Despite years of exposure to intense P. falciparum transmission, there is no evidence of acquired, sterile immunity to P. falciparum infection in this population, even as clinical immunity to blood-stage malaria is clearly acquired. Understanding why repeated P. falciparum infections do not induce sterile protection may lead to insights for developing vaccines that target the liver stage in malaria-endemic populations.

BackgroundMalaria and schistosomiasis often overlap in tropical and subtropical countries and impose tremendous disease burdens; however, the extent to which schistosomiasis modifies the risk of febrile malaria remains unclear.MethodsWe evaluated the effect of baseline S. haematobium mono-infection, baseline P. falciparum mono-infection, and co-infection with both parasites on the risk of febrile malaria in a prospective cohort study of 616 children and adults living in Kalifabougou, Mali. Individuals with S. haematobium were treated with praziquantel within 6 weeks of enrollment. Malaria episodes were detected by weekly physical examination and self-referral for 7 months. The primary outcome was time to first or only malaria episode defined as fever (≥37.5°C) and parasitemia (≥2500 asexual parasites/µl). Secondary definitions of malaria using different parasite densities were also explored.ResultsAfter adjusting for age, anemia status, sickle cell trait, distance from home to river, residence within a cluster of high S. haematobium transmission, and housing type, baseline P. falciparum mono-infection (n = 254) and co-infection (n = 39) were significantly associated with protection from febrile malaria by Cox regression (hazard ratios 0.71 and 0.44; P = 0.01 and 0.02; reference group: uninfected at baseline). Baseline S. haematobium mono-infection (n = 23) did not associate with malaria protection in the adjusted analysis, but this may be due to lack of statistical power. Anemia significantly interacted with co-infection (P = 0.009), and the malaria-protective effect of co-infection was strongest in non-anemic individuals. Co-infection was an independent negative predictor of lower parasite density at the first febrile malaria episode.ConclusionsCo-infection with S. haematobium and P. falciparum is significantly associated with reduced risk of febrile malaria in long-term asymptomatic carriers of P. falciparum. Future studies are needed to determine whether co-infection induces immunomodulatory mechanisms that protect against febrile malaria or whether genetic, behavioral, or environmental factors not accounted for here explain these findings.

BackgroundThis study was conducted to determine the efficacy of the antimalarial artemisinin-based combination therapy (ACT) artesunate +sulfamethoxypyrazine/pyrimethamine (As+SMP), administered in doses used for malaria, to treat Schistosoma haematobium in school aged children.Methodology/Principal FindingsThe study was conducted in Djalakorodji, a peri-urban area of Bamako, Mali, using a double blind setup in which As+SMP was compared with praziquantel (PZQ). Urine samples were examined for Schistosoma haematobium on days −1, 0, 28 and 29. Detection of haematuria, and haematological and biochemical exams were conducted on day 0 and day 28. Clinical exams were performed on days 0, 1, 2, and 28. A total of 800 children were included in the trial. The cure rate obtained without viability testing was 43.9% in the As+SMP group versus 53% in the PZQ group (Chi2 = 6.44, p = 0.011). Egg reduction rates were 95.6% with PZQ in comparison with 92.8% with As+SMP, p = 0.096. The proportion of participants who experienced adverse events related to the medication was 0.5% (2/400) in As+SMP treated children compared to 2.3% (9/399) in the PZQ group (p = 0.033). Abdominal pain and vomiting were the most frequent adverse events in both treatment arms. All adverse events were categorized as mild.Conclusions/SignificanceThe study demonstrates that PZQ was more effective than As+SMP for treating Schistosoma haematobium. However, the safety and tolerability profile of As+SMP was similar to that seen with PZQ. Our findings suggest that further investigations seem justifiable to determine the dose/efficacy/safety pattern of As+SMP in the treatment of Schistosoma infections.Trial RegistrationClinicalTrials.gov NCT00510159

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But : Décrire les aspects diagnostiques et thérapeu-tiques du cancer du sein. Méthodologie : C'est une étude rétrospective (mars 1999-juillet 2008) dans deux hôpitaux de Bamako au Mali. L'examen histologique a été effectué chez tous les malades. Résultats : Nous avons colligé 210 malades (205 femmes et cinq hommes) avec un âge moyen de 47,4 ans. Cinquantesept (27,14 %) malades avaient un antécédent de pathologie bénigne du sein ; chez 47 patients, le cancer du sein dans la famille a été retrouvé. La prise d'estroprogestatifs a été évo-quée par 59 patientes. Nous avons retrouvé 32 métastases osseuses, 56 pulmonaires et 43 métastases hépatiques. Nous avons effectué 138 mastectomies avec curage ganglionnaire selon Patey contre 21 cas de chirurgie conservatrice. La morbidité postopératoire a été de 13,81 %. L'examen histologique a révélé un cancer canalaire infiltrant chez 120 (57,14 %) malades et un carcinome lobulaire infiltrant chez 45 (21,43 %) malades. Cinquante-six (26,67 %) malades étaient de stade TNM I + II, 122 (58,10 %) malades étaient positifs au récepteur estrogénique (RE). Cent quatorze (54,86 %) malades ont bénéficié d'une hormonothérapie ou chimiothérapie, nous n'avons pas fait de radiothérapie. Dans le groupe des 97 malades qui avaient un recul de cinq ans, la survie à cinq ans a été de 37,1 %. Conclusion : Le pronostic du cancer du sein est grave au Mali. Mots clés Cancer · Sein · MaliAbstract Aim: To describe clinical and therapeutic aspects of breast cancer. Methodology: We made a retrospective study (March 1999-July 2008 in two hospitals of Bamako (Mali). The histological examination was done in all the cases. Results: We selected 210 patients (205 women and 5 men); the mean age was 47.4 ± 13.6 years and the extremes of 21 and 82 years. Fifty-seven women (27.14%) had antecedents of benign pathology of breast. Breast cancer occurred in a family member in 47 patients. The administration of estroprogestatives for contraception was found in 59 patients. We found 32 cases of bone metastases, 56 cases of pulmonary metastases, and 43 cases of hepatic metastases. We carried out 138 mastectomies with lymphadenectomy (Patey) and 21 quadrantectomies with lymphadenectomy. The morbidity after surgery (abscess of partition lymphoedeme) was 13.81% (29 cases). The histological examination revealed an infiltrating canal cancer in 120 cases (57.14%) and an infiltrating lobular carcinoma in 45 cases (21.43%). We classified 56 patients (26.67%) under stage TNM I + II, 122 patients (58.10%) were estrogen receivers positive. One hundred fourteen patients (54.86%) have benefited of chemotherapy or hormonotherapy but any radiotherapy. In the group of 97 patients who had a long-term follow-up, survival at 5 years was of 37.1%. Conclusion: The prognostic of breast cancer is serious in Mali.