectious Diseases, Royal Darwin Hospital, Darwin, Australia
- * E-mail:
| | - Enny Kenangalem
- Timika Malaria Research Program, Papuan Health and Community Development Foundation, Timika, Papua, Indonesia
- Mimika District Health Authority, Timika, Papua, Indonesia
| | - Afdhal Hasanuddin
- Department of Paediatrics, Rumah Sakit Mitra Masyarakat, Timika, Papua, Indonesia
| | - Nicholas M. Anstey
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
- Division of Infectious Diseases, Royal Darwin Hospital, Darwin, Australia
| | - Paulus Sugiarto
- Department of Paediatrics, Rumah Sakit Mitra Masyarakat, Timika, Papua, Indonesia
| | - Ric N. Price
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Jeanne Rini Poespoprodjo
- Timika Malaria Research Program, Papuan Health and Community Development Foundation, Timika, Papua, Indonesia
- Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
- Department of Paediatrics, Rumah Sakit Umum Daerah, Kabupaten Mimika, Timika, Papua, Indonesia
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Ley B, Winasti Satyagraha A, Rahmat H, von Fricken ME, Douglas NM, Pfeffer DA, Espino F, von Seidlein L, Henriques G, Oo NN, Menard D, Parikh S, Bancone G, Karahalios A, Price RN. Performance of the Access Bio/CareStart rapid diagnostic test for the detection of glucose-6-phosphate dehydrogenase deficiency: A systematic review and meta-analysis. PLoS Med 2019; 16:e1002992. [PMID: 31834890 PMCID: PMC6910667 DOI: 10.1371/journal.pmed.1002992] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 11/08/2019] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND To reduce the risk of drug-induced haemolysis, all patients should be tested for glucose-6-phosphate dehydrogenase (G6PD) deficiency (G6PDd) prior to prescribing primaquine (PQ)-based radical cure for the treatment of vivax malaria. This systematic review and individual patient meta-analysis assessed the utility of a qualitative lateral flow assay from Access Bio/CareStart (Somerset, NJ) (CareStart Screening test for G6PD deficiency) for the diagnosis of G6PDd compared to the gold standard spectrophotometry (International Prospective Register of Systematic Reviews [PROSPERO]: CRD42019110994). METHODS AND FINDINGS Articles published on PubMed between 1 January 2011 and 27 September 2019 were screened. Articles reporting performance of the standard CSG from venous or capillary blood samples collected prospectively and considering spectrophotometry as gold standard (using kits from Trinity Biotech PLC, Wicklow, Ireland) were included. Authors of articles fulfilling the inclusion criteria were contacted to contribute anonymized individual data. Minimal data requested were sex of the participant, CSG result, spectrophotometry result in U/gHb, and haemoglobin (Hb) reading. The adjusted male median (AMM) was calculated per site and defined as 100% G6PD activity. G6PDd was defined as an enzyme activity of less than 30%. Pooled estimates for sensitivity and specificity, unconditional negative predictive value (NPV), positive likelihood ratio (LR+), and negative likelihood ratio (LR-) were calculated comparing CSG results to spectrophotometry using a random-effects bivariate model. Of 11 eligible published articles, individual data were available from 8 studies, 6 from Southeast Asia, 1 from Africa, and 1 from the Americas. A total of 5,815 individual participant data (IPD) were available, of which 5,777 results (99.3%) were considered for analysis, including data from 3,095 (53.6%) females. Overall, the CSG had a pooled sensitivity of 0.96 (95% CI 0.90-0.99) and a specificity of 0.95 (95% CI 0.92-0.96). When the prevalence of G6PDd was varied from 5% to 30%, the unconditional NPV was 0.99 (95% CI 0.94-1.00), with an LR+ and an LR- of 18.23 (95% CI 13.04-25.48) and 0.05 (95% CI 0.02-0.12), respectively. Performance was significantly better in males compared to females (p = 0.027) but did not differ significantly between samples collected from capillary or venous blood (p = 0.547). Limitations of the study include the lack of wide geographical representation of the included data and that the CSG results were generated under research conditions, and therefore may not reflect performance in routine settings. CONCLUSIONS The CSG performed well at the 30% threshold. Its high NPV suggests that the test is suitable to guide PQ treatment, and the high LR+ and low LR- render the test suitable to confirm and exclude G6PDd. Further operational studies are needed to confirm the utility of the test in remote endemic settings.
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Affiliation(s)
- Benedikt Ley
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia
- * E-mail:
| | | | - Hisni Rahmat
- Eijkman Institute for Molecular Biology, Jakarta, Indonesia
| | - Michael E. von Fricken
- Department of Global and Community Health, George Mason University, Fairfax, Virginia, United States of America
| | - Nicholas M. Douglas
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia
| | - Daniel A. Pfeffer
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia
| | - Fe Espino
- Research Institute for Tropical Medicine, Department of Health, Muntinlupa City, Philippines
| | - Lorenz von Seidlein
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
| | - Gisela Henriques
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Nwe Nwe Oo
- Department of Medical Research (Lower Myanmar), Yangon, Republic of the Union of Myanmar
| | - Didier Menard
- Malaria Genetics and Resistance Unit, Institut Pasteur, Paris, France
| | - Sunil Parikh
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Germana Bancone
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Amalia Karahalios
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Ric N. Price
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
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20
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Patriani D, Arguni E, Kenangalem E, Dini S, Sugiarto P, Hasanuddin A, Lampah DA, Douglas NM, Anstey NM, Simpson JA, Price RN, Poespoprodjo JR. Early and late mortality after malaria in young children in Papua, Indonesia. BMC Infect Dis 2019; 19:922. [PMID: 31666012 PMCID: PMC6820991 DOI: 10.1186/s12879-019-4497-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 04/28/2018] [Accepted: 09/23/2019] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND In southern Papua, Indonesia, malaria is highly prevalent in young children and is a significant cause of morbidity and early mortality. The association between malaria and delayed mortality is unknown. METHODS Routinely-collected hospital surveillance data from southern Papua, Indonesia, were used to assess the risk of recurrent malaria and mortality within 12 months of an initial presentation with malaria in all children younger than 5 years old attending the local hospital. Analysis was primarily by Kaplan Meier and Cox regression methods. RESULTS In total 15,716 children presenting with malaria between April 2004 and December 2013 were included in the analysis; 6184 (39.3%) with Plasmodium falciparum, 7499 (47.7%) with P. vivax, 203 (1.3%) with P. malariae, 3 with P. ovale and 1827 (11.6%) with mixed infections. Within 1 year, 48.4% (7620/15,716) of children represented a total of 16,957 times with malaria (range 1 to 11 episodes), with the incidence of malaria being greater in patients initially presenting with P. vivax infection (1334 [95%CI 1307-1361] per 1000 patient years) compared to those with P. falciparum infection (920 [896-944]). In total 266 (1.7%) children died within 1 year of their initial presentation, 129 (48.5%) within 30 days and 137 (51.5%) between 31 and 365 days. There was no significant difference in the mortality risk in patients infected with P. vivax versus P. falciparum either before 30 days (Hazard Ratio (HR) 1.02 [0.69,1.49]) or between 31 and 365 days (HR = 1.30 [0.90,1.88]). Children who died had a greater incidence of malaria, 2280 [95%CI 1946-2671] per 1000 patient years preceding their death, compared to 1141 [95%CI 1124-1158] per 1000 patient years in those surviving. CONCLUSIONS Children under-5 years old with P. vivax malaria, are at significant risk of multiple representations with malaria and of dying within 1 year of their initial presentation. Preventing recurrent malaria must be a public health priority in this vulnerable population.
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Affiliation(s)
- Dewi Patriani
- grid.8570.aDepartment of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Jl. Kesehatan no.1, Sekip, Yogyakarta, 55284 Indonesia
| | - Eggi Arguni
- grid.8570.aDepartment of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Jl. Kesehatan no.1, Sekip, Yogyakarta, 55284 Indonesia
| | - Enny Kenangalem
- Timika Malaria Research Programme, Papuan Health and Community Development Foundation, Jl. SP2-SP5, RSMM Area, Timika, Papua 99910 Indonesia ,Mimika District Hospital, Jl. Yos Sudarso, Timika, Papua 99910 Indonesia
| | - Saber Dini
- 0000 0001 2179 088Xgrid.1008.9Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, 207 Bouverie Street, The University of Melbourne, Melbourne, Victoria 3010 Australia
| | - Paulus Sugiarto
- Mitra Masyarakat Hospital, Jl. SP2-SP5-Charitas, Timika, 99910 Indonesia
| | - Afdhal Hasanuddin
- Mitra Masyarakat Hospital, Jl. SP2-SP5-Charitas, Timika, 99910 Indonesia
| | - Daniel Adrian Lampah
- Timika Malaria Research Programme, Papuan Health and Community Development Foundation, Jl. SP2-SP5, RSMM Area, Timika, Papua 99910 Indonesia
| | - Nicholas M. Douglas
- 0000 0000 8523 7955grid.271089.5Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, PO Box 41096, Casuarina, Darwin, NT 0811 Australia
| | - Nicholas M. Anstey
- 0000 0000 8523 7955grid.271089.5Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, PO Box 41096, Casuarina, Darwin, NT 0811 Australia ,grid.240634.7Division of Medicine, Royal Darwin Hospital, Darwin, NT 0810 Australia
| | - Julie Anne Simpson
- Mitra Masyarakat Hospital, Jl. SP2-SP5-Charitas, Timika, 99910 Indonesia
| | - Ric N. Price
- 0000 0000 8523 7955grid.271089.5Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, PO Box 41096, Casuarina, Darwin, NT 0811 Australia ,0000 0004 1936 8948grid.4991.5Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, OX37LJ, Oxford, United Kingdom ,0000 0004 1937 0490grid.10223.32Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Jeanne Rini Poespoprodjo
- grid.8570.aDepartment of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Jl. Kesehatan no.1, Sekip, Yogyakarta, 55284 Indonesia ,Timika Malaria Research Programme, Papuan Health and Community Development Foundation, Jl. SP2-SP5, RSMM Area, Timika, Papua 99910 Indonesia ,Mimika District Hospital, Jl. Yos Sudarso, Timika, Papua 99910 Indonesia
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Commons RJ, Simpson JA, Thriemer K, Chu CS, Douglas NM, Abreha T, Alemu SG, Añez A, Anstey NM, Aseffa A, Assefa A, Awab GR, Baird JK, Barber BE, Borghini-Fuhrer I, D'Alessandro U, Dahal P, Daher A, de Vries PJ, Erhart A, Gomes MSM, Grigg MJ, Hwang J, Kager PA, Ketema T, Khan WA, Lacerda MVG, Leslie T, Ley B, Lidia K, Monteiro WM, Pereira DB, Phan GT, Phyo AP, Rowland M, Saravu K, Sibley CH, Siqueira AM, Stepniewska K, Taylor WRJ, Thwaites G, Tran BQ, Hien TT, Vieira JLF, Wangchuk S, Watson J, William T, Woodrow CJ, Nosten F, Guerin PJ, White NJ, Price RN. The haematological consequences of Plasmodium vivax malaria after chloroquine treatment with and without primaquine: a WorldWide Antimalarial Resistance Network systematic review and individual patient data meta-analysis. BMC Med 2019; 17:151. [PMID: 31366382 PMCID: PMC6670141 DOI: 10.1186/s12916-019-1386-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Accepted: 07/09/2019] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Malaria causes a reduction in haemoglobin that is compounded by primaquine, particularly in patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency. The aim of this study was to determine the relative contributions to red cell loss of malaria and primaquine in patients with uncomplicated Plasmodium vivax. METHODS A systematic review identified P. vivax efficacy studies of chloroquine with or without primaquine published between January 2000 and March 2017. Individual patient data were pooled using standardised methodology, and the haematological response versus time was quantified using a multivariable linear mixed effects model with non-linear terms for time. Mean differences in haemoglobin between treatment groups at day of nadir and day 42 were estimated from this model. RESULTS In total, 3421 patients from 29 studies were included: 1692 (49.5%) with normal G6PD status, 1701 (49.7%) with unknown status and 28 (0.8%) deficient or borderline individuals. Of 1975 patients treated with chloroquine alone, the mean haemoglobin fell from 12.22 g/dL [95% CI 11.93, 12.50] on day 0 to a nadir of 11.64 g/dL [11.36, 11.93] on day 2, before rising to 12.88 g/dL [12.60, 13.17] on day 42. In comparison to chloroquine alone, the mean haemoglobin in 1446 patients treated with chloroquine plus primaquine was - 0.13 g/dL [- 0.27, 0.01] lower at day of nadir (p = 0.072), but 0.49 g/dL [0.28, 0.69] higher by day 42 (p < 0.001). On day 42, patients with recurrent parasitaemia had a mean haemoglobin concentration - 0.72 g/dL [- 0.90, - 0.54] lower than patients without recurrence (p < 0.001). Seven days after starting primaquine, G6PD normal patients had a 0.3% (1/389) risk of clinically significant haemolysis (fall in haemoglobin > 25% to < 7 g/dL) and a 1% (4/389) risk of a fall in haemoglobin > 5 g/dL. CONCLUSIONS Primaquine has the potential to reduce malaria-related anaemia at day 42 and beyond by preventing recurrent parasitaemia. Its widespread implementation will require accurate diagnosis of G6PD deficiency to reduce the risk of drug-induced haemolysis in vulnerable individuals. TRIAL REGISTRATION This trial was registered with PROSPERO: CRD42016053312. The date of the first registration was 23 December 2016.
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Affiliation(s)
- Robert J Commons
- Global Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Northern Territory, Australia. .,WorldWide Antimalarial Resistance Network (WWARN), Clinical Module, Darwin, Northern Territory, Australia.
| | - Julie A Simpson
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Kamala Thriemer
- Global Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Northern Territory, Australia
| | - Cindy S Chu
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical 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
| | - Nicholas M Douglas
- Global Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Northern Territory, Australia.,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Tesfay Abreha
- ICAP, Columbia University Mailman School of Public Health, Addis Ababa, Ethiopia
| | - Sisay G Alemu
- Addis Ababa University, Addis Ababa, Ethiopia.,Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Arletta Añez
- Departamento de Salud Pública, Universidad de Barcelona, Barcelona, Spain.,Organización Panamericana de Salud, Oficina de País Bolivia, La Paz, Bolivia
| | - Nicholas M Anstey
- Global Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Northern Territory, Australia
| | - Abraham Aseffa
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Ashenafi Assefa
- Malaria and Neglected Tropical Diseases Research Team, Bacterial, Parasitic, Zoonotic Diseases Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Ghulam R Awab
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Nangarhar Medical Faculty, Nangarhar University, Jalalabad, Afghanistan
| | - J Kevin Baird
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK.,Eijkman-Oxford Clinical Research Unit, Jakarta, Indonesia
| | - Bridget E Barber
- Global Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Northern Territory, Australia.,Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit, Kota Kinabalu, Sabah, Malaysia
| | | | | | - Prabin Dahal
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK.,WorldWide Antimalarial Resistance Network (WWARN), Oxford, UK
| | - André Daher
- Institute of Drug Technology (Farmanguinhos), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil.,Vice-presidency of Research and Reference Laboratories, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil.,Liverpool School of Tropical Medicine, Liverpool, UK
| | - Peter J de Vries
- Department of Internal Medicine, Tergooi Hospital, Hilversum, the Netherlands
| | - Annette Erhart
- Medical Research Council Unit The Gambia at LSTMH, Fajara, The Gambia
| | - Margarete S M Gomes
- Superintendência de Vigilância em Saúde do Estado do Amapá - SVS/AP, Macapá, Amapá, Brazil.,Universidade Federal do Amapá - UNIFAP, Macapá, Amapá, Brazil
| | - Matthew J Grigg
- Global Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Northern Territory, Australia.,Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit, Kota Kinabalu, Sabah, Malaysia
| | - Jimee Hwang
- U.S. President's Malaria Initiative, Malaria Branch, U.S. Centers for Disease Control and Prevention, Atlanta, USA.,Global Health Group, University of California San Francisco, San Francisco, USA
| | - Piet A Kager
- Centre for Infection and Immunity Amsterdam (CINEMA), Division of Infectious Diseases, Tropical Medicine and AIDS, Academic Medical Centre, Amsterdam, the Netherlands
| | - Tsige Ketema
- Department of Biology, Addis Ababa University, Addis Ababa, Ethiopia.,Department of Biology, Jimma University, Jimma, Ethiopia
| | - Wasif A Khan
- International Centre for Diarrheal Diseases and Research, Dhaka, Bangladesh
| | - Marcus V G Lacerda
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil.,Fundação Oswaldo Cruz, Instituto Leônidas e Maria Deane (FIOCRUZ-Amazonas), Manaus, Brazil
| | - Toby Leslie
- Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.,HealthNet-TPO, Kabul, Afghanistan
| | - Benedikt Ley
- Global Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Northern Territory, Australia
| | - Kartini Lidia
- The Department of Pharmacology and Therapy, Faculty of Medicine, Nusa Cendana University, Kupang, Indonesia
| | - Wuelton M Monteiro
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil.,Universidade do Estado do Amazonas, Manaus, Brazil
| | - Dhelio B Pereira
- Centro de Pesquisa em Medicina Tropical de Rondônia (CEPEM), Porto Velho, Rondônia, Brazil.,Universidade Federal de Rondônia (UNIR), Porto Velho, Rondônia, Brazil
| | - Giao T Phan
- Division of Infectious Diseases, Tropical Medicine and AIDS, Academic Medical Center, Amsterdam, the Netherlands.,Tropical Diseases Clinical Research Center, Cho Ray Hospital, Ho Chi Minh City, Vietnam
| | - Aung P Phyo
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Mark Rowland
- Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Kavitha Saravu
- Department of Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Madhav Nagar, Manipal, Karnataka, India.,Manipal McGill Center for Infectious Diseases, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Carol H Sibley
- WorldWide Antimalarial Resistance Network (WWARN), Oxford, UK.,Department of Genome Sciences, University of Washington, Seattle, USA
| | - André M Siqueira
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil.,Programa de Pós-graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil.,Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Kasia Stepniewska
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK.,WorldWide Antimalarial Resistance Network (WWARN), Oxford, UK
| | - Walter R J Taylor
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK.,Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Guy Thwaites
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK.,Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Binh Q Tran
- Tropical Diseases Clinical Research Center, Cho Ray Hospital, Ho Chi Minh City, Vietnam
| | - Tran T Hien
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK.,Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - José Luiz F Vieira
- Federal University of Pará (Universidade Federal do Pará - UFPA), Belém, Pará, Brazil
| | - Sonam Wangchuk
- Public Health Laboratory, Department of Public Health, Ministry of Health, Thimphu, Bhutan
| | - James Watson
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK.,Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Timothy William
- Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit, Kota Kinabalu, Sabah, Malaysia.,Gleneagles Hospital, Kota Kinabalu, Sabah, Malaysia
| | - Charles J Woodrow
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Francois Nosten
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical 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
| | - Philippe J Guerin
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK.,WorldWide Antimalarial Resistance Network (WWARN), Oxford, UK
| | - Nicholas J White
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK.,Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Ric N Price
- Global Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Northern Territory, Australia. .,WorldWide Antimalarial Resistance Network (WWARN), Clinical Module, Darwin, Northern Territory, Australia. .,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK. .,Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
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22
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Setyadi A, Arguni E, Kenangalem E, Hasanuddin A, Lampah DA, Thriemer K, Anstey NM, Sugiarto P, Simpson JA, Price RN, Douglas NM, Poespoprodjo JR. Safety of primaquine in infants with Plasmodium vivax malaria in Papua, Indonesia. Malar J 2019; 18:111. [PMID: 30940140 PMCID: PMC6444676 DOI: 10.1186/s12936-019-2745-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 03/23/2019] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Primaquine (PQ) prevents relapses of vivax malaria but may induce severe haemolysis in glucose-6-phosphate dehydrogenase (G6PD) deficient patients. Data on the safety of primaquine in infants are limited. METHODS A retrospective, hospital-based cohort study of infants aged 1-12 months with vivax malaria was carried out in Timika, Papua province, Indonesia. Risks of admission, death and severe haematological outcomes within 30 days of first presentation were compared between infants who did and did not receive primaquine. Infants were not tested routinely for G6PD deficiency as per local guidelines. RESULTS Between 2004 and 2013, 4078 infants presented to the hospital for the first time with vivax malaria, of whom 3681 (90.3%) had data available for analysis. In total 1228 (33.4%) infants were aged between 1 and 6 months and 2453 (66.6%) between 6 and 12 months of age. Thirty-three (0.9%) patients received low-dose primaquine (LDP), 174 (4.7%) received high-dose primaquine (HDP), 3432 (93.2%) received no primaquine (NPQ) and 42 patients received either a single dose or an unknown dose of primaquine. The risk of the Hb concentration falling by > 25% to less than 5 g/dL was similar in the LDP or HDP groups (4.3%, 1/23) versus the NPQ group (3.5%, 16/461). Three infants (1.4%) died following receipt of PQ, all of whom had major comorbidities. Seventeen patients (0.5%) died in the NPQ group. None of the infants had documented massive haemolysis or renal impairment. CONCLUSIONS Severe clinical outcomes amongst infants treated with primaquine in Papua were rare. The risks of using primaquine in infancy must be weighed against the risks of recurrent vivax malaria in early life.
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Affiliation(s)
- Agus Setyadi
- grid.8570.aDepartment of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Eggi Arguni
- grid.8570.aDepartment of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Enny Kenangalem
- Timika Malaria Research Programme, Papuan Health and Community Development Foundation, Timika, Papua Indonesia ,Mimika District Hospital, Timika, Papua Indonesia
| | | | - Daniel A. Lampah
- Timika Malaria Research Programme, Papuan Health and Community Development Foundation, Timika, Papua Indonesia
| | - Kamala Thriemer
- 0000 0000 8523 7955grid.271089.5Global Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, NT Australia
| | - Nicholas M. Anstey
- 0000 0000 8523 7955grid.271089.5Global Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, NT Australia ,grid.240634.7Division of Medicine, Royal Darwin Hospital, Darwin, NT Australia
| | | | - Julie A. Simpson
- 0000 0001 2179 088Xgrid.1008.9Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Ric N. Price
- 0000 0000 8523 7955grid.271089.5Global Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, NT Australia ,0000 0004 1936 8948grid.4991.5Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK ,0000 0004 1937 0490grid.10223.32Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Nicholas M. Douglas
- 0000 0000 8523 7955grid.271089.5Global Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, NT Australia ,grid.240634.7Division of Medicine, Royal Darwin Hospital, Darwin, NT Australia
| | - Jeanne R. Poespoprodjo
- grid.8570.aDepartment of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia ,Timika Malaria Research Programme, Papuan Health and Community Development Foundation, Timika, Papua Indonesia ,Mimika District Hospital, Timika, Papua Indonesia
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23
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Kho S, Andries B, Poespoprodjo JR, Commons RJ, Shanti PAI, Kenangalem E, Douglas NM, Simpson JA, Sugiarto P, Anstey NM, Price RN. High Risk of Plasmodium vivax Malaria Following Splenectomy in Papua, Indonesia. Clin Infect Dis 2019; 68:51-60. [PMID: 29771281 PMCID: PMC6128403 DOI: 10.1093/cid/ciy403] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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] [Received: 02/15/2018] [Accepted: 05/07/2018] [Indexed: 01/12/2023] Open
Abstract
Background Splenectomy increases the risk of severe and fatal infections; however, the risk of Plasmodium vivax malaria is unknown. We quantified the Plasmodium species-specific risks of malaria and other outcomes following splenectomy in patients attending a hospital in Papua, Indonesia. Methods Records of all patients attending Mitra-Masyarakat Hospital 2004-2013 were reviewed, identifying those who underwent splenectomy. Subsequent risks of specific clinical outcomes within 12 months for splenectomized patients were compared to nonsplenectomized patients from their first recorded hospital admission. In addition, patients splenectomized for trauma 2015-2016 were followed prospectively for 14 months. Results Of the 10774 patients hospitalized during 2004-2013, 67 underwent splenectomy. Compared to nonsplenectomized inpatients, patients undergoing splenectomy had a 5-fold higher rate of malaria presentation within 12 months (adjusted hazard ratio [AHR] = 5.0 [95% confidence interval (CI): 3.4-7.3], P < .001). The AHR was 7.8 (95% CI: 5.0-12.3) for P. vivax and 3.0 (95% CI: 1.7-5.4) for P. falciparum (both P < .001). Splenectomized patients had greater risk of being hospitalized for any cause (AHR = 1.8 [95% CI: 1.0-3.0], P = .037) and diarrheal (AHR = 3.5 [95% CI: 1.3-9.6], P = .016). In the 14-month prospective cohort, 12 episodes of P. vivax and 6 episodes of P. falciparum were observed in 11 splenectomised patients. Conclusions Splenectomy is associated with a high risk of malaria, greater for P. vivax than P. falciparum. Eradication of P. vivax hypnozoites using primaquine (radical cure) and subsequent malaria prophylaxis is warranted following splenectomy in malaria-endemic areas.
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Affiliation(s)
- Steven Kho
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Northern Territory, Australia
| | - Benediktus Andries
- Timika Malaria Research Program, Papuan Health and Community Development Foundation, Timika, Papua
| | - Jeanne R Poespoprodjo
- Timika Malaria Research Program, Papuan Health and Community Development Foundation, Timika, Papua,Rumah Sakit Umum Daerah Kabupaten Mimika, Timika, Papua,Pediatric Research Office, Department of Pediatrics, University of Gadjah Mada, Yogyakarta, Indonesia
| | - Robert J Commons
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Northern Territory, Australia
| | | | - Enny Kenangalem
- Timika Malaria Research Program, Papuan Health and Community Development Foundation, Timika, Papua,Rumah Sakit Umum Daerah Kabupaten Mimika, Timika, Papua
| | - Nicholas M Douglas
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Northern Territory, Australia
| | - Julie A Simpson
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Victoria, Australia
| | | | - Nicholas M Anstey
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Northern Territory, Australia
| | - Ric N Price
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Northern Territory, Australia,Center for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, United Kingdom,Correspondence: R. N. Price, Global and Tropical Health Division, Menzies School of Health Research, PO Box 41096, Casuarina, Darwin 0811, Northern Territory, Australia ()
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24
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Commons RJ, Simpson JA, Thriemer K, Hossain MS, Douglas NM, Humphreys GS, Sibley CH, Guerin PJ, Price RN. Risk of Plasmodium vivax parasitaemia after Plasmodium falciparum infection: a systematic review and meta-analysis. Lancet Infect Dis 2019; 19:91-101. [PMID: 30587297 PMCID: PMC6300482 DOI: 10.1016/s1473-3099(18)30596-6] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 09/11/2018] [Accepted: 09/13/2018] [Indexed: 01/12/2023]
Abstract
BACKGROUND A 14-day course of primaquine is used for radical cure of Plasmodium vivax and Plasmodium ovale malaria only. We quantified the risk of P vivax parasitaemia after treatment of Plasmodium falciparum with commonly used antimalarial drugs to assess the potential benefits of radical cure for all patients with uncomplicated malaria in co-endemic regions. METHODS In this systematic review and meta-analysis, we searched MEDLINE, Embase, Web of Science, and the Cochrane Database of Systematic Reviews for prospective clinical studies in any language, published between Jan 1, 1960, and Jan 5, 2018, assessing drug efficacy in patients with uncomplicated P falciparum malaria in countries co-endemic for P vivax. Studies were included if the presence or absence of P vivax parasitaemia was recorded after treatment. The primary outcome was the risk of P vivax parasitaemia between day 7 and day 42 after initiation of antimalarial treatment for P falciparum, with the pooled risk calculated by random-effects meta-analysis. We compared the risk of P vivax parasitaemia after treatment with different artemisinin-based combination therapies (ACTs). This study is registered with PROSPERO, number CRD42017064838. FINDINGS 153 of 891 screened studies were included in the analysis, including 31 262 patients from 323 site-specific treatment groups: 130 (85%) studies were from the Asia-Pacific region, 16 (10%) from the Americas, and seven (5%) from Africa. The risk of P vivax parasitaemia by day 42 was 5·6% (95% CI 4·0-7·4; I2=92·0%; 117 estimates). The risk of P vivax parasitaemia was 6·5% (95% CI 4·6-8·6) in regions of short relapse periodicity compared with 1·9% (0·4-4·0) in regions of long periodicity, and was greater after treatment with a more rapidly eliminated ACT: 15·3% (5·1-29·3) for artemether-lumefantrine compared with 4·5% (1·2-9·3) for dihydroartemisinin-piperaquine and 5·2% (2·9-7·9) for artesunate-mefloquine. Recurrent parasitaemia was delayed in patients treated with ACTs containing mefloquine or piperaquine compared with artemether-lumefantrine, but by day 63 the risk of vivax parasitaemia was more than 15% for all ACTs assessed. INTERPRETATION Our findings show a high risk of vivax parasitaemia after treatment of falciparum malaria, particularly in areas with short relapse periodicity and after rapidly eliminated treatment. In co-endemic regions, universal radical cure for all patients with uncomplicated malaria has the potential to substantially reduce recurrent malaria. FUNDING Australian National Health and Medical Research Council, Royal Australasian College of Physicians, Wellcome Trust, and Bill & Melinda Gates Foundation.
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Affiliation(s)
- Robert J Commons
- Global Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, NT, Australia; WorldWide Antimalarial Resistance Network, Oxford, UK.
| | - Julie A Simpson
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Kamala Thriemer
- Global Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, NT, Australia
| | - Mohammad S Hossain
- Global Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, NT, Australia; WorldWide Antimalarial Resistance Network, Oxford, UK; Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia; International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Nicholas M Douglas
- Global Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, NT, Australia; Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Georgina S Humphreys
- WorldWide Antimalarial Resistance Network, Oxford, UK; Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Carol H Sibley
- WorldWide Antimalarial Resistance Network, Oxford, UK; Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK; Department of Genome Sciences, University of Washington, Seattle, WA, USA
| | - Philippe J Guerin
- WorldWide Antimalarial Resistance Network, Oxford, UK; Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Ric N Price
- Global Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, NT, Australia; WorldWide Antimalarial Resistance Network, Oxford, UK; Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
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25
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Alam MS, Kibria MG, Jahan N, Thriemer K, Hossain MS, Douglas NM, Phru CS, Khan WA, Price RN, Ley B. Field evaluation of quantitative point of care diagnostics to measure glucose-6-phosphate dehydrogenase activity. PLoS One 2018; 13:e0206331. [PMID: 30388146 PMCID: PMC6214512 DOI: 10.1371/journal.pone.0206331] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [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: 07/25/2018] [Accepted: 10/10/2018] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Glucose-6-Phosphate dehydrogenase (G6PD) deficiency is the most common enzymopathy worldwide, no reliable bedside diagnostic tests to quantify G6PD activity exist. This study evaluated two novel quantitative G6PD diagnostics. METHODS Participants with known G6PD activity were enrolled in Bangladesh. G6PD activity was measured by spectrophotometry, Biosensor (BS; AccessBio/CareStart, USA) and STANDARD G6PD (SG; SDBiosensor, ROK). G6PD activity was measured repeatedly in a subset of samples stored at room temperature and 4°C. RESULTS 158 participants were enrolled, 152 samples tested by BS, 108 samples by SG and 102 samples were tested by all three methods. In comparison to spectrophotometry BS had sensitivity and specificity of 72% (95%CI: 53-86) and 100% (95%CI: 97-100) at 30% cut off respectively, while SG had a sensitivity of 100% (95%CI: 88-100) and specificity of 97% (95%CI: 91-99) at the same cut off. The sensitivity and specificity at 70% cut off activity were 71% (95%CI: 59-82) and 98% (95%CI, 92-100) respectively for BS and 89% (95%CI: 77-96) and 93% (95%CI: 83-98) respectively for SG. When an optimal cut-off was applied the sensitivity of the BS at 70 cut off rose to 91% [95%CI: 80-96] and specificity to 82% [95%CI: 83-89]; a diagnostic accuracy comparable to that of the SG (p = 0.879). G6PD activity dropped significantly (-0.31U/gHb, 95%CI: -0.61 to -0.01, p = 0.022) within 24 hours in samples stored at room temperature, but did not fall below 90% of baseline activity until day 13 (-0.87U/gHb, 95%CI: (-1.11 to -0.62), p<0.001). CONCLUSION BS and SG are the first quantitative diagnostics to measure G6PD activity reliably at the bedside and represent suitable alternatives to spectrophotometry in resource poor settings. If samples are stored at 4°C, G6PD activity can be measured reliably for at least 7 days after sample collection.
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Affiliation(s)
- Mohammad Shafiul Alam
- Infectious Diseases Division, International Centre for Diarrheal Diseases Research, Bangladesh, Mohakhali, Dhaka, Bangladesh
| | - Mohammad Golam Kibria
- Infectious Diseases Division, International Centre for Diarrheal Diseases Research, Bangladesh, Mohakhali, Dhaka, Bangladesh
| | - Nusrat Jahan
- Infectious Diseases Division, International Centre for Diarrheal Diseases Research, Bangladesh, Mohakhali, Dhaka, Bangladesh
| | - Kamala Thriemer
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia
| | - Mohammad Sharif Hossain
- Infectious Diseases Division, International Centre for Diarrheal Diseases Research, Bangladesh, Mohakhali, Dhaka, Bangladesh
| | - Nicholas M. Douglas
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Ching Swe Phru
- Infectious Diseases Division, International Centre for Diarrheal Diseases Research, Bangladesh, Mohakhali, Dhaka, Bangladesh
| | - Wasif Ali Khan
- Infectious Diseases Division, International Centre for Diarrheal Diseases Research, Bangladesh, Mohakhali, Dhaka, Bangladesh
| | - 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 Clinical Medicine, University of Oxford, Oxford, United Kingdom
| | - Benedikt Ley
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia
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26
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Price RN, Douglas NM. Expanding the Use of Primaquine for the Radical Cure of Plasmodium vivax. Clin Infect Dis 2018; 67:1008-1009. [PMID: 29590343 PMCID: PMC6128399 DOI: 10.1093/cid/ciy236] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 03/23/2018] [Indexed: 01/12/2023] Open
Affiliation(s)
- Ric N. Price
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, United Kingdom,Global Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Nicholas M. Douglas
- Global Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
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27
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Douglas NM, Poespoprodjo JR, Patriani D, Malloy MJ, Kenangalem E, Sugiarto P, Simpson JA, Soenarto Y, Anstey NM, Price RN. Unsupervised primaquine for the treatment of Plasmodium vivax malaria relapses in southern Papua: A hospital-based cohort study. PLoS Med 2017; 14:e1002379. [PMID: 28850568 PMCID: PMC5574534 DOI: 10.1371/journal.pmed.1002379] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 07/27/2017] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Primaquine is the only licensed drug for eradicating Plasmodium vivax hypnozoites and, therefore, preventing relapses of vivax malaria. It is a vital component of global malaria elimination efforts. Primaquine is efficacious when supervised in clinical trials, but its effectiveness in real-world settings is unknown. We aimed to determine whether unsupervised primaquine was effective for preventing re-presentation to hospital with vivax malaria in southern Papua, Indonesia. METHODS AND FINDINGS Routinely-collected hospital surveillance data were used to undertake a pragmatic comparison of the risk of re-presentation to hospital with vivax malaria in patients prescribed dihydroartemisinin-piperaquine (DHP) combined with primaquine versus those patients prescribed DHP alone. The omission of primaquine was predominantly due to 3 stock outages. Individual clinical, pharmacy, and laboratory data were merged using individual hospital identification numbers and the date of presentation to hospital. Between April 2004 and December 2013, there were 86,797 documented episodes of vivax malaria, of which 62,492 (72.0%) were included in the analysis. The risk of re-presentation with vivax malaria within 1 year was 33.8% (95% confidence Interval [CI] 33.1%-34.5%) after initial monoinfection with P. vivax and 29.2% (95% CI 28.1%-30.4%) after mixed-species infection. The risk of re-presentation with P. vivax malaria was higher in children 1 to <5 years of age (49.6% [95% CI 48.4%-50.9%]) compared to patients 15 years of age or older (24.2% [95% CI 23.4-24.9%]); Adjusted Hazard Ratio (AHR) = 2.23 (95% CI 2.15-2.31), p < 0.001. Overall, the risk of re-presentation was 37.2% (95% CI 35.6%-38.8%) in patients who were prescribed no primaquine compared to 31.6% (95% CI 30.9%-32.3%) in those prescribed either a low (≥1.5 mg/kg and <5 mg/kg) or high (≥5 mg/kg) dose of primaquine (AHR = 0.90 [95% CI 0.86-0.95, p < 0.001]). Limiting the comparison to high dose versus no primaquine in the period during and 12 months before and after a large stock outage resulted in minimal change in the estimated clinical effectiveness of primaquine (AHR 0.91, 95% CI 0.85-0.97, p = 0.003). Our pragmatic study avoided the clinical influences associated with prospective study involvement but was subject to attrition bias caused by passive follow-up. CONCLUSIONS Unsupervised primaquine for vivax malaria, prescribed according to the current World Health Organization guidelines, was associated with a minimal reduction in the risk of clinical recurrence within 1 year in Papua, Indonesia. New strategies for the effective radical cure of vivax malaria are needed in resource-poor settings.
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Affiliation(s)
- Nicholas M. Douglas
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
- Division of Infectious Diseases, Christchurch Hospital, Christchurch, New Zealand
| | - Jeanne Rini Poespoprodjo
- Timika Malaria Research Program, Papuan Health and Community Development Foundation, Timika, Papua, Indonesia
- Department of Child Health, Faculty of Medicine, University Gadjah Mada, Yogyakarta, Indonesia
| | - Dewi Patriani
- Department of Child Health, Faculty of Medicine, University Gadjah Mada, Yogyakarta, Indonesia
| | - Michael J. Malloy
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
- Victorian Cytology Service Ltd., Melbourne, Victoria, Australia
| | - Enny Kenangalem
- Timika Malaria Research Program, Papuan Health and Community Development Foundation, Timika, Papua, Indonesia
- Mimika District Hospital, Timika, Papua, Indonesia
| | | | - Julie A. Simpson
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Yati Soenarto
- Department of Child Health, Faculty of Medicine, University Gadjah Mada, Yogyakarta, Indonesia
| | - Nicholas M. Anstey
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Ric N. Price
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
- * E-mail:
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Pava Z, Burdam FH, Handayuni I, Trianty L, Utami RAS, Tirta YK, Kenangalem E, Lampah D, Kusuma A, Wirjanata G, Kho S, Simpson JA, Auburn S, Douglas NM, Noviyanti R, Anstey NM, Poespoprodjo JR, Marfurt J, Price RN. Submicroscopic and Asymptomatic Plasmodium Parasitaemia Associated with Significant Risk of Anaemia in Papua, Indonesia. PLoS One 2016; 11:e0165340. [PMID: 27788243 PMCID: PMC5082812 DOI: 10.1371/journal.pone.0165340] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [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: 07/26/2016] [Accepted: 10/10/2016] [Indexed: 11/19/2022] Open
Abstract
Submicroscopic Plasmodium infections are an important parasite reservoir, but their clinical relevance is poorly defined. A cross-sectional household survey was conducted in southern Papua, Indonesia, using cluster random sampling. Data were recorded using a standardized questionnaire. Blood samples were collected for haemoglobin measurement. Plasmodium parasitaemia was determined by blood film microscopy and PCR. Between April and July 2013, 800 households and 2,830 individuals were surveyed. Peripheral parasitaemia was detected in 37.7% (968/2,567) of individuals, 36.8% (357) of whom were identified by blood film examination. Overall the prevalence of P. falciparum parasitaemia was 15.4% (396/2567) and that of P. vivax 18.3% (471/2567). In parasitaemic individuals, submicroscopic infection was significantly more likely in adults (adjusted odds ratio (AOR): 3.82 [95%CI: 2.49-5.86], p<0.001) compared to children, females (AOR = 1.41 [1.07-1.86], p = 0.013), individuals not sleeping under a bednet (AOR = 1.4 [1.0-1.8], p = 0.035), and being afebrile (AOR = 3.2 [1.49-6.93], p = 0.003). The risk of anaemia (according to WHO guidelines) was 32.8% and significantly increased in those with asymptomatic parasitaemia (AOR 2.9 [95% 2.1-4.0], p = 0.007), and submicroscopic P. falciparum infections (AOR 2.5 [95% 1.7-3.6], p = 0.002). Asymptomatic and submicroscopic infections in this area co-endemic for P. falciparum and P. vivax constitute two thirds of detectable parasitaemia and are associated with a high risk of anaemia. Novel public health strategies are needed to detect and eliminate these parasite reservoirs, for the benefit both of the patient and the community.
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Affiliation(s)
- Zuleima Pava
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Faustina H. Burdam
- Mimika District Health Authority, Timika, Papua, Indonesia
- Timika Malaria Research Programme, Papuan Health and Community Development Foundation, Timika, Papua, Indonesia
- Maternal and Child Health and Reproductive Health, Department of Public Health, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Irene Handayuni
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Leily Trianty
- Eijkman Institute for Molecular Biology, Jakarta, Indonesia
| | | | | | - Enny Kenangalem
- Mimika District Health Authority, Timika, Papua, Indonesia
- Timika Malaria Research Programme, Papuan Health and Community Development Foundation, Timika, Papua, Indonesia
| | - Daniel Lampah
- Timika Malaria Research Programme, Papuan Health and Community Development Foundation, Timika, Papua, Indonesia
| | - Andreas Kusuma
- Eijkman Institute for Molecular Biology, Jakarta, Indonesia
| | - Grennady Wirjanata
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Steven Kho
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Julie A. Simpson
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Sarah Auburn
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Nicholas M. Douglas
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
- Division of Medicine, Christchurch Hospital, Christchurch, New Zealand
| | | | - Nicholas M. Anstey
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Jeanne R. Poespoprodjo
- Mimika District Health Authority, Timika, Papua, Indonesia
- Timika Malaria Research Programme, Papuan Health and Community Development Foundation, Timika, Papua, Indonesia
- Maternal and Child Health and Reproductive Health, Department of Public Health, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Jutta Marfurt
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Ric N. Price
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
- * E-mail:
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Burdam FH, Hakimi M, Thio F, Kenangalem E, Indrawanti R, Noviyanti R, Trianty L, Marfurt J, Handayuni I, Soenarto Y, Douglas NM, Anstey NM, Price RN, Poespoprodjo JR. Asymptomatic Vivax and Falciparum Parasitaemia with Helminth Co-Infection: Major Risk Factors for Anaemia in Early Life. PLoS One 2016; 11:e0160917. [PMID: 27504828 PMCID: PMC4978495 DOI: 10.1371/journal.pone.0160917] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [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: 03/22/2016] [Accepted: 07/27/2016] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Anaemia in children under five years old is associated with poor health, growth and developmental outcomes. In Papua, Indonesia, where the burden of anaemia in infants is high, we conducted a community survey to assess the association between Plasmodium infection, helminth carriage and the risk of anaemia. METHODS A cross sectional household survey was carried out between April and July 2013 in 16 villages in the District of Mimika using a multistage sampling procedure. A total of 629 children aged 1-59 months from 800 households were included in the study. Demographic, symptom and anthropometry data were recorded using a standardized questionnaire. Blood and stool samples were collected for examination. RESULTS Of the 533 children with blood film examination, 8.8% (47) had P. vivax parasitaemia and 3.9% (21) had P. falciparum; the majority of children with malaria were asymptomatic (94.4%, 68/72). Soil transmitted helminth (STH) infection was present in 43% (105/269) of children assessed; those with STH were at significantly greater risk of P. vivax parasitaemia compared to those without STH (OR = 3.7 [95%CI 1.5-9.2], p = 0.004). Anaemia (Hb<10 g/dl) was present in 24.5% (122/497) of children and associated with P. vivax parasitaemia (OR = 2.9 [95%CI, 1.7-4.9], p = 0.001), P. falciparum parasitaemia (OR = 4.3 [95%CI, 2.0-9.4], p<0.001), hookworm carriage (OR = 2.6 [95%CI, 1.2-5.8], p = 0.026), Plasmodium-helminth coinfection (OR 4.0 [95%CI, 1.4-11.3], p = 0.008) and severe stunting (OR = 1.9 ([95%CI, 1.1-3.3], p = 0.012). CONCLUSIONS Asymptomatic P. vivax and P. falciparum infections and hookworm all contribute to risk of paediatric anaemia in coendemic areas and should be targeted with prevention and treatment programs. The relationship between helminth infections and the increased risk of P. vivax parasitaemia should be explored prospectively.
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Affiliation(s)
- Faustina Helena Burdam
- Mimika District Health Authority, Timika, Papua, Indonesia
- Timika Malaria Research Programme, Papuan Health and Community Development Foundation, Timika, Papua, Indonesia
- Maternal and Child Health and Reproductive Health, Department of Public Health, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Mohammad Hakimi
- Maternal and Child Health and Reproductive Health, Department of Public Health, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Franciscus Thio
- Mimika District Hospital, Timika, Papua, Indonesia
- Timika Malaria Research Programme, Papuan Health and Community Development Foundation, Timika, Papua, Indonesia
| | - Enny Kenangalem
- Mimika District Health Authority, Timika, Papua, Indonesia
- Mimika District Hospital, Timika, Papua, Indonesia
- Timika Malaria Research Programme, Papuan Health and Community Development Foundation, Timika, Papua, Indonesia
| | - Ratni Indrawanti
- Department of Child Health, Faculty of Medicine, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | | | - Leily Trianty
- Eijkman Institute for Molecular Biology, Jakarta, Indonesia
| | - Jutta Marfurt
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia
| | - Irene Handayuni
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia
| | - Yati Soenarto
- Department of Child Health, Faculty of Medicine, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Nicholas M. Douglas
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia
| | - Nicholas M. Anstey
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia
| | - 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 Clinical Medicine, University of Oxford, Oxford, United Kingdom
| | - Jeanne Rini Poespoprodjo
- Mimika District Hospital, Timika, Papua, Indonesia
- Timika Malaria Research Programme, Papuan Health and Community Development Foundation, Timika, Papua, Indonesia
- Department of Child Health, Faculty of Medicine, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
- * E-mail:
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Kenangalem E, Karyana M, Burdarm L, Yeung S, Simpson JA, Tjitra E, Anstey NM, Poespoprodjo JR, Price RN, Douglas NM. Plasmodium vivax infection: a major determinant of severe anaemia in infancy. Malar J 2016; 15:321. [PMID: 27306221 PMCID: PMC4910236 DOI: 10.1186/s12936-016-1373-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [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: 03/22/2016] [Accepted: 06/04/2016] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Most malarious countries outside of Africa are co-endemic for Plasmodium falciparum and Plasmodium vivax. The comparative burden of anaemia in the community caused by these two species is incompletely characterized. METHODS A three-stage, cross-sectional, community survey was used to determine the proportion of moderate or severe anaemia (haemoglobin <7 g/dL) attributable to patent P. vivax, P. falciparum and mixed parasitaemia in Papua, Indonesia. Adjusted population-attributable fractions were calculated from multivariable logistic regression models. Eight hundred and twenty-five households were surveyed with a total of 5255 occupants, 3890 (74 %) of whom were present and provided a blood sample. Plasmodium falciparum parasitaemia was present in 8.1 % (n = 315) of participants, P. vivax in 6.4 % (n = 250) and mixed infections in 1.9 % (n = 72). Overall, P. falciparum was associated with a mean reduction in haemoglobin of 1.16 g/dL compared to those without patent parasitaemia [95 % confidence interval (95 % CI) 0.91, 1.41 g/dL]. The corresponding values for P. vivax and mixed infections were 0.66 g/dL (95 % CI 0.35, 0.96) and 1.25 g/dL (0.71, 1.80), respectively. Overall, 16.7 % (95 % CI 8.52, 24.2 %) of haemoglobin concentrations <7 g/dL in the community were estimated to be attributable to patent parasitaemia. The fractions for infants and 1-5 years old were 34.4 % (95 % CI -3.30, 58.3 %) and 23.2 % (95 % CI 3.34, 39.0 %), respectively. Plasmodium vivax was associated with a greater than threefold higher attributable fraction of anaemia in infants compared with P. falciparum [27.6 % (95 % CI -3.20, 49.2 %) versus 7.94 % (-5.87, 20.0 %)]. CONCLUSION Despite comparatively low-level endemicity, malaria is associated with a significant proportion of all cases of community anaemia in southern Papua. Contrary to its benign reputation, P. vivax is an important and preventable risk factor for anaemia during infancy-a probable consequence of relapsing disease prior to the development of immunity.
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Affiliation(s)
- Enny Kenangalem
- Timika Malaria Research Program, Papuan Health and Community Development Foundation, Timika, Papua Indonesia ,Mimika District Health Authority, Timika, Papua Indonesia
| | - Muhammad Karyana
- National Institute of Health Research and Development, Ministry of Health, Jakarta, Indonesia
| | - Lenny Burdarm
- Mimika District Health Authority, Timika, Papua Indonesia
| | - Shunmay Yeung
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Julie A. Simpson
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Emiliana Tjitra
- National Institute of Health Research and Development, Ministry of Health, Jakarta, Indonesia
| | - Nicholas M. Anstey
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, PO Box 41096, Casuarina, Darwin, 0811 Australia ,Division of Medicine, Royal Darwin Hospital, Darwin, NT Australia
| | - Jeanne Rini Poespoprodjo
- Timika Malaria Research Program, Papuan Health and Community Development Foundation, Timika, Papua Indonesia ,Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, PO Box 41096, Casuarina, Darwin, 0811 Australia ,Department of Child Health, Faculty of Medicine, University Gadjah Mada, Yogyakarta, Indonesia
| | - Ric N. Price
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, PO Box 41096, Casuarina, Darwin, 0811 Australia ,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Nicholas M. Douglas
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, PO Box 41096, Casuarina, Darwin, 0811 Australia ,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK ,Division of Medicine, Christchurch Hospital, Christchurch, New Zealand
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Langford S, Douglas NM, Lampah DA, Simpson JA, Kenangalem E, Sugiarto P, Anstey NM, Poespoprodjo JR, Price RN. Plasmodium malariae Infection Associated with a High Burden of Anemia: A Hospital-Based Surveillance Study. PLoS Negl Trop Dis 2015; 9:e0004195. [PMID: 26720002 PMCID: PMC4697806 DOI: 10.1371/journal.pntd.0004195] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [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: 07/24/2015] [Accepted: 10/05/2015] [Indexed: 11/23/2022] Open
Abstract
Background Plasmodium malariae is a slow-growing parasite with a wide geographic distribution. Although generally regarded as a benign cause of malaria, it has been associated with nephrotic syndrome, particularly in young children, and can persist in the host for years. Morbidity associated with P. malariae infection has received relatively little attention, and the risk of P. malariae-associated nephrotic syndrome is unknown. Methodology/Principal Findings We used data from a very large hospital-based surveillance system incorporating information on clinical diagnoses, blood cell parameters and treatment to describe the demographic distribution, morbidity and mortality associated with P. malariae infection in southern Papua, Indonesia. Between April 2004 and December 2013 there were 1,054,674 patient presentations to Mitra Masyarakat Hospital of which 196,380 (18.6%) were associated with malaria and 5,097 were with P. malariae infection (constituting 2.6% of all malaria cases). The proportion of malaria cases attributable to P. malariae increased with age from 0.9% for patients under one year old to 3.1% for patients older than 15 years. Overall, 8.5% of patients with P. malariae infection required admission to hospital and the median length of stay for these patients was 2.5 days (Interquartile Range: 2.0–4.0 days). Patients with P. malariae infection had a lower mean hemoglobin concentration (9.0g/dL) than patients with P. falciparum (9.5g/dL), P. vivax (9.6g/dL) and mixed species infections (9.3g/dL). There were four cases of nephrotic syndrome recorded in patients with P. malariae infection, three of which were in children younger than 5 years old, giving a risk in this age group of 0.47% (95% Confidence Interval; 0.10% to 1.4%). Overall, 2.4% (n = 16) of patients hospitalized with P. malariae infection subsequently died in hospital, similar to the proportions for the other endemic Plasmodium species (range: 0% for P. ovale to 1.6% for P. falciparum). Conclusions/Significance Plasmodium malariae infection is relatively uncommon in Papua, Indonesia but is associated with significant morbidity from anemia and a similar risk of mortality to patients hospitalized with P. falciparum and P. vivax infection. In our large hospital database, one in 200 children under the age of 5 years with P. malariae infection were recorded as having nephrotic syndrome. Plasmodium malariae is a relatively rare, but widely distributed, cause of malaria. It can persist in the human host for years, often without causing significant symptoms. As a result, P. malariae will be a very difficult species to eradicate. Our study used data from a routine hospital-based surveillance system in southern Papua, Indonesia to describe the clinical epidemiology of P. malariae infections. Over a 10-year period there were 5,097 patient presentations to Mitra Masyarakat Hospital associated with P. malariae infection constituting 2.6% of all malaria cases. Patients with P. malariae malaria had a significantly older age distribution than those with P. vivax infections. They also had lower mean hemoglobin concentrations than patients infected with P. falciparum, P. vivax or mixed Plasmodium species. We speculate that this may be due to chronic hemolysis of parasitized and non-parasitized red cells as a result of persistent infection. One in 200 children under the age of 5 years with P. malariae infection were recorded as having nephrotic syndrome, a well-known but to date unquantified complication. Overall, 0.3% of patients with P. malariae malaria died. These findings emphasize the need to consider this parasite when designing comprehensive malaria elimination strategies.
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Affiliation(s)
- Siobhan Langford
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Casuarina, Darwin, Northern Territory, Australia
| | - Nicholas M. Douglas
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Casuarina, Darwin, Northern Territory, Australia
- Division of Medicine, Christchurch Hospital, Christchurch, New Zealand
| | - Daniel A. Lampah
- Timika Malaria Research Program, Papuan Health and Community Development Foundation, Timika, Papua, Indonesia
| | - Julie A. Simpson
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Enny Kenangalem
- Timika Malaria Research Program, Papuan Health and Community Development Foundation, Timika, Papua, Indonesia
- Mimika District Health Authority, Timika, Papua, Indonesia
| | | | - Nicholas M. Anstey
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Casuarina, Darwin, Northern Territory, Australia
- Division of Medicine, Royal Darwin Hospital, Darwin, Australia
| | - Jeanne Rini Poespoprodjo
- Timika Malaria Research Program, Papuan Health and Community Development Foundation, Timika, Papua, Indonesia
- Mimika District Health Authority, Timika, Papua, Indonesia
- Department of Child Health, Faculty of Medicine, University Gadjah Mada, Yogyakarta, Indonesia
| | - Ric N. Price
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Casuarina, Darwin, Northern Territory, Australia
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
- * E-mail:
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32
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Douglas NM, Pontororing GJ, Lampah DA, Yeo TW, Kenangalem E, Poespoprodjo JR, Ralph AP, Bangs MJ, Sugiarto P, Anstey NM, Price RN. Mortality attributable to Plasmodium vivax malaria: a clinical audit from Papua, Indonesia. BMC Med 2014; 12:217. [PMID: 25406857 PMCID: PMC4264333 DOI: 10.1186/s12916-014-0217-z] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Accepted: 10/22/2014] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Plasmodium vivax causes almost half of all malaria cases in Asia and is recognised as a significant cause of morbidity. In recent years it has been associated with severe and fatal disease. The extent to which P. vivax contributes to death is not known. METHODS To define the epidemiology of mortality attributable to vivax malaria in southern Papua, Indonesia, a retrospective clinical records-based audit was conducted of all deaths in patients with vivax malaria at a tertiary referral hospital. RESULTS Between January 2004 and September 2009, hospital surveillance identified 3,495 inpatients with P. vivax monoinfection and 65 (1.9%) patients who subsequently died. Charts for 54 of these 65 patients could be reviewed, 40 (74%) of whom had pure P. vivax infections on cross-checking. Using pre-defined conservative criteria, vivax malaria was the primary cause of death in 6 cases, a major contributor in 17 cases and a minor contributor in a further 13 cases. Extreme anaemia was the most common primary cause of death. Malnutrition, sepsis with respiratory and gastrointestinal manifestations, and chronic diseases were the commonest attributed causes of death for patients in the latter two categories. There were an estimated 293,763 cases of pure P. vivax infection in the community during the study period giving an overall minimum case fatality of 0.12 per 1,000 infections. The corresponding case fatality in hospitalised patients was 10.3 per 1,000 infections. CONCLUSIONS Although uncommonly directly fatal, vivax malaria is an important indirect cause of death in southern Papua in patients with malnutrition, sepsis syndrome and chronic diseases, including HIV infection.
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Affiliation(s)
- Nicholas M Douglas
- Global Health Division, Menzies School of Health Research and Charles Darwin University, PO Box 41096, Casuarina, Darwin, NT 0811, Australia. .,Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
| | - Gysje J Pontororing
- Papuan Health and Community Development Foundation, Timika, Papua, Indonesia.
| | - Daniel A Lampah
- Papuan Health and Community Development Foundation, Timika, Papua, Indonesia.
| | - Tsin W Yeo
- Global Health Division, Menzies School of Health Research and Charles Darwin University, PO Box 41096, Casuarina, Darwin, NT 0811, Australia.
| | - Enny Kenangalem
- Papuan Health and Community Development Foundation, Timika, Papua, Indonesia. .,District Health Authority, Timika, Papua, Indonesia.
| | - Jeanne Rini Poespoprodjo
- Papuan Health and Community Development Foundation, Timika, Papua, Indonesia. .,District Health Authority, Timika, Papua, Indonesia. .,Department of Paediatrics, Faculty of Medicine, Gadjah Mada University, Yogyakarta, Indonesia.
| | - Anna P Ralph
- Global Health Division, Menzies School of Health Research and Charles Darwin University, PO Box 41096, Casuarina, Darwin, NT 0811, Australia. .,Division of Medicine, Royal Darwin Hospital, Darwin, Australia.
| | - Michael J Bangs
- Public Health & Malaria Control Department, International SOS, PT Freeport Indonesia, Kuala Kencana, Papua, Indonesia. .,Department of Entomology, Faculty of Agriculture, Kasetsart University, Bangkok, 10900, Thailand.
| | | | - Nicholas M Anstey
- Global Health Division, Menzies School of Health Research and Charles Darwin University, PO Box 41096, Casuarina, Darwin, NT 0811, Australia. .,Division of Medicine, Royal Darwin Hospital, Darwin, Australia.
| | - Ric N Price
- Global Health Division, Menzies School of Health Research and Charles Darwin University, PO Box 41096, Casuarina, Darwin, NT 0811, Australia. .,Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
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Lampah DA, Yeo TW, Malloy M, Kenangalem E, Douglas NM, Ronaldo D, Sugiarto P, Simpson JA, Poespoprodjo JR, Anstey NM, Price RN. Severe malarial thrombocytopenia: a risk factor for mortality in Papua, Indonesia. J Infect Dis 2014; 211:623-34. [PMID: 25170106 PMCID: PMC4305266 DOI: 10.1093/infdis/jiu487] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [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] [Indexed: 12/24/2022] Open
Abstract
Background The significance of thrombocytopenia to the morbidity and mortality of malaria is poorly defined. We compared the platelet counts and clinical correlates of patients with and those without malaria in southern Papua, Indonesia. Methods Data were collated on patients presenting to a referral hospital between April 2004 and December 2012. Results Platelet measurements were available in 215 479 patients (23.4%), 66 421 (30.8%) of whom had clinical malaria. Patients with Plasmodium falciparum monoinfection had the lowest platelet counts and greatest risk of severe thrombocytopenia (platelet count, <50 000 platelets/µL), compared with those without malaria (adjusted odds ratio [OR], 6.03; 95% confidence interval [CI], 5.77–6.30]). The corresponding risks were 5.4 (95% CI, 5.02–5.80) for mixed infections, 3.73 (95% CI, 3.51–3.97) for Plasmodium vivax infection, and 2.16 (95% CI, 1.78–2.63) for Plasmodium malariae infection (P < .001). In total, 1.3% of patients (2701 of 215 479) died. Patients with severe malarial anemia alone (hemoglobin level, <5 g/dL) had an adjusted OR for death of 4.93 (95% CI, 3.79–6.42), those with severe malarial thrombocytopenia alone had an adjusted OR of 2.77 (95% CI, 2.20–3.48), and those with both risk factors had an adjusted OR of 13.76 (95% CI, 10.22–18.54; P < .001). Conclusions Severe thrombocytopenia identifies both children and adults at increased risk of death from falciparum or vivax malaria, particularly in those with concurrent severe anemia.
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Affiliation(s)
- Daniel A Lampah
- Timika Malaria Research Program, Papuan Health and Community Development Foundation Mimika District Health Authority
| | - Tsin W Yeo
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University Lee Kong Chian School of Medicine, Nanyang Technological University Institute of Infectious Disease and Epidemiology, Tan Tock Seng Hospital, Singapore
| | - Michael Malloy
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne Victorian Cytology Service, Carlton, Australia
| | - Enny Kenangalem
- Timika Malaria Research Program, Papuan Health and Community Development Foundation Mimika District Health Authority
| | - Nicholas M Douglas
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University Division of Medicine, Christchurch Hospital, New Zealand
| | - Donny Ronaldo
- Department of Pediatrics, Faculty of Medicine, Gadjah Mada University, Yogyakarta, Indonesia
| | | | - Julie A Simpson
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne
| | - Jeanne Rini Poespoprodjo
- Timika Malaria Research Program, Papuan Health and Community Development Foundation Mimika District Health Authority
| | - Nicholas M Anstey
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University Division of Medicine, Royal Darwin Hospital, Darwin
| | - Ric N Price
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, United Kingdom
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Douglas NM, Simpson JA, Phyo AP, Siswantoro H, Hasugian AR, Kenangalem E, Poespoprodjo JR, Singhasivanon P, Anstey NM, White NJ, Tjitra E, Nosten F, Price RN. Gametocyte dynamics and the role of drugs in reducing the transmission potential of Plasmodium vivax. J Infect Dis 2013; 208:801-12. [PMID: 23766527 PMCID: PMC3733516 DOI: 10.1093/infdis/jit261] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [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] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Designing interventions that will reduce transmission of vivax malaria requires knowledge of Plasmodium vivax gametocyte dynamics. METHODS We analyzed data from a randomized controlled trial in northwestern Thailand and 2 trials in Papua, Indonesia, to identify and compare risk factors for vivax gametocytemia at enrollment and following treatment. RESULTS A total of 492 patients with P. vivax infections from Thailand and 476 patients (162 with concurrent falciparum parasitemia) from Indonesia were evaluable. Also, 84.3% (415/492) and 66.6% (209/314) of patients with monoinfection were gametocytemic at enrollment, respectively. The ratio of gametocytemia to asexual parasitemia did not differ between acute and recurrent infections (P = .48 in Thailand, P = .08 in Indonesia). High asexual parasitemia was associated with an increased risk of gametocytemia during follow-up in both locations. In Thailand, the cumulative incidence of gametocytemia between day 7 and day 42 following dihydroartemisinin + piperaquine (DHA + PIP) was 6.92% vs 29.1% following chloroquine (P < .001). In Indonesia, the incidence of gametocytemia was 33.6% following artesunate + amodiaquine (AS + AQ), 7.42% following artemether + lumefantrine, and 6.80% following DHA + PIP (P < .001 for DHA + PIP vs AS + AQ). CONCLUSIONS P. vivax gametocyte carriage mirrors asexual-stage infection. Prevention of relapses, particularly in those with high asexual parasitemia, is likely the most important strategy for interrupting P. vivax transmission.
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Affiliation(s)
- Nicholas M Douglas
- Global Health Division, Menzies School of Health Research, Charles Darwin University, Darwin 0811, Australia
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Abstract
Effective use of anti-malarial drugs is key to reducing the transmission potential of Plasmodium vivax. In patients presenting with symptomatic disease, treatment with potent and relatively slowly eliminated blood schizontocidal regimens administered concurrently with a supervised course of 7 mg/kg primaquine over 7-14 days has potential to exert the greatest transmission-blocking benefit. Given the spread of chloroquine-resistant P. vivax strains, the artemisinin combination therapies dihydroartemisinin + piperaquine and artesunate + mefloquine are currently the most assured means of preventing P. vivax recrudescence. Preliminary evidence suggests that, like chloroquine, these combinations potentiate the hypnozoitocidal effect of primaquine, but further supportive evidence is required. In view of the high rate of P. vivax relapse following falciparum infections in co-endemic regions, there is a strong argument for broadening current radical cure policy to include the administration of hypnozoitocidal doses of primaquine to patients with Plasmodium falciparum malaria. The most important reservoir for P. vivax transmission is likely to be very low-density, asymptomatic infections, the majority of which will arise from liver-stage relapses. Therefore, judicious mass administration of hypnozoitocidal therapy will reduce transmission of P. vivax to a greater extent than strategies focused on treatment of symptomatic patients. An efficacious hypnozoitocidal agent with a short curative treatment course would be particularly useful in mass drug administration campaigns.
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Affiliation(s)
- Nicholas M Douglas
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK.
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Abstract
Vivax malaria was historically described as 'benign tertian malaria' because individual clinical episodes were less likely to cause severe illness than Plasmodium falciparum. Despite this, Plasmodium vivax was, and remains, responsible for major morbidity and significant mortality in vivax-endemic areas. Single infections causing febrile illness in otherwise healthy individuals rarely progress to severe disease. Nevertheless, in the presence of co-morbidities, P. vivax can cause severe illness and fatal outcomes. Recurrent or chronic infections in endemic areas can cause severe anaemia and malnutrition, particularly in early childhood. Other severe manifestations include acute lung injury, acute kidney injury and uncommonly, coma. Multiorgan failure and shock are described but further studies are needed to investigate the role of bacterial and other co-infections in these syndromes. In pregnancy, P. vivax infection can cause maternal anaemia, miscarriage, low birth weight and congenital malaria. Compared to P. falciparum, P. vivax has a greater capacity to elicit an inflammatory response, resulting in a lower pyrogenic threshold. Conversely, cytoadherence of P. vivax to endothelial cells is less frequent and parasite sequestration is not thought to be a significant cause of severe illness in vivax malaria. With a predilection for young red cells, P. vivax does not result in the high parasite biomass associated with severe disease in P. falciparum, but a four to fivefold greater removal of uninfected red cells from the circulation relative to P. falciparum is associated with a similar risk of severe anaemia. Mechanisms underlying the pathogenesis of severe vivax syndromes remain incompletely understood.
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Affiliation(s)
- Nicholas M Anstey
- Global Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia
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John GK, Douglas NM, von Seidlein L, Nosten F, Baird JK, White NJ, Price RN. Primaquine radical cure of Plasmodium vivax: a critical review of the literature. Malar J 2012; 11:280. [PMID: 22900786 PMCID: PMC3489597 DOI: 10.1186/1475-2875-11-280] [Citation(s) in RCA: 141] [Impact Index Per Article: 11.8] [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: 05/22/2012] [Accepted: 08/08/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Primaquine has been the only widely available hypnozoitocidal anti-malarial drug for half a century. Despite this its clinical efficacy is poorly characterized resulting in a lack of consensus over the optimal regimen for the radical cure of Plasmodium vivax. METHODS Published studies since 1950 of the use of primaquine regimens for preventing P. vivax relapse were reviewed. Data were extracted systematically from available papers. Primaquine regimens were categorized according to the total dose administered: very low (≤2.5 mg/kg), low (>2.5 mg/kg- < 5.0 mg/kg) and high (≥ 5.0 mg/kg). The risk of recurrent infection were summarized across geographical regions and the odds ratios between treatment regimens calculated after stratifying by total treatment dose and duration of study follow up. RESULTS Data could be retrieved from 87 clinical trials presenting data in 59,735 patients enrolled into 156 treatment arms, conducted in 20 countries. There was marked heterogeneity in study design, particularly primaquine dosing and duration of follow up. The median rate of recurrence following very low dose of primaquine (n = 44) was 25% (range 0-90%) at 4-6 months, compared to 6.7 % (range 0-59%) following low dose primaquine (n = 82). High dose primaquine regimens were assessed in 28 treatment arms, and were associated with a median recurrence rate of 0% (Range: 0-15%) at one month. In 18 studies with control arms, the effectiveness of a very low dose primaquine regimen was no different from patients who did not receive primaquine (OR = 0.60, 95%CI 0.33-1.09, p = 0.09), whereas for the low dose regimens a significant difference was reported in 50% (6/12) of studies (overall OR = 0.14, 95%CI: 0.06-0.35, p < 0.001). Two studies enrolling 171 patients demonstrated high effectiveness of high dose primaquine compared to a control arm (OR = 0.03 (95%CI: 0.01-0.13); p < 0.0001). CONCLUSIONS Low dose regimens retain adequate efficacy in some areas, but this is not uniform. The efficacy and safety of pragmatic high dose primaquine regimens needs to be assessed in a range of endemic and geographical locations. Such studies will require a prolonged period of follow up and comparison with control arms to account for confounding factors.
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Affiliation(s)
- George K John
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
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Abstract
Plasmodium vivax threatens nearly half the world's population and is a significant impediment to achievement of the millennium development goals. It is an important, but incompletely understood, cause of anaemia. This review synthesizes current evidence on the epidemiology, pathogenesis, treatment and consequences of vivax-associated anaemia. Young children are at high risk of clinically significant and potentially severe vivax-associated anaemia, particularly in countries where transmission is intense and relapses are frequent. Despite reaching lower densities than Plasmodium falciparum, Plasmodium vivax causes similar absolute reduction in red blood cell mass because it results in proportionately greater removal of uninfected red blood cells. Severe vivax anaemia is associated with substantial indirect mortality and morbidity through impaired resilience to co-morbidities, obstetric complications and requirement for blood transfusion. Anaemia can be averted by early and effective anti-malarial treatment.
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Affiliation(s)
- Nicholas M Douglas
- Global Health Division, Menzies School of Health Research, PO Box 41096, Casuarina, NT 0811, Australia
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
- Division of Medicine, Royal Darwin Hospital, Darwin, NT, Australia
| | - Nicholas M Anstey
- Global Health Division, Menzies School of Health Research, PO Box 41096, Casuarina, NT 0811, Australia
- Division of Medicine, Royal Darwin Hospital, Darwin, NT, Australia
| | - Pierre A Buffet
- INSERM - UPMC, (Paris 6 University) UMRs945, F-75013, Paris, France
- Department of Parasitology, Pitié-Salpétrière Hospital, Assistance Publique – Hôpitaux de Paris, F-75013, Paris, France
- Institut Pasteur, Unité d’Immunologie Moléculaire des Parasites, Département de Parasitologie Mycologie, F-75015, Paris, France
| | - Jeanne R Poespoprodjo
- Global Health Division, Menzies School of Health Research, PO Box 41096, Casuarina, NT 0811, Australia
- Mimika District Health Authority, Timika, Papua, Indonesia
- Papuan Health and Community Development Foundation, Timika, Papua, Indonesia
| | - Tsin W Yeo
- Global Health Division, Menzies School of Health Research, PO Box 41096, Casuarina, NT 0811, Australia
- Division of Medicine, Royal Darwin Hospital, Darwin, NT, Australia
| | - Nicholas J White
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
- Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Ric N Price
- Global Health Division, Menzies School of Health Research, PO Box 41096, Casuarina, NT 0811, Australia
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
- Division of Medicine, Royal Darwin Hospital, Darwin, NT, Australia
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Douglas NM, Nosten F, Ashley EA, Phaiphun L, van Vugt M, Singhasivanon P, White NJ, Price RN. Plasmodium vivax recurrence following falciparum and mixed species malaria: risk factors and effect of antimalarial kinetics. Clin Infect Dis 2011; 52:612-20. [PMID: 21292666 PMCID: PMC3060895 DOI: 10.1093/cid/ciq249] [Citation(s) in RCA: 116] [Impact Index Per Article: 8.9] [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: 09/24/2010] [Accepted: 12/17/2010] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Plasmodium vivax malaria commonly follows treatment of falciparum malaria in regions of co-endemicity. This is an important cause of preventable morbidity. METHODS We examined the factors contributing to the risk of recurrence of P. vivax infection after treatment of acute falciparum malaria in a series of clinical trials conducted on the Thai-Myanmar border from 1991 through 2005. RESULTS Overall, 10,549 patients (4960 children aged <15 years and 5589 adults) were treated for falciparum malaria; of these patients, 9385 (89.0%) had Plasmodium falciparum monoinfection and 1164 (11.0%) had mixed P. falciparum/P. vivax infections according to microscopic examinations performed at screening. The cumulative proportion of patients with P. falciparum infection recurrence by day 63 was 21.5% (95% confidence interval [CI], 20.3%-22.8%), and the cumulative proportion with P. vivax infection recurrence was 31.5% (95% CI, 30.1%-33.0%). Significant risk factors for P. vivax infection recurrence were mixed infection at enrollment, male sex, younger age, lower hematocrit, higher asexual P. falciparum parasite density (P < .001 for all factors), and P. falciparum gametocytemia at enrollment (P = .001). By day 63, the cumulative risk of vivax malaria after P. falciparum monoinfection was 51.1% (95% CI, 46.1%-56.2%) after treatment with rapidly eliminated drugs (t(1/2) <1 day), 35.3% (95% CI, 31.8%-39.0%) after treatment with intermediate half-life drugs (t(1/2) 1-7 days), and 19.6% (95% CI, 18.1%-21.3%) after treatment with slowly eliminated drugs (t(1/2) > 7 days) (P < .001, by test for trend). Artemisinin-based combinations containing mefloquine or piperaquine, compared with the artemether-lumefantrine and artesunate-atovaquone-proguanil combinations, were associated with a 3.6-fold to 4.2-fold lower adjusted hazard ratio for P. vivax infection recurrence within 63 days after pure or mixed P. falciparum infections (P < .001, for comparisons with artesunate-mefloquine). CONCLUSIONS On the Thai-Myanmar border, P. vivax is the most common cause of parasitological failure after treatment for falciparum malaria. Slowly eliminated antimalarials reduce the risk of early P. vivax infection recurrence.
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Affiliation(s)
- Nicholas M. Douglas
- Global Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, United Kingdom
| | - François Nosten
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, United Kingdom
- Shoklo Malaria Research Unit, Tak Province, Thailand
- Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Elizabeth A. Ashley
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, United Kingdom
- Shoklo Malaria Research Unit, Tak Province, Thailand
- Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Lucy Phaiphun
- Shoklo Malaria Research Unit, Tak Province, Thailand
| | - Michèle van Vugt
- Shoklo Malaria Research Unit, Tak Province, Thailand
- Department of Internal Medicine, Division of Infectious Diseases, Tropical Medicine and AIDS and Center for Infection and Immunity, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | | | - Nicholas J. White
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, United Kingdom
- Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Ric N. Price
- Global Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, United Kingdom
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Abstract
Early parasitological diagnosis and treatment with artemisinin-based combination therapies (ACTs) are key components of worldwide malaria elimination programmes. In general, use of ACTs has been limited to patients with falciparum malaria whereas blood-stage infections with Plasmodium vivax are mostly still treated with chloroquine. We review the evidence for the relative benefits and disadvantages of the existing separate treatment approach versus a unified ACT-based strategy for treating Plasmodium falciparum and P vivax infections in regions where both species are endemic (co-endemic). The separate treatment scenario is justifiable if P vivax remains sensitive to chloroquine and diagnostic tests reliably distinguish P vivax from P falciparum. However, with the high number of misdiagnoses in routine practice and the rise and spread of chloroquine-resistant P vivax, there might be a compelling rationale for a unified ACT-based strategy for vivax and falciparum malaria in all co-endemic regions. Analyses of the cost-effectiveness of ACTs for both Plasmodium species are needed to assess the role of these drugs in the control and elimination of vivax malaria.
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Douglas TM, Douglas NM. Absence of significant dissent should be sufficient for deceased donor organ procurement in New Zealand. Aust N Z J Public Health 2009; 33:449-54. [PMID: 19811481 DOI: 10.1111/j.1753-6405.2009.00427.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE New Zealand's organ donation rates are among the lowest in the OECD. In a bid to increase organ availability, the New Zealand Human Tissue Act 2008 introduces new consent arrangements for deceased donor organ procurement. This article assesses these new arrangements and presents the case for further reform. APPROACH Our assessment and arguments are based on philosophical analysis informed by empirical data on the effectiveness of alternative consent systems. We: 1) Identify widely held ethical judgments about policies and practices relevant to organ donation (e.g. those relating to coronial post-mortems), 2) Assess the implications of these judgments for the Human Tissue Act and the assumptions that underpin it, and 3) Derive policy recommendations that are consistent with the judgments. CONCLUSION The Human Tissue Act 2008 retains a strong consent requirement for organ procurement: organs may not be transplanted unless either the deceased or the family consents. We argue that organ availability could and should be increased by shifting from a model that requires consent to one that requires the absence of significant dissent. IMPLICATIONS We recommend that New Zealand adopt either 1) an organ donation system similar to the existing system for ordering coronial post-mortems, or 2) a variant of the 'opt-out' system already in place in several other countries.
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Affiliation(s)
- Thomas M Douglas
- Oxford Uehiro Centre for Practical Ethics, Oxford University, UK.
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Douglas TM, Douglas NM. Authors' response: On the post-mortem analogy and the duty to donate. Aust N Z J Public Health 2009. [DOI: 10.1111/j.1753-6405.2009.00429.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Abstract
AIM This study aimed to assess survival by ethnicity for all New Zealand children (0-14 years) diagnosed with cancer during 1990-1993 and second, to determine the accuracy of the children's routinely collected ethnicity information. METHODS Four hundred and nine children were followed up using two largely independent sources. We compared survival using the Cox model. RESULTS Maori and Pacific Island children had the same survival as non-Maori/non-Pacific children for 'all cancers combined' (hazard ratios (HR): 0.98; 95% confidence interval (CI): 0.64-1.50 and 1.01; 95% CI: 0.53-1.89 respectively) and acute lymphoblastic leukaemia (HR: 1.09; 95% CI: 0.45-2.62 and 0.99; 95% CI: 0.24-4.16, respectively). The ethnicity data stored within the National Health Index and the New Zealand Cancer Registry showed reasonably close agreement with ethnicity data provided by the children's mothers at interview (Kappa statistics: 0.82 and 0.81 respectively) while the Mortality Collection showed only moderate agreement (Kappa statistic: 0.63). CONCLUSION The point estimates in this study provide no evidence of ethnic disparities in survival from childhood cancer in New Zealand. However, even in this national study there were small numbers of Maori and Pacific children leading to wide confidence intervals. We therefore recommend cautious interpretation.
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Affiliation(s)
- Nicholas M Douglas
- Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
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Douglas NM, Dockerty JD. Population-based survival of children in New Zealand diagnosed with cancer during 1990-1993. Eur J Cancer 2005; 41:1604-9. [PMID: 15963713 DOI: 10.1016/j.ejca.2005.03.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [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: 01/18/2005] [Revised: 03/07/2005] [Accepted: 03/10/2005] [Indexed: 11/15/2022]
Abstract
In this study, we have aimed to characterise the survival of all 0-14 year-old New Zealand children who were diagnosed with cancer during 1990-1993. Four hundred and nine children were followed up using two largely independent sources. We calculated Kaplan-Meier survival probabilities and investigated various prognostic factors using the Cox model. Five-year survival for all cancers was 66% (95% confidence interval (CI) 62-71%) and for acute lymphoblastic leukaemia it was 70% (CI 62-79%). Cancers with particularly favourable prognoses (followed by their respective 5-year survival probabilities) included: retinoblastoma 100% (CI 74-100%), Hodgkin's disease 93% (CI 79-100%), non-Hodgkin's lymphoma 87% (CI 73-100%) and osteosarcoma 91% (CI 74-100%). Cancers with poor prognoses included: neuroblastoma 35% (CI 14-56%), rhabdomyosarcoma 42% (CI 14-70%) and central nervous system tumours 49% (CI 38-60%). Girls with any cancer had a significantly lower risk of death than boys. Generally, survival for childhood cancers in New Zealand increased greatly between 1961-1965 and 1990-1993. Nevertheless, outcomes for some cancers remained poor.
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Affiliation(s)
- N M Douglas
- Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
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Powell DG, Douglas NM, Westlake PH. Physician participation in a medical information system. MD Comput 1994; 11:140-1, 147. [PMID: 8057785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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