Plasmodium Vivax-infected Patients Research Articles

The Pattern of Parasite Density, Plasma Total Bile Acids and Lactate Dehydrogenase in Plasmodium Infected Patients in Rural Community

<b>Background to the study: </b>Pathophysiology of Plasmodium (vivax, ovale, falciparum and malariae) infection involves liver. Liver dysfunction and destruction of tissues could be indicated by the plasma level of Total Bile Acid (TBA) and Lactate Dehydrogenase (LDH). <b>Aim and Objective:</b> This work was designed to evaluate the pattern of parasite density, plasma total bile acids, and Lactate dehydrogenase in Plasmodium infected patients in rural community. <b>Materials and Methods:</b> The study was carried out in Kishi, the Headquarter of Irepo Local government area of Oyo state - Nigeria. Seven hundred and nine (709) subjects (Female: n=403: male: n=306) aged 5 to 68 years were tested for Plasmodium infection using Giemsa- thick film technique. The overall prevalence of Plasmodium infection among the seven hundred and nine subjects screened was found to be 29.1% (206) including 12.97% (92) HIV, HBsAg and anti-HCV seronagative patients and 16.1% (114) HIV, HBsAg or anti-HCV seropositive patients. Ninety two (92 (12.97%)) that were HIV, HBsAg and anti-HCV seronagative(female-58 (63.0%); male-34 (37%)) were recruited out of 206 (29.1%) that were found to be infected with plasmodium spp for the study. None of the subject was jaundiced as at the time of sample collection. Hepatitis B surface antigen (HBsAg) and anti-HCV tests were carried out by Enzyme Linked Immunozorbent Assay (ELIZA). HIV screening and confirmation were carried out by immuno-chromatographic and Immunobloting (Western blot) assays respectively. Fasting Plasma Total Bile Acids (TBA) and Lactate Dehydrogenase (LDH) were analyzed in the patients biochemically by spectrophotometry. <b>Result:</b> The result obtained showed an overall prevalence of Plasmodium infection as 29.1% (206) (female: 107 (52%); male: 99 (48%)) including 12.97% (92) (Female: 58 (63.0%) Male: 34 (37%)) that were HIV, HBsAg and anti-HCV seronagative and 16.1% (114) (Female: 61 (53.5%); Male: 53 (46.5%)) were co-infected with at least one of HIV, HBV or HCV. The plasmodium infected subjects were grouped into three based on the parasite density such as: patients with parasite density of 50-499; 500-999 and ≥1000. The mean value of the parasite density of each group was correlated with the plasma level of LDH and TBA. In all groups there was a strong positive correlation(R=1; R2 =1) between the plasma TBA, LDH and plasmodium parasite density. The pattern of parasite density obtained in the rural community studied include 45.7% had a mean parasite density of 282±12.0; 43.5% (853±31.0) and 10.9% (1130±61.0). There was also a statistical significant increase in the mean value of LDH and TBA with increase in parasite density with p<0.05. <b>Conclusion:</b> This work showed an overall prevalence of 29.1% (206) plasmodium infection including 16.1% (114) of the patients co-infected with at least one of HIV, HBV or HCV. The plasma level of LDH and TBA was also found to be positively correlated and directly proportional to the parasite density. Evaluation of these parameters is therefore recommended for effective control and management.

Evaluation of Parasite Density, Plasma Total Bile Acids, Alanine Transaminase, Lactate Dehydrogenase and CD4 in Plasmodium Infected Patients Treated with Morinda lucida (Oowo)

<i>Morinda Lucida</i> has been tested to have antimalarial and antidibetic effect among other health benefits. It is commonly used for the treatment of malaria infection in Oke-Ogun and its environs. Despite the health usefulness of this extract little has been reported about its biochemical alterations. This work was therefore designed to evaluate the parasite density, plasma total bile acids, Alanine transaminase, Lactate dehydrogenase and CD4 in Plasmodium infected patients treated with <i>Morinda Lucida</i><b> (Oowo)</b>. Sixty four(64) HIV, HBsAg and anti-HCV seronagative Plasmodium infected patients visiting traditional hoimes in Oke-Ogun the Nothern part of Oyo state Nigeria for traditional malaria cure aged 5 to 73 years classified into Female (n=34) and Male (n=30) were investigated. Hepatitis B surface antigen (HBsAg) and anti-HCV tests were carried out by Enzyme Linked Immunozorbent Assay (ELIZA). HIV screening and confirmation were carried out by immuno-chromatographic and Immunobloting (Western blot) assays respectively. Fasting Plasma Total Bile Acids (TBA), Lactate Dehydrogenase (LDH) and Alanine aminotransferase (ALT) were carried out biochemically by spectrophotometry while CD4 cell count was carried out by cytoflowmetry using Partec Cyflow machine and reagent. The tests were carried out in the control and test subjects before and after the treatment with the raw liquid extract of the leaf of <i>Morinda Lucida</i>. The result obtained showed a significantly higher mean values of falciparum parasite density and plasma ALT in the plasmodium infected test subjects than the values of the parameters obtained in plasmodium non-infected control subjects before and after treatment of the plasmodium infected subjects with the raw liquid extract of <i>Morinda lucida</i> with p<0.05. There was also a higher significant difference in the value of plasma LDH in the plasmodium infected test subjects before the administration of the extract than the result obtained in the plasmodium non-infected control subjects with p<0.05. A significantly higher value of plasma LDH was obtained in the test subjects before the treatment compared to the value of this parameter obtained in the test subjects after treatment (p<0.05). There was also a significantly higher mean value of TBA in the test subjects compared with the control after treatment (p<0.05). There was no significant alteration in the mean values of the CD4 cell count in the subjects before and after treatment and also in test compared with the control subjects. This recent work showed significant alterations in the mean values of the plasmodium parasite density, ALT, LDH, TBA in the test subjects studied due to plasmodium infection and the effectiveness of the raw liquid extract of the leaf of <i>Morinda Lucida </i>in the treatment of malaria<i>. </i>Estimation of plasmodium parasite density, plasma ALT, LDH, and TBA should be considered in the treatment of malaria using the raw liquid extract of the leaf of <i>Morinda Lucida</i>.

Quinine interactions with tryptophan and tyrosine in malaria patients, and implications for quinine responses in the clinical setting

Recent work with the yeast model revealed that the antiprotozoal drug quinine competes with tryptophan for uptake via a common transport protein, causing cellular tryptophan starvation. In the present work, it was hypothesized that similar interactions may occur in malaria patients receiving quinine therapy. A direct observational study was conducted in which plasma levels of drug and amino acids (tryptophan, tyrosine and phenylalanine) were monitored during quinine treatment of malaria patients with Plasmodium falciparum infections. Consistent with competition for uptake from plasma into cells, plasma tryptophan and tyrosine levels increased ≥2-fold during quinine therapy. Plasma quinine levels in individual plasma samples were significantly and positively correlated with tryptophan and tyrosine in the same samples. Control studies indicated no effect on phenylalanine. Chloroquine treatment of Plasmodium vivax-infected patients did not affect plasma tryptophan or tyrosine. During quinine treatment, plasma tryptophan was significantly lower (and quinine significantly higher) in patients experiencing adverse drug reactions. Plasma quinine levels during therapy are related to patient tryptophan and tyrosine levels, and these interactions can determine patient responses to quinine. The study also highlights the potential for extrapolating insights directly from the yeast model to human malaria patients.

Malaria seroprevalence in blood bank donors from endemic and non-endemic areas of Venezuela

In Venezuela, a total of 363,466 malaria cases were reported between 1999-2009. Several states are experiencing malaria epidemics, increasing the risk of vector and possibly transfusion transmission. We investigated the risk of transfusion transmission in blood banks from endemic and non-endemic areas of Venezuela by examining blood donations for evidence of malaria infection. For this, commercial kits were used to detect both malaria-specific antibodies (all species) and malaria antigen (Plasmodium falciparum only) in samples from Venezuelan blood donors (n = 762). All samples were further studied by microscopy and polymerase chain reaction (PCR). The antibody results showed that P. falciparum-infected patients had a lower sample/cut-off ratio than Plasmodium vivax-infected patients. Conversely, a higher ratio for antigen was observed among all P. falciparum-infected individuals. Sensitivity and specificity were higher for malarial antigens (100 and 99.8%) than for antibodies (82.2 and 97.4%). Antibody-positive donors were observed in Caracas, Ciudad Bolívar, Puerto Ayacucho and Cumaná, with prevalences of 1.02, 1.60, 3.23 and 3.63%, respectively. No PCR-positive samples were observed among the donors. However, our results show significant levels of seropositivity in blood donors, suggesting that more effective measures are required to ensure that transfusion transmission does not occur.

Antimalarials and the fight against malaria in Brazil

Malaria, known as the "fevers," has been treated for over three thousand years in China with extracts of plants of the genus Artemisia (including Artemisia annua, A. opiacea, and A. lancea) from which the active compound is artemisin, a sesquiterpene that is highly effective in the treatment of the disease, especially against young forms of the parasite. South American Indians in the seventeenth century already used an extract of the bark of chinchona tree, commonly named "Jesuits' powder." Its active compound was isolated in 1820 and its use spread all over the world being used as a prophylactic drug during the construction of the Madeira-Mamoré railroad in the beginning of the twentieth century. During the 1920s to the 1940s, new antimalarial drugs were synthesized to increase the arsenal against this parasite. However, the parasite has presented systematic resistence to conventional antimalarial drugs, driving researchers to find new strategies to treat the disease. In the present review we discuss how Brazil treats Plasmodium-infected patients.

Pathological rupture of the spleen in malaria: Analysis of 55 cases (1958–2008)

Splenic rupture during acute malaria is rare but underreported. Because splenic rupture occurs mostly in non-immune adults, ongoing malaria elimination efforts may paradoxically increase the proportion of Plasmodium-infected patients suffering from this life-threatening complication. The pathogenesis and optimal patient management are still debated. We collected and analysed reports of pathological rupture of the spleen associated with malaria published over the last 50 years in five languages. Fifty-five cases were reported, due to Plasmodium falciparum (n=26), Plasmodium vivax (n=23), Plasmodium ovale (n=2), Plasmodium malariae (n=2), or P. vivax-falciparum (n=2), and occurred in travellers (n=24), locals (n=21), expatriates (n=6) or migrants (n=4). Median age was 31.5 years and sex ratio M/F 3.2. Splenic rupture was complete with hemoperitoneum (n=50), or partial (n=5). Death occurred in 12 patients (22%), 8 of whom from early irreversible collapse (n=7) or unexpected death (n=1). Death rate was higher among travellers than in other patients (9/24, 38%, versus 3/31, 10%, p=0.01). Clinical features of P. falciparum- or P. vivax-associated splenic rupture were strikingly similar. Treatment included in-hospital medical observation without surgery (conservative management, n=14), immediate splenectomy (n=29), delayed splenectomy (n=4), or none (patients dying at admission, n=8). The type of treatment, conservative or not, had no influence on prognosis. The median duration of malaria symptoms before diagnosis was longer in our review (5-6 days) than in previous reports on imported malaria (3-4 days), suggesting that early diagnosis and therapy of malaria may reduce the incidence of splenic rupture. Abdominal pain, collapse, or fainting is warning symptoms. Fourteen published observations support conservative management in carefully selected patients. Spleen preservation likely reduces the risk of future severe malaria attacks in patients with potential further exposition to Plasmodium sp., and also that of overwhelming sepsis in all.

Identification of New Antigens in Visceral Leishmaniasis by Expression Cloning and Immunoblotting with Sera of Kala-Azar Patients from Bihar, India

Sera of kala-azar patients from Bihar, India, were used to identify Leishmania donovani antigens encoded by a phage expression library. Ten antigens were identified, five of which have not been described as leishmania antigens before. The antigens specifically react with sera of leishmania-infected patients but not of toxoplasma- or plasmodium-infected patients.

White Blood Cell Counts and Malaria

White blood cells (WBCs) were counted in 4697 individuals who presented to outpatient malaria clinics in Maesod, Tak Province, Thailand, and Iquitos, Peru, between 28 May and 28 August 1998 and between 17 May and 9 July 1999. At each site and in each year, WBC counts in the Plasmodium falciparum-infected patients were lower than those in the Plasmodium vivax-infected patients, which, in turn, were lower than those in the uninfected patients. In Thailand, one-sixth of the P. falciparum-infected patients had WBC counts of <4000 cells/microL. Leukopenia may confound population studies that estimate parasite densities on the basis of an assumed WBC count of 8000 cells/microL. For instance, in the present study, use of this conventional approach would have overestimated average asexual parasite densities in the P. falciparum-infected patients in Thailand by nearly one-third.

IgG isotype to C-terminal 19�kDa of Plasmodium vivax merozoite surface protein 1 among subjects with different levels of exposure to malaria in Brazil

Subclasses of antibodies to the C-terminal 19 kDa fragment of the Plasmodium vivax merozoite surface protein 1 (PvMSP-1(19)) were assessed among subjects with distinct degrees of malaria exposure in the Brazilian endemic area. The PvMSP-1(19) specific IgG1and IgG3 levels were low among subjects with long-term exposure (approximately 19 years) when compared to subjects less and sporadically exposed (<1 year). No statistically difference was observed in IgG subclass distribution of antibodies from symptomatic Plasmodium-infected patients, asymptomatic parasite carriers and non-infected subjects living in a same mesoendemic area. Subjects briefly exposed to a P. vivax outbreak living in a rural community outside the endemic area were also evaluated to measure the persistence of specific antibodies. IgG anti-PvMSP-1(19) antibodies persisted in 40% of the subjects who had had malarial symptoms 8 months before and decreased after 7 years (28%). Specific IgG1 were the predominant isotype. Our study emphasizes the highly immunogenicity of the PvMSP-1(19) and points toward its possible use as a potential malaria vaccine.

Changes in glutathione metabolic enzymes in erythrocytes of Plasmodium vivax infected patients

Reduced glutathione in erythrocytes has been thought to participate in intracellular redox reactions to protect haemoglobin and some thiol-dependent enzymes or membrane proteins from oxidative damage. The depletion of intracellular glutathione is thought to be a cause of haemolysis induced by oxidative stress. The intracellular malarial parasite has been shown to produce distinct structural changes in the infected erythrocyte membrane [I]. Alterations in th . reduced glutathione content in malarial erythrocytes have been reported [2,3]. However, knowledge regarding the status of glutathione-related enzymes that are involved in the antioxidant defence system in Plasmodium vivax-infected cells is limited. The concerted effort of these enzymes in the regeneration of glutathione in the face of an oxidant stress provides a vital link to intracellular mechanisms and parasite death/survival. A number of studies have demonstrated the susceptibility of erythrocyte~ to oxygen-mediated damage [4,5]. Very little research has been done on vivax malaria because of the inadequacies of the culture system [6], the low fatality and fewer complications of P. vivax infection [7] and the paucity of clinical cases in developed countries.