MALARIA

Selected abstracts:

1                    Bell D, Wongsrichanalai C, Barnwell JW. Ensuring quality and access for malaria diagnosis: how can it be achieved? Nat Rev Microbiol. 2006 Sep;4(9 Suppl):S7-20.

            Malaria, and other Vector-borne and Parasitic Diseases, World Health Organization Regional Office for the Western Pacific, P.O. Box 2932, Manila, Philippines. belld@wpro.who.int
The replacement of conventional antimalarial drugs with high-cost, artemisinin-based alternatives has created a gap in the successful management of malaria. This gap reflects an increased need for accurate disease diagnosis that cannot be met by traditional microscopy techniques. The recent introduction of rapid diagnostic tests (RDTs) has the potential to meet this need, but successful RDT implementation has been curtailed by poor product performance, inadequate methods to determine the quality of products and a lack of emphasis and capacity to deal with these issues. Economics and a desire for improved case management will result in the rapid growth of RDT use in the coming years. However, for their potential to be realized, it is crucial that high-quality RDT products that perform reliably and accurately under field conditions are made available. In achieving this goal, the shift from symptom-based diagnosis to parasite-based management of malaria can bring significant improvements to tropical fever management, rather than represent a further burden on poor, malaria-endemic populations and their overstretched health services.

2                    Borrmann S, Lundgren I, Oyakhirome S, Impouma B, Matsiegui PB, Adegnika AA, Issifou S, Kun JF, Hutchinson D, Wiesner J, Jomaa H, Kremsner PG. Fosmidomycin plus clindamycin for treatment of pediatric patients aged 1 to 14 years with Plasmodium falciparum malaria. Antimicrob Agents Chemother. 2006 Aug;50(8):2713-8.

Medical Research Unit, Albert Schweitzer Hospital, Lambarene, Gabon.

Fosmidomycin plus clindamycin was shown to be efficacious in the treatment of uncomplicated Plasmodium falciparum malaria in a small cohort of pediatric patients aged 7 to 14 years, but more data, including data on younger children with less antiparasitic immunity, are needed to determine the potential value of this new antimalarial combination. We conducted a single-arm study to improve the precision of efficacy estimates for an oral 3-day fixed-ratio combination of fosmidomycin and clindamycin at 30 and 10 mg/kg of body weight, respectively, every 12 hours for the treatment of uncomplicated P. falciparum malaria in 51 pediatric outpatients aged 1 to 14 years. Fosmidomycin plus clindamycin was generally well tolerated, but relatively high rates of treatment-associated neutropenia (8/51 [16%]) and falls of hemoglobin concentrations of > or =2 g/dl (7/51 [14%]) are of concern. Asexual parasites and fever were cleared within median periods of 42 h and 38 h, respectively. All patients who could be evaluated were parasitologically and clinically cured by day 14 (49/49; 95% confidence interval [CI], 93 to 100%). The per-protocol, PCR-adjusted day 28 cure rate was 89% (42/47; 95% CI, 77 to 96%). Efficacy appeared to be significantly reduced in children aged 1 to 2 years, with a day 28 cure rate of only 62% for this small subgroup (5/8). The inadequate efficacy in children of <3 years highlights the need for continued systematic studies of the current dosing regimen, which should include randomized trial designs.

3                    Enwere G, Biney E, Cheung YB, Zaman SM, Okoko B, Oluwalana C, Vaughan A, Greenwood B, Adegbola R, Cutts FT. Epidemiologic and clinical characteristics of community-acquired invasive bacterial infections in children aged 2-29 months in The Gambia. Pediatr Infect Dis J. 2006 Aug;25(8):700-5.

Medical Research Council Laboratories, The Gambia.

BACKGROUND: The incidence of community-acquired bacteremia (CAB) in Africa is several-fold higher than in industrialized countries. We report here the incidence of invasive bacterial infections in rural Gambia and compare the clinical characteristics of children with pneumococcal infection with those of children with extraintestinal nontyphoidal salmonella infection (NTS) or other bacterial infections. METHODS: As part of a pneumococcal conjugate vaccine trial, we investigated children aged 2-29 months who presented with signs suggestive of invasive bacterial infections. RESULTS: The incidence of invasive bacterial infections in all subjects was 1009 (95% CI, 903-1124) cases per 100,000 person-years. It was 1108 (95% CI, 953-1282) among children who had not received pneumococcal conjugate vaccine. Incidence decreased with increasing age but remained relatively high in 24- to 29-month-olds for pneumococcal infections. Pneumococcal infection was more frequent than NTS infections in the hot dry season. Respiratory symptoms and signs, consolidation on chest radiograph, and a primary diagnosis of pneumonia were more frequent in children with pneumococcal infection than in those with NTS or other infections. Diarrhea, laboratory evidence of malaria infection, and a primary diagnosis of malaria were more common in children with NTS infections. CONCLUSIONS: Bacterial infections continue to cause significant morbidity in rural Africa. Although vaccines could greatly reduce the pneumococcal burden, a high index of suspicion and appropriate use of antimicrobials are needed to manage other causes of invasive bacterial infections.

4                    Ochola LB, Vounatsou P, Smith T, Mabaso ML, Newton CR The reliability of diagnostic techniques in the diagnosis and management of malaria in the absence of a gold standard. Lancet Infect Dis. 2006 Sep;6(9):582-8.

Centre for Geographic Medicine Research, KEMRI, Kilifi, Kenya. lochola@kilifi.kemri-wellcome.org

The accuracy of techniques for the diagnosis of malaria are usually compared with optical microscopy, which is considered to be a gold standard. However, microscopy is prone to error and therefore makes it difficult to assess the reliability of other diagnostic techniques. We did a systematic review to assess the specificity and sensitivity of diagnostic techniques in different settings, using a statistical method that avoided defining a gold standard. Performance varied depending on species of the malaria parasite, level of parasitaemia, and immunity. Overall, histidine-rich protein 2 (HRP2)-based dipsticks showed a high sensitivity (92.7%) and specificity (99.2%) for Plasmodium falciparum in endemic areas. The acridine orange test was more sensitive (97.1%) in detecting P falciparum in epidemiological studies, with a specificity of 97.9%. In the absence of a gold standard, HRP2 dipsticks and acridine orange could provide an alternative for detecting falciparum infections in endemic areas and epidemiological studies, respectively. Microscopy still remains more reliable in detecting non-falciparum infections.

5.                  Shanbag P, Juvekar M, More V, Vaidya M. Exchange transfusion in children with severe falciparum malaria and heavy parasitaemia. Ann Trop Paediatr. 2006 Sep;26(3):199-204.

Paediatric Intensive Care Unit, Department of Paediatrics, Lokmanya Tilak Municipal Medical College & General Hospital, Mumbai, India. pshanbag@yahoo.com

While exchange transfusion has been advocated as an adjunctive treatment in severe falciparum malaria complicated by heavy parasitaemia, its role in severe life-threatening disease refractory to standard life support measures is less well recognised. We describe four children with severe falciparum malaria, multi-system involvement and heavy parasitaemia in whom we undertook exchange transfusion because of their deteriorating clinical condition despite antimalarials and supportive therapy. All patients received quinine (one also received artesunate). All patients improved dramatically following the procedure, with subsequent complete clinical recovery.

6.                  Ward DI. A case of fatal Plasmodium falciparum malaria complicated by acute dengue fever in East Timor. Am J Trop Med Hyg. 2006 Jul;75(1):182-5.

Department of Emergency Medicine, Nambour General Hospital, Nambour, Queensland, Australia. David_Ward@health.qld.gov.au

A case is reported of a seven-year-old girl who had concurrent infections with Plasmodium falciparum malaria and dengue in a remote area of East Timor. The diagnosis of malaria was delayed because of two false-negative results with malaria rapid diagnosis test cards. Diagnosis was eventually made on microscopic examination of the patient's blood. Despite treatment, the patient subsequently died. This case serves as a reminder of the fallibility of rapid diagnostic tests, and the importance of examining the patient's blood microscopically if malaria is suspected.

Diagnosis, Diagnostics, Immunodiagnosis, Immunodiagnostic:

15059.  Bhalla A, Sharma N, Sharma A, Suri V.  Concurrent infection with dengue and malaria. Indian J Med Sci. 2006 Aug;60(8):330-1.

15060.  Chilton D, Malik AN, Armstrong M, Kettelhut M, Parker-Williams J, Chiodini PL. Use of rapid diagnostic tests for diagnosis of malaria in the UK. J Clin Pathol. 2006 Aug;59(8):862-6.

15061.  Cottrell G, Deloron P, Fievet N, Sow S, Gaye O, Le Hesran JY. Prediction of Plasmodium falciparum placental infection according to the time of infection during pregnancy. Acta Trop. 2006 Jul;98(3):255-60.

15062.  Makundi EA, Malebo HM, Mhame P, Kitua AY, Warsame M.  Role of traditional healers in the management of severe malaria among children below five years of age: the case of Kilosa and Handeni Districts, Tanzania. Malar J. 2006 Jul 18;5:58. 

15063.  Osterholt DM, Rowe AK, Hamel MJ, Flanders WD, Mkandala C, Marum LH, Kaimila N. Predictors of treatment error for children with uncomplicated malaria seen as outpatients in Blantyre district, Malawi. Trop Med Int Health. 2006 Aug;11(8):1147-56.

15064.  Stauffer WM, Magill A, Kain KC. Parasitic central nervous system infections in immunocompromised hosts: clarification of malaria diagnosis. Clin Infect Dis. 2006 Jul 1;43(1):114-5; author reply 115-6.

15065.  Tran TM, Browning J, Dell ML.  Psychosis with paranoid delusions after a therapeutic dose of mefloquine: a case report. Malar J. 2006 Aug 23;5:74.

15066.  Whitty CJ, Lalloo D, Ustianowski A. Malaria: an update on treatment of adults in non-endemic countries. BMJ. 2006 Jul 29;333(7561):241-5. Review.

Pathogenesis:

15067.  Clark IA, Budd AC, Hsue G, Haymore BR, Joyce AJ, Thorner R, Krause PJ.   Absence of erythrocyte sequestration in a case of babesiosis in a splenectomized human patient. Malar J. 2006 Aug 4;5:69. 

Vaccine:

15068.  Brogan D, Mossialos E. Applying the concepts of financial options to stimulate vaccine development. Nat Rev Drug Discov. 2006 Aug;5(8):641-7. Epub 2006 Jul 14. 

15069.  Hutton G, F. The costs of introducing a malaria vaccine through the expanded program on immunization in Tanzania. Am J Trop Med Hyg. 2006 Aug;75(2 Suppl):119-30. 

15070.  Matuschewski K.  Vaccine development against malaria. Curr Opin Immunol. 2006 Aug;18(4):449-57.

15071.  Renia L, Gruner AC, Mauduit M, Snounou G. Vaccination against malaria with live parasites. Expert Rev Vaccines. 2006 Aug;5(4):473-81. Review.

Therapy:

15072.  Adam I, Magzoub M, Osman ME, Khalil IF, Alifrangis M, Elmardi KA.  A fixed-dose 24-hour regimen of artesunate plus sulfamethoxypyrazine-pyrimethamine for the treatment of uncomplicated Plasmodium falciparum malaria in eastern Sudan. Ann Clin Microbiol Antimicrob. 2006 Aug 26;5:18. 

15073.  Adam I, Ali DM, Abdalla MA.  Artesunate plus sulfadoxine-pyrimethamine in the treatment of uncomplicated Plasmodium falciparum malaria during pregnancy in eastern Sudan. Trans R Soc Trop Med Hyg. 2006 Jul;100(7):632-5. Epub 2006 Jan 24. 

15074.  Alecrim MG, de Lacerda MV, Mourao MP, Alecrim WD, Padilha A, Cardoso B, Boulos M.  First Brazilian experience with the use of artemether-lumefantrine (Coartem) a fixed-dosed ACT combination. Am J Trop Med Hyg. 2006 Aug;75(2):187.

15075.  Bathurst I, Hentschel C. Medicines for Malaria Venture: sustaining antimalarial drug development. Trends Parasitol. 2006 Jul;22(7):301-7. Epub 2006 Jun 6. Review. 

15076.  Bedu-Addo G. Chloroquine-induced bilateral ptosis. Trans R Soc Trop Med Hyg. 2006 Jul;100(7):696-7. 

15077.  Briand V, Cottrell G, Pilkington H, Cot M. Malaria and pregnancy. BJOG. 2006 Jul;113(7):854.

15078.  Brutus L, Watier L, Briand V, Hanitrasoamampionona V, Razanatsoarilala H, Cot M. Parasitic co-infections: does Ascaris lumbricoides protect against Plasmodium falciparum infection? Am J Trop Med Hyg. 2006 Aug;75(2):194-8. 

15079.  Checchi F, Piola P, Fogg C, Bajunirwe F, Biraro S, Grandesso F, Ruzagira E, Babigumira J, Kigozi I, Kiguli J, Kyomuhendo J, Ferradini L, Taylor WR,  Guthmann JP. Supervised versus unsupervised antimalarial treatment with six-dose artemether-lumefantrine: pharmacokinetic and dosage-related findings from a clinical trial in Uganda. Malar J. 2006 Jul 19;5:59. 

15080.  Chinbuah AM, Gyapong JO, Pagnoni F, Wellington EK, Gyapong M.  Feasibility and acceptability of the use of artemether-lumefantrine in the home management of uncomplicated malaria in children 6-59 months old in Ghana. Trop Med Int Health. 2006 Jul;11(7):1003-16.

15081.  Denis MB, Tsuyuoka R, Poravuth Y, Narann TS, Seila S, Lim C, Incardona S, Lim P, Sem R, Socheat D, Christophel EM, Ringwald P. Surveillance of the efficacy of artesunate and mefloquine combination for the treatment of uncomplicated falciparum malaria in Cambodia. Trop Med Int Health. 2006 Sep;11(9):1360-6.

15082.  Drakeley C, Sutherland C, Bousema JT, Sauerwein RW, Targett GA. The epidemiology of Plasmodium falciparum gametocytes: weapons of mass dispersion. Trends Parasitol. 2006 Sep;22(9):424-30. 

15083.  Enwonwu CO, Falkler WA Jr, Phillips RS. Noma (cancrum oris). Lancet. 2006 Jul 8;368(9530):147-56. Review.  

15084.  Gatton ML, Cheng Q. Plasmodium falciparum infection dynamics and transmission potential following treatment with sulfadoxine-pyrimethamine. J Antimicrob Chemother. 2006 Jul;58(1):47-51.

15085.  George IA, Varghese L, Mathews PK. Hemiparesis and cerebellar dysfunction complicating mixed malarial infection with falciparum and vivax malaria. Indian J Med Sci. 2006 Jul;60(7):296-7.

15086.  Greenwood B. Review: Intermittent preventive treatment--a new approach to the prevention of malaria in children in areas with seasonal malaria transmission. Trop Med Int Health. 2006 Jul;11(7):983-91. Review.

15087.  Guthmann JP, Cohuet S, Rigutto C, Fortes F, Saraiva N, Kiguli J, Kyomuhendo J, Francis M, Noel F, Mulemba M, Balkan S.  High efficacy of two artemisinin-based combinations (artesunate + amodiaquine and artemether + lumefantrine) in Caala, Central Angola. Am J Trop Med Hyg. 2006 Jul;75(1):143-5.

15088.   Hastings IM.  Gametocytocidal activity in antimalarial drugs speeds the spread of drug resistance. Trop Med Int Health. 2006 Aug;11(8):1206-17. Henry M, Alibert S, Orlandi-Pradines E, Bogreau H, Fusai T, Rogier C, Barbe

15089.  J, Pradines B. Chloroquine resistance reversal agents as promising antimalarial drugs. Curr Drug Targets. 2006 Aug;7(8):935-48. Review. 

15090.  Kachur SP, Slutsker L. Measuring malaria drug efficacy and transmission intensity. Lancet. 2006 Jul 1;368(9529):10-2.

15091.  Kendrick BJ, Gray AG, Pickworth A, Watters MP. Drotrecogin alfa (activated) in severe falciparum malaria. Anaesthesia. 2006 Sep;61(9):899-902. 

15092.  Kirira PG, Rukunga GM, Wanyonyi AW, Muregi FM, Gathirwa JW, Muthaura CN, Omar SA, Tolo F, Mungai GM, Ndiege IO.  Anti-plasmodial activity and toxicity of extracts of plants used in traditional malaria therapy in Meru and Kilifi Districts of Kenya. J Ethnopharmacol. 2006 Jul 19;106(3):403-7. Epub 2006 Mar 13. 

15093.  Kokwaro GO, Muchohi SN, Ogutu BR, Newton CR. Chloramphenicol pharmacokinetics in African children with severe malaria. J Trop Pediatr. 2006 Aug;52(4):239-43.

15094.  Melzer M.  Outpatient treatment of falciparum malaria is possible. BMJ. 2006 Aug 19;333(7564):397-8.

15095.  Nieuwenhuis JA, Meertens JH, Zijlstra JG, Ligtenberg JJ, Tulleken JE, van der Werf TS. Automated erythrocytapheresis in severe falciparum malaria: A critical appraisal. Acta Trop. 2006 Jul;98(3):201-6.

15096.  Nosten F, Ashley E, McGready R, Price R.  We still need artesunate monotherapy. BMJ. 2006 Jul 1;333(7557):45.

15097.  Pareek A, Nandy A, Kochar D, Patel KH, Mishra SK, Mathur PC. Efficacy and safety of beta-arteether and alpha/beta-arteether for treatment of acute Plasmodium falciparum malaria. Am J Trop Med Hyg. 2006 Jul;75(1):139-42. 

15098.  Quashie NB, Akanmori BD, Ofori-Adjei D, Goka BQ, Kurtzhals JA. Factors contributing to the development of anaemia in Plasmodium falciparum malaria: what about drug-resistant parasites? J Trop Pediatr. 2006 Aug;52(4):254-9.

15099.  Sarbib JL, Nankani G, Patel P. The Booster Program for Malaria Control: putting knowledge and money to work. Lancet. 2006 Jul 15;368(9531):253-7.

15100.  Sushil Kumar, Srivastava S. Establishment of artemisinin combination therapy as first line treatment for combating malaria: Artemisia annua cultivaiton in India needed for providing sustainable supply chain of artemisinin. currSci 2005, 89(7), 1097-102.

15101.  Wegmuller R, Camara F, Zimmermann MB, Adou P, Hurrell RF. Salt dual-fortified with iodine and micronized ground ferric pyrophosphate affects iron status but not hemoglobin in children in Cote d'Ivoire. J Nutr. 2006 Jul;136(7):1814-20. 

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