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PLoS Neglected Tropical Diseases Jun 2024Effective radical cure of Plasmodium vivax malaria is essential for malaria elimination in Brazil. P. vivax radical cure requires administration of a schizonticide, such...
Effective radical cure of Plasmodium vivax malaria is essential for malaria elimination in Brazil. P. vivax radical cure requires administration of a schizonticide, such as chloroquine, plus an 8-aminoquinoline. However, 8-aminoquinolines cause hemolysis in individuals with glucose-6-phosphate dehydrogenase (G6PD) deficiency, requiring prior screening to exclude those at risk. Brazil is pioneering the implementation of tafenoquine, a single-dose 8-aminoquinoline indicated for P. vivax patients with >70% of normal G6PD activity. Tafenoquine implementation in Manaus and Porto Velho, two municipalities located in the western Brazilian Amazon, included comprehensive training of healthcare professionals (HCPs) on point-of-care quantitative G6PD testing and a new treatment algorithm for P. vivax radical cure incorporating tafenoquine. Training was initially provided to higher-level facilities (phase one) and later adapted for primary care units (phase two). This study analyzed HCP experiences during training and implementation and identified barriers and facilitators. In-depth interviews and focus discussion groups were conducted 30 days after each training for a purposive random sample of 115 HCPs. Thematic analysis was employed using MAXQDA software, analyzing data through inductive and deductive coding. Analysis showed that following the initial training for higher-level facilities, some HCPs did not feel confident performing quantitative G6PD testing and prescribing the tafenoquine regimen. Modifications to the training in phase two resulted in an improvement in understanding the implementation process of the G6PD test and tafenoquine, as well as in the knowledge acquired by HCPs. Additionally, knowledge gaps were addressed through in situ training, peer communication via a messaging app, and educational materials. Training supported effective deployment of the new tools in Manaus and Porto Velho and increased awareness of the need for pharmacovigilance. A training approach for nationwide implementation of these tools was devised. Implementing quantitative G6PD testing and tafenoquine represents a significant shift in P. vivax malaria case management. Consistent engagement with HCPs is needed to overcome challenges in fully integrating these tools within the Brazilian health system.
Topics: Humans; Brazil; Malaria, Vivax; Antimalarials; Aminoquinolines; Glucosephosphate Dehydrogenase Deficiency; Health Personnel; Female; Glucosephosphate Dehydrogenase; Male; Plasmodium vivax; Adult
PubMed: 38837977
DOI: 10.1371/journal.pntd.0012197 -
Antimicrobial Agents and Chemotherapy Jun 2024The human malaria- monkey model has served the malaria research community since its inception in 1966 at the Gorgas Memorial Laboratory (GML) in Panama. Spanning over... (Review)
Review
The human malaria- monkey model has served the malaria research community since its inception in 1966 at the Gorgas Memorial Laboratory (GML) in Panama. Spanning over five decades, this model has been instrumental in evaluating the efficacy and pharmacokinetics of a wide array of candidate antimalarial drugs, whether used singly or in combination. The animal model could be infected with drug-resistant and susceptible and strains that follow a characteristic and reproducible course of infection, remarkably like human untreated and treated infections. Over the years, the model has enabled the evaluation of several synthetic and semisynthetic endoperoxides, for instance, artelinic acid, artesunate, artemether, arteether, and artemisone. These compounds have been evaluated alone and in combination with long-acting partner drugs, commonly referred to as artemisinin-based combination therapies, which are recommended as first-line treatment against uncomplicated malaria. Further, the model has also supported the evaluation of the primaquine analog tafenoquine against blood stages of , contributing to its progression to clinical trials and eventual approval. Besides, the / model at GML has also played a pivotal role in exploring the biology, immunology, and pathogenesis of malaria and in the characterization of drug-resistant and strains. This minireview offers a historical overview of the most significant contributions made by the Panamanian owl monkey () to malaria chemotherapy research.
PubMed: 38837364
DOI: 10.1128/aac.00338-24 -
Frontiers in Cellular and Infection... 2024Recent studies indicate that human spleen contains over 95% of the total parasite biomass during chronic asymptomatic infections caused by . Previous studies have...
Recent studies indicate that human spleen contains over 95% of the total parasite biomass during chronic asymptomatic infections caused by . Previous studies have demonstrated that extracellular vesicles (EVs) secreted from infected reticulocytes facilitate binding to human spleen fibroblasts (hSFs) and identified parasite genes whose expression was dependent on an intact spleen. Here, we characterize the spleen-dependent hypothetical gene (PVX_114580). Using CRISPR/Cas9, PVX_114580 was integrated into 3D7 genome and expressed during asexual stages. Immunofluorescence analysis demonstrated that the protein, which we named (PvSDP1), was located at the surface of infected red blood cells in the transgenic line and this localization was later confirmed in natural infections. Plasma-derived EVs from -infected individuals (PvEVs) significantly increased cytoadherence of 3D7_PvSDP1 transgenic line to hSFs and this binding was inhibited by anti-PvSDP1 antibodies. Single-cell RNAseq of PvEVs-treated hSFs revealed increased expression of adhesion-related genes. These findings demonstrate the importance of parasite spleen-dependent genes and EVs from natural infections in the formation of intrasplenic niches in , a major challenge for malaria elimination.
Topics: Extracellular Vesicles; Plasmodium vivax; Humans; Spleen; Malaria, Vivax; Protozoan Proteins; Erythrocytes; Fibroblasts; Plasmodium falciparum; Cell Adhesion; Host-Parasite Interactions
PubMed: 38828264
DOI: 10.3389/fcimb.2024.1408451 -
Risk Management and Healthcare Policy 2024Malaria is one of the most widespread infections worldwide, particularly in developing countries. Accordingly, Jimma Zone is one of the widely affected areas by malaria...
BACKGROUND
Malaria is one of the most widespread infections worldwide, particularly in developing countries. Accordingly, Jimma Zone is one of the widely affected areas by malaria in Ethiopia. In 2020 woreda health offices have reported the possible malaria epidemic that needs further investigation. Accordingly, this study aims to characterize the scope, pinpoint determinants connected to the Nono Benja woreda malaria outbreak, and implement suitable public health management measures.
METHODS
A descriptive cross-sectional study was followed by an unmatched case-control study with a 1:1 ratio of cases to controls. The sample size of 136 individuals (68 cases and 68 controls) was used. The collected data was imported into Epi-data version 3.1 and analyzed using SPSS version 25.0. By doing multivariate logistic regression association was determined at 95% confidence intervals P value of 5%.
RESULTS
A total of 687 instances were identified, giving an overall attack incidence of 1%. The assault rate ranged from 51.6 per 1000 people in Benja rural to 1.1 per 1000 people in Dhokonu Kebele. But there were no recorded deaths. and were the major types of Plasmodium species reported. From independent variables absence of ITNS [AOR 3.98 (CI = 1.11-24.8)], residing in an unsprayed home [AOR = 3.83 (CI = 1.04-14.08], presence of stagnant water in residential area [AOR = 4.25, CI (1.37-12.24113.10)], and lack of awareness on malaria prevention [AOR = 8.28 (CI 2.31-29.73)] were significantly associated with Malaria outbreak.
CONCLUSION
A number of factors, including lack of ITNS, lack of malaria health education, stagnant water, and IRS (indoor residual spray), were significantly linked with the occurrence of malaria outbreaks. The woreda health office should therefore provide ITNS to the community, use indoor residual spray, and disseminate health information regarding efficient and long-lasting malaria preventive and control techniques.
PubMed: 38828105
DOI: 10.2147/RMHP.S456958 -
Malaria Journal May 2024Nonadherence to national standards for malaria diagnosis and treatment has been reported in Sudan. In this study, qualitative research examined the clinical domains of...
BACKGROUND
Nonadherence to national standards for malaria diagnosis and treatment has been reported in Sudan. In this study, qualitative research examined the clinical domains of nonadherence, factors influencing nonadherent practices and health workers' views on how to improve adherence.
METHODS
In September 2023, five Focus Group Discussions (FGDs) were undertaken with 104 health workers from 42 health facilities in Sudan's Northern State. The participants included medical assistants, doctors, nurses, laboratory personnel, pharmacists and public health officers. The FGDs followed a semi-structured guide reflecting the national malaria case management protocol. Qualitative thematic analysis was performed.
RESULTS
Nonadherent practices included disregarding parasitological test results, suboptimal paediatric artemether-lumefantrine (AL) dosing, lack of counselling, use of prohibited artemether injections for uncomplicated and severe malaria, artesunate dose approximations and suboptimal preparations, lack of AL follow on treatment for severe malaria; and rare use of primaquine for radical Plasmodium vivax treatment and dihydroartemisinin-piperaquine as the second-line treatment for uncomplicated malaria. Factors influencing nonadherence included stock-outs of anti-malarials and RDTs; staff shortages; lack of training, job aids and supervision; malpractice by specialists; distrust of malaria microscopy and RDTs; and patient pressure for diagnosis and treatment. Health workers recommended strengthening the supply chain; hiring personnel; providing in-service protocol training including specialists; establishing external quality assurance for malaria diagnosis; and providing onsite supportive supervision and public health campaigns.
CONCLUSIONS
This study revealed a broad spectrum of behavioural and systemic challenges in malaria management among frontline health workers in Northern Sudan, including nonadherence to protocols due to resource shortages, training gaps, a lack of supportive supervision and patient pressure. These insights, including health workers' views about improvements, will inform evidence-based interventions by Sudan's National Malaria Control Programme to improve health systems readiness and the quality of malaria case management.
Topics: Sudan; Malaria; Health Personnel; Case Management; Humans; Antimalarials; Qualitative Research; Guideline Adherence; Male; Focus Groups; Female; Adult
PubMed: 38816778
DOI: 10.1186/s12936-024-04998-9 -
International Journal For Parasitology.... Apr 2024Target-based approaches have traditionally been used in the search for new anti-infective molecules. Target selection process, a critical step in Drug Discovery,...
Target-based approaches have traditionally been used in the search for new anti-infective molecules. Target selection process, a critical step in Drug Discovery, identifies targets that are essential to establish or maintain the infection, tractable to be susceptible for inhibition, selective towards their human ortholog and amenable for large scale purification and high throughput screening. The work presented herein validates the Plasmodium falciparum mRNA 5' triphosphatase (PfPRT1), the first enzymatic step to cap parasite nuclear mRNAs, as a candidate target for the development of new antimalarial compounds. mRNA capping is essential to maintain the integrity and stability of the messengers, allowing their translation. PfPRT1 has been identified as a member of the tunnel, metal dependent mRNA 5' triphosphatase family which differs structurally and mechanistically from human metal independent mRNA 5' triphosphatase. In the present study the essentiality of PfPRT1 was confirmed and molecular biology tools and methods for target purification, enzymatic assessment and target engagement were developed, with the goal of running a future high throughput screening to discover PfPRT1 inhibitors.
PubMed: 38810336
DOI: 10.1016/j.ijpddr.2024.100537 -
Heliyon May 2024[This corrects the article DOI: 10.1016/j.heliyon.2018.e00612.].
Corrigendum to "Discovery of small molecules through pharmacophore modeling, docking and molecular dynamics simulation against Plasmodium vivax Vivapain-3 (VP-3)" [Heliyon 4(5), May 2018, Article e00612].
[This corrects the article DOI: 10.1016/j.heliyon.2018.e00612.].
PubMed: 38807609
DOI: 10.1016/j.heliyon.2024.e30425 -
Malaria Journal May 2024Deforestation is an important driver of malaria dynamics, with a relevant impact on mosquito ecology, including larval habitat availability, blood-feeding behaviour, and...
BACKGROUND
Deforestation is an important driver of malaria dynamics, with a relevant impact on mosquito ecology, including larval habitat availability, blood-feeding behaviour, and peak biting time. The latter is one of several entomological metrics to evaluate vectorial capacity and effectiveness of disease control. This study aimed to test the effect of forest cover percentage on the peak biting time of Plasmodium-uninfected and infected Nyssorhynchus darlingi females.
METHODS
Mosquitoes were captured utilizing human landing catch (HLC) in the peridomestic habitat in field collections carried out in the wet, wet-dry transition, and dry seasons from 2014 to 2017 in areas with active malaria transmission in Amazonian Brazil. The study locations were in rural settlements in areas with the mean annual malaria parasite incidence (Annual Parasite Incidence, API ≥ 30). All Ny. darlingi females were tested for Plasmodium spp. infection using real time PCR technique. Forest cover percentage was calculated for each collection site using QGIS v. 2.8 and was categorized in three distinct deforestation scenarios: (1) degraded, < 30% forest cover, (2) intermediate, 30-70% forest cover, and (3) preserved, > 70% forest cover.
RESULTS
The highest number of uninfected female Ny. darlingi was found in degraded landscape-sites with forest cover < 30% in any peak biting time between 18:00 and 0:00. Partially degraded landscape-sites, with (30-70%) forest cover, showed the highest number of vivax-infected females, with a peak biting time of 21:00-23:00. The number of P. falciparum-infected mosquitoes was highest in preserved sites with > 70% forest cover, a peak biting at 19:00-20:00, and in sites with 30-70% forest cover at 22:00-23:00.
CONCLUSIONS
Results of this study show empirically that degraded landscapes favour uninfected Ny. darlingi with a peak biting time at dusk (18:00-19:00), whereas partially degraded landscapes affect the behaviour of Plasmodium-infected Ny. darlingi by shifting its peak biting time towards hours after dark (21:00-23:00). In preserved sites, Plasmodium-infected Ny. darlingi bite around dusk (18:00-19:00) and shortly after (19:00-20:00).
Topics: Animals; Brazil; Forests; Female; Feeding Behavior; Mosquito Vectors; Conservation of Natural Resources; Insect Bites and Stings; Seasons; Malaria
PubMed: 38807105
DOI: 10.1186/s12936-024-04984-1 -
Trends in Parasitology May 2024The geographic origin of Plasmodium vivax, a leading cause of human malaria, has been the subject of much speculation. Here we review the evolutionary history of P.... (Review)
Review
The geographic origin of Plasmodium vivax, a leading cause of human malaria, has been the subject of much speculation. Here we review the evolutionary history of P. vivax and P. vivax-like parasites in humans and non-human primates on three continents, providing overwhelming evidence for an African origin. This conclusion is consistent with recent reports showing that Duffy-negative humans in Africa are, in fact, susceptible to P. vivax, with parasites invading Duffy-antigen-expressing erythroid precursors. Thus, the African origin of P. vivax not only explains the distribution of the Duffy-negative genotype but also provides new insight into the history and status of P. vivax malaria in Africa and efforts geared toward its eradication.
PubMed: 38806300
DOI: 10.1016/j.pt.2024.05.001 -
Parasites & Vectors May 2024The spleen plays a critical role in the immune response against malaria parasite infection, where splenic fibroblasts (SFs) are abundantly present and contribute to...
BACKGROUND
The spleen plays a critical role in the immune response against malaria parasite infection, where splenic fibroblasts (SFs) are abundantly present and contribute to immune function by secreting type I collagen (collagen I). The protein family is characterized by Plasmodium vivax tryptophan-rich antigens (PvTRAgs), comprising 40 members. PvTRAg23 has been reported to bind to human SFs (HSFs) and affect collagen I levels. Given the role of type I collagen in splenic immune function, it is important to investigate the functions of the other members within the PvTRAg protein family.
METHODS
Protein structural prediction was conducted utilizing bioinformatics analysis tools and software. A total of 23 PvTRAgs were successfully expressed and purified using an Escherichia coli prokaryotic expression system, and the purified proteins were used for co-culture with HSFs. The collagen I levels and collagen-related signaling pathway protein levels were detected by immunoblotting, and the relative expression levels of inflammatory factors were determined by quantitative real-time PCR.
RESULTS
In silico analysis showed that P. vivax has 40 genes encoding the TRAg family. The C-terminal region of all PvTRAgs is characterized by the presence of a domain rich in tryptophan residues. A total of 23 recombinant PvTRAgs were successfully expressed and purified. Only five PvTRAgs (PvTRAg5, PvTRAg16, PvTRAg23, PvTRAg30, and PvTRAg32) mediated the activation of the NF-κBp65 signaling pathway, which resulted in the production of inflammatory molecules and ultimately a significant reduction in collagen I levels in HSFs.
CONCLUSIONS
Our research contributes to the expansion of knowledge regarding the functional role of PvTRAgs, while it also enhances our understanding of the immune evasion mechanisms utilized by parasites.
Topics: Plasmodium vivax; Fibroblasts; Antigens, Protozoan; Signal Transduction; Animals; Collagen Type I; Spleen; Transcription Factor RelA; Mice; Humans; Malaria, Vivax; Protozoan Proteins; Tryptophan; Escherichia coli; Computational Biology
PubMed: 38802961
DOI: 10.1186/s13071-024-06264-y