Dengue and falciparum malaria co-infection in travelers returning from Burkina Faso:Report of two cases in Northeastern Italy

Rationale: Malaria and dengue are the most prevalent vector-borne diseases in tropical countries. Plasmodium parasite and dengue virus(DENV) concurrent infection is possible and often under-recognized in geographical areas where these infections are both endemic.Patients concern and diagnosis: We describe the first two cases of Plasmodium falciparum and DENV-3 co-infection in travelers returning to northeastern Italy from Burkina Faso during 2013-2014.Interventions: Malaria infection in both patients was treated with mefloquine. Due to the persistence of symptoms despite of the antimalaria treatment, dengue was also investigated;the treatment of dengue was symptomatic.Outcomes: The patients were discharged in good general condition.Lessons: The need for surveillance of potential malaria and dengue co-infection in travelers returning to Europe from endemic areas is highlighted, as infection with Plasmodium does not exclude arboviral co-infection.

A Comparative Study of Dihydroartemisin in Compounds in Treatment of Uncomplicated Falciparum Malaria in Kampong of Cambodia

Objective: To compare the safety and efficacy of two compounds of dihydroartemisinin(DHA) -Artekin and Artekin (T) in the treatment of uncomplicated falciparum malaria. Methods:The regimen of 8-tablet for 2 days of Artekin and Artekin (T) were applied to 100 patients with uncomplicated falciparum malaria, who were randomly divided into two groups. Each group contained 50 cases. The cure rate, the mean parasites clearance time, the mean fever clearance and side-effects were observed to assess the safety and efficacy of the compounds used. Results: The mean parasites clearance time was 31. 7±9.0 hours in the Artekin group and 32. 8±8. 8 hours in Artekin (T) group respectively; the mean fever clearance time was 12. 7±7. 2 hours in Artekin group and 16. 5±7. 9 hours in Artekin (T) group; there were no recrudescence case in both groups within the 28 days of follow-up, the cure rates in Artekin group and Artekin (T) groups were 100%. It indicated that the tolerability of both compounds were very good, the side-effects such as nausea, abdominal pain were mild and self-limited. Conclusion: The study preliminarily indicated that the DHA and PQ compounds were of high efficacy, rapid acting and low toxici-ty. Artekin is very promising as a cheap, simple, effective treatment for multi-resistance malaria in Cambodia.

Definition of hyperparasitemia in severe falciparum malaria should be updated

Hyperparasitemia is one criterion of severe falciparum malariaby World Health Organization(WHO)for more than two decades[1].Although there is a correlation between density of parasittemiaand severity of malaria,some individuals with high parasite countsmay not be severely ill,whereas others with low parasitemia mayhave ultimately fatal infections.Hyperparasitemia(more than 5%

Association of ABO blood group and Plasmodium falciparum malaria in Dore Bafeno Area,Southern Ethiopia

Objective:To assess the distribution of ABO blood group and their relationship with Plasmodium falciparum(P.falciparum) malaria among febrile outpatients who sought medical attention at Dore Bafeno Health Center,Southern Ethiopia.Methods:A total of 269 febrile outpatients who visited Dore Bafeno Health Center,Southern Ethiopia,were examined for malaria and also tested for ABO blood groups in January 2010.The blood specimens were collected by finger pricking,stained with Geimsa,and examined microscopically.Positive cases of the parasitemia were counted.CareStart^(TM) Malaria PflPv Combo was also used to test the blood specimens for malaria.ABO blood groups were determined by agglutination test using ERYCLONE antisera.Data on socio-demographic characteristics and treatment status of the participants were also collected.Chi-square and ANOVA tests were used to assess the difference between frequencies and means,respectively.Results:Out of a total of 269 participants,178(66.2%) febrile patients were found to be infected with Plasmodium parasites,among which 146(54.3%),28(10.4%),and 4(1.5%) belonged to P.falciparum,P.vivax,and mixed infections,respectively.All febrile patients were also tested for ABO blood groups and 51.3%,23.5%,21.9%and 3.3%were found to be blood types of 0,A,B and AB,respectively.Both total malaria infection and P.falciparum infection showed significant association with blood types(P<0.05).The proportion of A or B but not 0 phenotypes was higher(P<0.05) in individuals with P.falciparum as compared with non-infected individuals.The chance of having P.falciparum infection in patients with blood groups A,B and AB was 2.5,2.5 and 3.3times more than individuals showing blood 0 phenotypes,respectively.The mean P.falciparum malaria parasitemia for blood groups A,B,AB,and 0 were 3 744/μ L,1 805/ μ L,5 331/μ L,and1 515/μ L,respectively(P<0.01).Conclusions:The present findings indicate that individuals of blood groups A,B and AB are more susceptible to P.falciparum infection as compared with individuals of blood group O.Nevertheless,further in depth studies are required to clearly establish the role that ABO blood group plays in P.falciparum malaria.

Hemozoin triggers tumor necrosis factor alpha-mediated release of lysozyme by human adherent monocytes:new evidences on leukocyte degranulation in P.falciparum malaria

Objective:Avidly phagocytosed hemozoin(malarial pigment) alters several functions of human monocytes and stimulates generation of several cytokines.Recently,we showed that phagocytosis of hemozoin by human monocytes increases expression and activity of matrix metalloproteinase-9,a proteolytic enzyme available in specific gelatinase granules,which contain several enzymes including lysozyme.Present work investigated active lysozyme release after phagocytosis of hemozoin and its dependence on production of tumor necrosis factor alpha. Methods:After phagocytosis of hemozoin,hemozoin-containing trophozoites or control meals(opsonized nonparasitized red blood cells and latex particles),monocyte supematants were monitored for 2 hours,in presence of blocking anti-human tumor necrosis factor alpha antibodies or recombinant human tumor necrosis factor alpha cytokine in selected experiments.Lysozyme release was evaluated by a specific spectrometric assay measuring lysozyme activity after coincubation of cell supematants with suspensions of Mycrococcus Lysodeikticus,while levels of soluble tumor necrosis factor alpha were analyzed by specific enzyme-linked immunodsorbent assay. Results:Levels of lysozyme activity and soluble tumor necrosis factor alpha protein were increased in hemozoin in-or trophozoites-laden monocytes supematants.Phagocytosis per se(control meals) also increased lysozyme release,but levels were significantly lower than those obtained after phagocytosis of hemozoin or trophozoites. Interestingly,all effects on lysozyme release observed after phagocytosis were abrogated by blocking anti-human tumor necrosis factor alpha antibodies,while they were mimicked by recombinant human tumor necrosis factor alpha cytokine.Conclusions:Present work shows that phagocytosis of hemozoin promotes monocyte degranulation and enhances active lysozyme release.The effect requires tumor necrosis factor alpha mediation.

Indicators of fatal outcome in severe Plasmodium falciparum malaria:a study in a tertiary-care hospital in Thailand

Objective:To illustrate the clinical features and investigate the indicators associated with a fatal outcome in adult patients with severe Plasmodium falciparum malaria admitted to the Hospital for Tropical Diseases,Bangkok,Thailand.Methods:We studied 202 adult malaria patients admitted to the Intensive Care Unit.A total of 43 clinical variables were identified by univariate and logistic regression analyses,to eliminate confounding factors.Results:Regarding the statistical methods,only 6 variables-jaundice,cerebral malaria,metabolic acidosis,body mass index,initial respiratory rate,and white blood cell count-were significant indicators of death, with adjusted odds ratios(95%CI) of 15.2(2.1-32.3).4.3(2.3-12.6),3.3(2.3-5.7),2.4(1.9-3.5),2.2 (1.5-2.6),and 1.7(1.2-3.1),respectively.Conclusions:Our study found that jaundice,cerebral malaria,metabolic acidosis,body mass index,initial respiratory rate and white blood cell count were indicators of fatal outcome in severe Plasmodium falciparum malaria.Further studies on the fatal indicators in severe malaria need to be compared with data from different geographical areas,to construct practical measures to address potentially fatal indicators in different settings.

Schistosoma haematobium and Plasmodium falciparum coinfection with protection against Plasmodium falciparum malaria in Nigerian children

Objective:Malaria remains the single leading killer of children in sub - Sahara Africa and Schistosomiasis is considered to be second to malaria in global importance.Co - infection of malaria and urinary schistosomiasis has been reported to exacerbate disease morbidity such as anaemia.In different part of the globe,the co - infection between malaria and schistosomiasis provides some protections on the infected persons.The protective effect of this co - infection elucidated immunologically using cytokines is lacking in our locality.Methods:Urine and blood samples obtained from the 160 volunteers were subjected to standard parasitological techniques for diagnosis of urinary schistosomiasis and malaria respectively.Blood samples collected from these volunteers comprising 80 children with schistosomiasis and malaria and the 80 children who had malaria only were subjected to cytokines concentration determination using commercial standard enzyme linked immunosorbent assay kits(Abeam,UK).Results:Eighty participants with co - infection had a mean malarial parasitaemia of 662±201.1μL while the 80 participants with only P.falciparum malaria had a mean malarial parasiteamia of 5943±3270.7μL.Also the volunteers had mean haemoglobin of 11.2 g/dL for co - infected individuals and 5.7 g/dL for participants with single infection of malaria.The serum cytokine levels of the children with S. haematobium and P.falciparum and only P.falciparum infection are as follows;interleukin - 4(16.6 pg/ mL versus 5.2 pg/mL),IL - 5(501.3 pg/mL versus 357.5 pg/mL);IL -8(2 550 pg/mL versus 309 pg/mL),IL - 10(273 pg/mL versus 290 pg/mL),TNF -α(25 pg/mL versus 290 pg/mL) and IFN -γ(21.9 pg/mL versus 2.5 pg/mL).The TNF -α/IL - 10 ratio is 7 for the children with co - infection while those with only P.falciparum malaria infection had a TNF -α/IL - 10 ratio of 0.9.Conclusion:We conclude that the elevated IL - 4,IL - 5,IL - 8 and IFN -γconcentration induced by schistosomiasis altered the Th1/Th 2 profile and protected the children against the morbidity and severity of malaria attack among the children with co - infection.

Higher production of tumor necrosis factor alpha in hemozoin-fed human adherent monocytes is dependent on lipidic component of malarial pigment:new evidences on cytokine regulation in Plasmodium falciparum malaria

Objective:To investigate whether the increase of tumor necrosis factor alpha is dependent on lipidic component of malarial pigment.Methods:Adherent human monocytes were fed for 3 hours with different meals(native hemozoin;lipid free hemozoin;and control latex particles),then tumor necrosis factor alpha was monitored in cell supernatants up to 48 hours through western blotting or specific enzyme-linked immunoadsorbent assay.In selected experiments,unfed monocytes were treated with different doses of 15(S,R)-hydroxy-6,8,11,13-eicosatetraenoic acid or 4-hydroxynonenal instead of phagocytosis.Results:Hemozoin-fed monocytes produced higher levels of tumor necrosis factor alpha than unstimulated and latex-fed cells, while lipid-free hemozoin did not reproduce these results.Additionally,hemozoin effects were mimicked dose-dependently by 15(S,R)-hydroxy-6,8,11,13-eicosatetraenoic acid,but not by 4-hydroxynonenal.Conclusions:Present data suggest an essential role for lipids in hemozoindependent enhanced release of tumor necrosis factor alpha from monocytes,and 15(S,R)hydroxy -6,8,11,13-eicosatetraenoic acid could be one possible specific mediator.

Cortisol and uncomplicated Plasmodium falciparum malaria in an area of unstable malaria transmission in eastern Sudan

Objective:To investigate the levels of serum Cortisol in patients with uncomplicated Plasmodium falciparum(P.falciparum) malaria in an area of unstable malaria transmission in eastern Sudan. Methods:The concentrations of Cortisol were measured in sera of 25 patients with uncomplicated P.fylciparum malaria(at presentation,24 h and 7 d later) and 25 healthy volunteers using radioimmunoassay gamma counter.Results:There was no significant difference in mean(SD) of total Cortisol levels in patients with malaria in comparison with the control group;602.2(369.6) vs. 449.2(311.7) ng/mL,P=0.12.In patients with uncomplicated P.falciparum malaria,the mean(SD) presenting Cortisol levels were significantly higher in comparison to the levels on day 7;602.2 (369.6) vs.373.6(139.1) ng/mL,P=0.009.In the patients with uncomplicated P.falciparum malaria (on presentation) Cortisol levels were not correlated with initial temperature or the presenting parasitaemia.Conclusions:Thus,Cortisol levels were not significantly different between the patients and the controls.

Changing trends in prevalence of different Plasmodium species with dominance of Plasmodium falciparum malaria infection in Aligarh(India)

Objective:To determine the prevalence of malaria in Aligarh and analyze species dominance in different years over a decade.Methods:Diagnosis of malaria was done using microscopy as gold standard,rapid antigen detection assays and quantitative buffy coat(QBC) assays.Giemsa stained blood smear examination was done,thick and thin films were examined for presence of different Plasmodium spp.Rapid antigen detection assays employing detection of HRP-2 and parasite lactate dehydrogenase antigen(pLDH) by immunochromatography was done in patients whose blood smear found to be negative by conventional Giemsa slide examination.QBC was done in cases where there is strong clinical suspicion of malaria with blood smear negative,in patients with chronic malaria,splenomegaly,or in those patients who had inadequate treatment and for post-treatment follow up.Results:Plasmodium vivax and Plasmodium falciparum were only species detected in our hospital.Overall prevalence of malaria in Aligarh was found to be 8.8%.The maximum prevalence of 20.1%was observed in year 2008 and lowest 2.3%in 2002. Conclusions:High prevalence of malaria is observed in this part of country with dominance of both species particularly Plasmodium falciparum should be monitored and factors accounting for occurrence should be studied to employ effective control measures.

Investigation of the Efficacy of Home-Based Oral Chloroquine Treatment among Under-Five Children with Plasmodium falciparum Malaria in Some Parts of Jos, Plateau State, Nigeria

Background: Nigeria is currently a malaria endemic country with an estimated 76% of her population at risk of contracting malaria [1]. According to a study in Nigeria, the first line of action mothers took when their children under 5 years have malaria showed that over 50% of them used non-prescription drugs they have at home or bought from pharmacy stores. And 60% of the most commonly used drugs for malaria treatment were chloroquine [2]. Many recent studies have demonstrated re-emergence of chloroquine-sensitive P. falciparum, suggesting a possible role in future malaria control [3]. Objective: The aim of this study was to investigate the effect of home-based oral chloroquine treatment among children under 5 years with Plasmodium falciparum malaria attending Jos University Teaching Hospital and OLA Hospital in Jos Metropolis. Method: This is a cross-sectional study of 93 malaria and non-malaria children. Malaria diagnosis was carried out using microscopical examination of Leishman’s stained thick and thin blood films, P. falciparum parasitemia was assessed by standard microscopy techniques and complete blood count was done using Beckman Coulter Analyzer. Results: The body temperature on admission was significantly lower (p &#730;C ± 0.07&#730;C) than in the three malaria groups. The mean body temperature of chloroquine treated children with malaria was significantly lower (p Conclusion: The results obtained in this study demonstrate that there was significant positive impact of chloroquine treatment on Plasmodium falciparum parasitemia and degree of anemia in children under 5 years with Plasmodium falciparum in Jos Metropolis.

Effect of Primaquine on Gametocyte Carriage in the Case-Management of Uncomplicated Falciparum Malaria with Acts: Nigerian Perspective

Background: Drugs that kill or inhibit sexual stages of Plasmodium such as Primaqiune (PQ) could potentially amplify or synergize the impact of first line antimalarials by blocking transmission to mosquitoes. This study examined the effect of Primaquine on gametocyte carriage in the case management of uncomplicated falciparum malaria with artemisinin-based combination therapy (ACT) with the overall purpose of possibly recommending it as an adjunct drug for malaria control. Methods: A total of 181 patients with uncomplicated falciparum malaria, normal glucose-6-phosphate dehydrogenase (G6PD) enzyme levels, and haemoglobin levels ≥ 8 g/dL completed this two-arm randomized blinded clinical trial to test the efficacy of a single dose PQ (0.75 mg/kg) on falciparum gametocytaemia. 88 subjects were assigned to a standard 3-day course of Dihydroartemisinin-Piperaquine (DHP) alone (n = 88) while 93 others had DHP combined with a single dose of PQ on day 3 (n = 93). A 28-day follow-up schedule carried out in the outpatient clinic of a Primary health facility in Vom, Plateau State Nigeria where study participants were seen on days 1, 3, 7 and then weekly to assess the presence of asexual parasites and gametocytes by microscopy. A Kaplan-Meier analysis was employed to determine the survival function of gametocytes on day 3. The data was analyzed using Epi info version 7.1.5. Results: With a gametocyte prevalence of 27.1%, gametocyte carriage rate was lower in the PQ group due to higher probability of clearing gametocytes (Breslow test χ2 = 8.306, df = 1, p = 0.004) and significantly less likely to harbor gametocytes by day 7 when compared to the DHP-alone group (χ2 = 6.218, df = 1, p = 0.013). Conclusion: Addition of single-dose 0.75 mg/kg PQ was associated with reduced gametocyte carriage as a result of faster gametocyte clearance and lower incidence of gametocyte development in DHP-treated patients. PQ as gametocytocidal drug may be useful in combination with artemisinin-based combination therapy (ACT) regimen to clear gametocytes and thereby interrupt malaria transmission to mosquito vector more effectively than ACT alone.

Prolonged parasite clearance in a Chinese splenectomized patient with falciparum malaria imported from Nigeria

Background:The spleen plays a pivotal role in the rapid clearance of parasitized red blood cells in patients with falciparum malaria after artemisinin treatment.Prolonged parasite clearance can be found in patients who have had a splenectomy,or those with hemoglobin abnormalities and/or reduced immunity,which are all distinguishable from artemisinin resistance.This paper reports on a case of prolonged parasite clearance in a Chinese splenectomized patient with falciparum malaria imported from Nigeria.Case presentation:A 35-year-old Chinese male suffered 2 days of febrile illness after returning to Zhumadian city of Henan province from Nigeria on October 1,2014.The main symptoms were febrile,including the highest axillary temperature of 40℃,headache,and chills.A peripheral blood smear showed parasitemia(53913 asexual parasites/μl)of Plasmodium falciparum.The patient had not used any chemoprophylaxis against malaria in Nigeria when he worked there as a construction worker between 2009 and 2014.The patient had three episodes of malaria in Nigeria and had a splenectomy due to a traffic accident 8 years ago from the time he was admitted to hospital.The patient was orally administrated a total of 320 mg/2.56 g dihydroartemisinin-piperaquine for 2 days and intravenously administrated a total of 3000 mg artesunate for 18 days.The axillary temperature of the patient ranged between 37.0 and 37.7℃ from Day 0 to Day 3,and blood microscopy revealed falciparum malaria parasitemia(26674 asexual parasites/μl)on Day 3.The patient was afebrile on Day 4,falciparum malaria parasitemia was continuously present and then gradually decreased on the next days,and was negative on Day 21.The patient was cured and left hospital on Day 24 after no plasmodium falciparum was found in the blood on Day 21 to Day 23.No mutation was found in the K13 propeller gene when compared with the PF3D7_1343700 K13 propeller gene reference sequence.Conclusions:This is the first reported case in China of prolonged parasite clearance in a splenectomized patient with imported falciparum malaria.Artemisinin resistance should be distinguished when prolonged parasite clearance is found in a malaria patient who has had splenectomy.

Soil-transmitted helminths and plasmodium falciparum malaria among individuals living in different agroecosystems in two rural communities in the mount Cameroon area:a cross-sectional study

Background:Soil-transmitted helminths(STHs)and Plasmodium falciparum infections remain public health problems in Cameroon.A cross-sectional study was carried out in the Mount Cameroon area to determine the prevalence and intensity of STHs and P.falciparum infections in individuals living in different agroecosystems;to assess the influence of these infections on haematological parameters;and to identify the risk factors associated with STH infections.Methods:STH and malaria parasites were detected using the Kato-Katz method and Giemsa staining of blood films,respectively.Complete blood count values were obtained using an automatic haematology analyser.Soil samples were analysed using the sucrose floatation sedimentation method.Categorical and continuous variables were compared as required and logistic regression models were used to assess the risk factors for STH infections and anaemia.Results:Of the 450 participants examined,STHs,P.falciparum and mixed co-infections were detected in 14.0,33.3 and 5.6%of participants,respectively.Significantly higher prevalences of Ascaris(18.8%)and Trichuris(7.9%)infections were observed in participants from tea plantation areas compared to those from banana and palm plantation areas,with similar trends in egg density.P.falciparum prevalence and parasite density were comparable between the different agroecosystems.The overall prevalence of anaemia was 64.2%.The prevalence of haematological manifestations such as moderate(48.0%)and severe(8.0%)anaemia,leucopenia(26.9%)and microcytosis(30.8%)was significantly higher among Plasmodium-STH co-infected participants.Soil samples from plantations showed the highest prevalences of STH eggs compared to soil samples from areas around pit toilets and public water taps.Living in a tea plantation area(OR=3.07),age(AOR=1.49)and lack of access to potable water(OR=2.25)were identified as risk factors for STH infections,while the age groups 15-25 years(OR=2.928)and 26-35 years(OR=2.832),and being female(OR=2.671)were significant risk factors for anaemia.Conclusions:STHs,malaria and anaemia are still of public health concern in plantation communities.Co-infections negatively influence haematological parameters.The tea farming agroecosystem,age and lack of access to potable water were identified as significant risk factors for STH infections.Trial registration:Not applicable.

Optimal control analysis of hepatocytic-erythrocytic dynamics of Plasmodium falciparum malaria

This paper presents an in-host malaria model subject to anti-malarial drug treatment and malaria vaccine antigens combinations.Pontryagin's Maximum Principle is applied to establish optimal control strategies against infected erythrocytes,infected hepatocytes and malaria parasites.Results from numerical simulation reveal that a combination of preerythrocytic vaccine antigen,blood schizontocide and gametocytocide drugs would offer the best strategy to eradicate clinical P.falciparum malaria.Sensitivity analysis,further reveal that the efficacy of blood schizontocides and blood stage vaccines are crucial in the control of clinical malaria infection.Futhermore,we found that an effective blood schizontocide should be used alongside efficacious blood stage vaccine for rapid eradication of infective malaria parasites.The authors hope that the results of this study will help accelerate malaria elimination efforts by combining malaria vaccines and anti-malarial drugs against the deadly P.falciparum malaria.

Evaluation of ECL Labeled DNA Probe for the Diagnosis of Falciparum Malaria

A commercially available non—radioactive DNA labelling kit "enhanced chemiluminescence"(ECL) was evaluated for the diagnosis of falciparum malaria. The results showed that ECL labeled probe successfully detected as little as 25 pg. Purified DNA of 0.001％ parasitemia of cultured Plasmodium falciparum and did not react with human

A Randomized,Controlled Trial of Artemisinin-piperaquine vs Dihydroartemisinin-piperaquine Phosphate in Treatment of Falciparum Malaria

Objective:The study aimed to evaluate and compare the efficacy and safety of dihydroartemisininpiperaquine phosphate(Artekin) and artemisinin-piperaquine(Artequick) in the treatment of uncomplicated falciparum malaria.Methods:A total of 103 uncomplicated falciparum malaria patients were enrolled and randomly assigned to two groups:52 cases in the Artequick group,and 51 cases in the Artekin group.The patients in the Artequick group were administered with Artequick,twice in 24 h,whereas the patients in the Ar...

Sequence Analysis and Genotypes of Glutamate Rich Protein of Plasmodium falciparum Isolates from Different Malaria Endemic Areas in China

Objective To sequence the gene encoding glutamate rich protein (GLURP) andidentify the genotypes of geographically different Plasmodium falciparum (P. f ) isolatesfrom China. Methods The gene of R2 repeat region of GLURP was amplified by nestedpolymerase chain reaction and cloned into T-vector. The nucleotide sequence of GLURPgene was determined by automatic sequencer (Dideoxy termination method) and analyzed byDNA Star software. Results At least 7 different GLURP genotypes ranging from 600 bpto 1 500 bp were found in Yunnan and Hainan provinces. R2 region of GLURP gene consistedof several repeat units. Each repeat unit was composed of 19-20 residues which were shownto be highly conserved. GLURP gene was also size polymorphic due to differences in thenumber of repeat units, whereas the repeat sequence was conserved. Sequence analysisshowed that DNA sequences and deduced amino acid sequences were highly homologousamong the geographically dispersed isolates or various isolates from the same geographicalregion. No obvious differences were found in the GLURP gene sequences amonggeographically different isolates. Conclusion GLURP gene is highly structure conservedand size polymorphic, and so is useful in searching for malaria vaccine candidate antigen anddeveloping a genotyping method for malaria research.

Acquisition of naturally acquired antibody response to Plasmodium falciparum erythrocyte membrane protein 1-DBLα and differential regulation of IgG subclasses in severe and uncomplicated malaria

Objectives: To explore whether individuals infected with Plasmodium falciparum(P. falciparum) develop antibodies directed against Pf EMP1-DBLa, and to assess their IgG subclass distribution in severe and uncomplicated malaria.Methods: The anti-PfDBLα IgG and their IgG subclass distributions in plasma of severe(SM) and uncomplicated malaria(UCM) were assessed by enzyme-linked immunoabsorbent assay. The antibody profiles to P. falciparum blood stage antigens were evaluated. CD36 binding ability was determined by static receptor-binding assays.Rosette formation was performed by staining with acridine orange.Results: Significantly higher number of UCM(86.48%) than SM(57.78%) plasma contained total acquisition of specific IgG to P. falciparum antigens(P = 0.000). Similar manners were seen in response to P. falciparum DBLa with significant difference(UCM,59.46% vs SM, 40.00%; P = 0.014). Anti-PfDBLα-IgG1 and-IgG3 were the predominant subclasses. Similar percentage of UCM(31.82%) and SM(33.33%) plasma contained only IgG1, while 13.64% of UCM and 27.78% of SM plasma contained only IgG3. AntiPfDBLα-IgG1 coexpressed with more than one subclass was noted(UCM, 27.27%; SM,16.67%). Obviously, IgG1 coexpressed with IgG3(9.09%) was observed in only UCM plasma. IgG1 was coexpressed with IgG2 in UCM(9.09%) and SM(11.11%) plasma,while IgG1 was coexpressed with IgG4 only in UCM plasma(4.55%). IgG subclasses to P. falciparum antigens were distributed in a similar manner. Only the levels of IgG1, but not IgG3 were significantly higher in UCM than in SM.Conclusions: These data suggest that individuals infected with P. falciparum can develop the anti-Pf EMP1 antibodies with the major contribution of specific IgG subclasses. The balance and the levels of anti-PfDBLα IgG subclasses play a crucial role in antibody mediated protection against severe malaria.

Mapping and Prevalence of Malaria Falciparum Patients with ACT Failed Therapy, in Hanura Public Health Center, Pesawaran, Lampung, Indonesia

Malaria is a public health issue that can cause death. According to the Indonesian Health Profile, in the year 2010, an estimated 45% of Indonesia’s population live in malaria-endemic areas. Pesawaran District is one of the malaria-endemic areas in Lampung province, whose Annual Parasite Incidence in 2010 and 2011 were 2.77 and 4.76 respectively. One of the factors that may inhibit the malaria control is Plasmodium resistance to antimalarial drugs. This study aims to conduct a mapping study and see the prevalence of ACT treatment failure, in Pesawaran District, Lampung Province, Indonesia. Data collection was performed at the Primary Health Centers (PHC) Hanura. A total of 69 samples according to the inclusion and exclusion criteria, the microscopic examination serially for 28 days was done. Microscopic examination performed on D0, D1, D2, D3, D7, D14, D28, and a complaint is found outside the schedule. Coordinates of patient house, determined using GPS. Based on observations, microscopic examination and spatial analysis, the prevalence of ACT treatment failure in patients with falcipaum malaria was 11.59%. The malaria falcifarum patient spread around the coast, that were near vector breeding places. There were five clusters of malaria falciparum patients and one cluster of malaria falciparum patient with treatment failure that were formed. Only one significant cluster of malaria falciparum patient (P = 0.0027, radius 0 km) is found, while the other cluster is not statistically significant. The cluster of malaria falciparum patient with treatment failure was not statistically significant (P = 1.000, radius 0.15 km), but this cluster is located in the area of the suspected vector breeding place. The cluster formation means that people living within a radius of these clusters have a greater risk to get malaria infection.