Quantification of parasite density is an important component in the diagnosis of malaria infection. The accuracy of this estimation varies according to the method used. The aim of this study was to assess the agreement between the parasite density values obtained with the assumed value of 8,000 cells/μL and the automated WBC count. Moreover, the same comparative analysis was carried out for other assumed values of WBCs. The study was carried out in Brazil with 403 malaria patients who were infected in different endemic areas of the Brazilian Amazon. The use of a fixed WBC count of 8,000 cells/μL to quantify parasite density in malaria patients led to overestimated parasitemia and resulted in low reliability when compared to the automated WBC count. Assumed values ranging between 5,000 and 6,000 cells/μL, and 5,500 cells/μL in particular, showed higher reliability and more similar values of parasite density when compared between the 2 methods. The findings show that assumed WBC count of 5,500 cells/μL could lead to a more accurate estimation of parasite density for malaria patients in this endemic region.

This open retrospective cohort study aimed to describe the incidence of recurrent Plasmodium vivax malaria and associated factors in Porto Velho, Rondônia State, Brazil, in 2009. Data were collected from the National Information System for Malaria Epidemiological Surveillance. There were 23,365 reported P. vivax malaria cases in 2009, 23% of which were classified as relapses. Incidence density of P. vivax recurrence was 45.1/100 patient-years, mostly occurring between the 4th and 13th week after initiating treatment. Male gender, shorter time since onset of symptoms, and higher parasitemia in the initial infection increased the risk of relapse during the year, with a 10% reduction in relative risk for longer symptoms and 11% and 15% increases in relative risk for males and higher initial parasitemia, respectively. However, the results show low clinical relevance for these associations, thereby limiting their applicability to decision-making at the public health level.

Revista da Sociedade Brasileira de Medicina Tropical http://dx.doi. org/10.1590/0037-8682-0013-2012 In vitro antimalarial activity of tigecycline against Plasmodium falciparum culture-adapted reference strains and clinical isolates from the Brazilian Amazon ABSTRACT Introduction:We evaluated the in vitro antimalarial activity of tigecycline as an alternative drug for the treatment of severe malaria. Methods: A chloroquine-sensitive Plasmodium falciparum reference strain, a chloroquine-resistant reference strain, and three clinical isolates were tested for in vitro susceptibility to tigecycline. A histidine-rich protein in vitro assay was used to evaluate antimalarial activity. Results: The geometric-mean 50% effective concentration (EC50%) of tigecycline was 535.5 nM (confidence interval (CI): 344.3-726.8). No significant correlation was found between the EC50% of tigecycline and that of any other tested antimalarial drug. Conclusions: Tigecycline may represent an alternative drug for the treatment of patients with severe malaria.

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