Abstract. A safe and reproducible Plasmodium vivax infectious challenge method is required to evaluate the efficacy of malaria vaccine candidates. Seventeen healthy Duffy (+) and five Duffy (−) subjects were randomly allocated into three (A-C) groups and were exposed to the bites of 2-4 Anopheles albimanus mosquitoes infected with Plasmodium vivax derived from three donors. Duffy (−) subjects were included as controls for each group. Clinical manifestations of malaria and parasitemia were monitored beginning 7 days post-challenge. All Duffy (+) volunteers developed patent malaria infection within 16 days after challenge. Prepatent period determined by thick smear, was longer for Group A (median 14.5 d) than for Groups B and C (median 10 d/each). Infected volunteers recovered rapidly after treatment with no serious adverse events. The bite of as low as two P. vivax -infected mosquitoes provides safe and reliable infections in malaria-naive volunteers, suitable for assessing antimalarial and vaccine efficacy trials.
Abstract. Vaccine development for Plasmodium vivax malaria is underway. A model to assess the protective efficacy of vaccine candidates in humans is urgently needed. Given the lack of continuous P. vivax cultures, we developed a system to infect Anopheles albimanus mosquitoes using blood from P. vivax-infected patients and determined parameters for challenge of malaria-naive volunteers by mosquito bite. Absence of co-infections in parasitized blood was confirmed by tests consistent with blood bank screening. A total of 119 experiments were conducted using batches of 900-4,500 mosquitoes fed by an artificial membrane feeding method. Optimal conditions for mosquito probing and infection were determined. Presence of oocyst and sporozoites were assessed on Days 7-8 and 14-15, respectively, and conditions to choose batches of infected mosquitoes for sporozoite challenge were established. Procedures to infect volunteers took a 2-hour period including verification of inoculum dose. Anopheles albimanus mosquitoes represent a valuable resource for P. vivax sporozoite challenge of volunteers.
Plasmodium vivax transmission-blocking activity was assessed in sera from acutely infected patients from a malaria-endemic area in Colombia. We measured reduction in the number of oocysts that developed in the midguts of Anopheles albimanus mosquitoes artificially fed with blood from these patients. Of 88 mosquito batches that developed infections when parasites were mixed with normal AB human serum, one-third (36.4%) showed full transmission-blocking activity (>or= 90% inhibition) when mixed with autologous sera, 29.6% showed partial activity (50-89%), 17.0% did not block transmission (0-50%), and 17% did not enhance transmission. Transmission-blocking activity correlated with antibody titer by an immunofluorescent antibody test and decreased with the serial dilution of the sera. This activity disappeared at a 1:4 dilution in most sera tested. Afro-Colombian individuals showed lower activity than other ethnic groups and febrile patients produced stronger inhibition than those without fever.
Artificial membrane feeding (AMF) assays are used to determine malaria transmission-blocking activity in Anopheles. The purpose of this study was to determine the effect of the most widely used anticoagulants, EDTA and heparin, on development of the Plasmodium vivax sporogonic cycle. Blood samples collected from 60 patients carrying P. vivax infections were used to feed An. albimanus using AMF. Seven days after feeding, mosquitoes were dissected to assess mosquito infection. Mosquitoes fed with blood containing EDTA showed a lower mean oocyst number as compared with those fed blood with heparin. However, this effect was minimized upon reduction of EDTA concentrations in the serum. This result may be explained by the fact that microgametocytes require Ca(2+), Mn(2+), and Mg(+2) to activate enzymes important for exflagellation process and for motility of ookinetes. We therefore recommend that heparin be used as the anticoagulant of choice for blood used in AMF assays.
Abstract. Malaria infection induces antibodies capable of suppressing the infectivity of gametocytes and gametes, however, little is known about the duration of the antibody response, the parasite specificity, and the role of complement. We report the analyses of the transmission-blocking (TB) activity of sera collected from 105 Plasmodium vivaxinfected and 44 non-infected individuals from a malaria endemic region of Colombia, using a membrane feeding assay in Anopheles albimanus mosquitoes. In infected donors we found that TB activity was antibody dose dependent (35%), lasted for 2-4 months after infection, and in 70% of the cases different P. vivax wild isolates displayed differential susceptibility to blocking antibodies. Additionally, in a number of assays TB was complement-dependent. Twenty-seven percent of non-infected individuals presented TB activity that correlated with antibody titers. Studies here provide preliminary data on factors of great importance for further work on the development of TB vaccines.
RESUMO -Embora não esteja definitivamente comprovada que a severidade da malária esteja associada com o vírus da imunodeficiência humana (HIV), sabe-se que a infecção pelo Plasmodium falciparum pode favorecer uma rápida evolução da infecção pelo HIV. Além disso a associação da malária com HIV/AIDS, do ponto de vista clínico, pode ser extremamente grave face a ocorrência de outros microorganismos e/ou neoplasias, o que piora a evolução e prognóstico dos pacientes. A concomitância do vírus HIV com o Plasmodium em zonas endêmicas de malária, é uma possibilidade que deve ser sempre pensada, visto que a sua transmissão está relacionada a fatores de risco ligados aos comportamentos das pessoas, que nem sempre são logo revelados e/ou identificados. Os autores descrevem um caso de malária cerebral porPlasmodium vivaxe Plasmodiumfalciparum em um paciente com AIDS. Descrevem sua evolução clínica e terapêutica. PALAVRAS-CHAVE: malária cerebral, AIDS (SIDA).Cerebral malaria and AIDS: case report ABSTRACT -Although it has not been definitely proven that the severity of malaria is associated to human immunodeficiency virus (HIV) we know that infection through Plasmodium falciparum can favor a rapid evolution of the HIV infection. Besides, association of malaria with HIV/AIDS from a clinical point of view can be clinically severe in the face of the occurrence of other microorganisms or neoplasias, which worsens the evolution and prognosis of the affected patients. The concurrence of HIV with Plasmodium in malaria endemic zones is a possibility which should always be taken into consideration, since transmission is related to risk factors caused by people's behavior which are not always promptly revealed and/or identified. The authors report one case of brain malaria infection by Plasmodium vivax and Plasmodium falciparum in a patient with AIDS. They describe the clinical evolution and therapy.KEY WORDS: cerebral malaria, AIDS.A malária é doença infecciosa febril, de evolução potencialmente grave, causada por protozoários do gênero Plasmodium. O homem pode ser infectado por quatro espécies
RESUMO -Foram estudados 50 pacientes com AIDS. Todos estes pacientes apresentavam anticorpos anti-HIV1 (ELISA) e preenchiam os critérios de pontuação OPAS/Caracas de definição de casos de AIDS em adultos. A análise do liquido cefalorraqueano (LCR) incluiu: pressão; citologia (número de células e aspectos citomorfológicos); proteína total e eletroforese; concentrações de glicose, cloretos e testes imunológicos para sífilis, toxoplasmose e infecções virais (citomegalovírus, varicela-zoster, Herpes simplex, e HI VI). Investigações bacteriológicas e micológicas (pesquisa direta e cultura), além de teste de aglutinação (látex) para Cryptococcus foram também realizados. Os testes imunológicos usados foram fixação do complemento, imunofluorescência indireta, hemaglutinação passiva e/ou ELISA. Todos os LCR foram analisados no mesmo laboratório seguindo sempre a mesma metodologia. O LCR esteve alterado em 45 pacientes (90,0%) dos 50 pacientes estudados. As principais alterações encontradas no LCR foram: aumento de gamaglobulina em 25 casos (55,5%); aumento da proteína total em 23 (51,1%); hipercitose em 22 (48,9%) e diminuição dos cloretos em 18(40,0%). A detecção de anticorpos anti-HIV1 estiveram presentes em 42 pacientes (93,3%). Toxoplasmose isolada ou associada a outros agentes foi a infecção oportunista mais freqüente, detectada em 26 casos (57,7%). O LCR deverá ser sempre analisado em todos os pacientes com AIDS, com ou sem sintomas neurológicos. PALAVRAS-CHAVE: AIDS (SIDA), líquido cefalorraqueano, infecções oportunisticas.Cerebrospinal fluid in 50 AIDS patients ABSTRACT -Fifty AIDS patients were studied. AH patients had anti-HIV antibodies (ELISA) present and met OPAS/ Caracas punctuation criteria for AIDS cases in adults. Cerebrospinal fluid (CSF) analysis included pressure, cytology (number and cytomorphological aspects), total protein and electrophoresis, glucose and chloride concentration. Bacteriological and mycological investigations were performed as well as agglutination tests for Cryptococcus. Complement fixation, indirect immunoflorescence, passive hemagglutination and/or ELISA tests were performed for syphilis, toxoplasmosis, viral and fungal infections. AH CSF analysis were made in the same laboratory following the same methodology. CSF was alterated in 45 cases (90.0%) of the 50 patients studied. The most important alterations observed were: gammaglobulin (55.5%) and total protein (51.1%) increase, hypercytosis (48.9%) and decrease of chloride concentration (40.0%). HIV antibodies were detected in 42 patients (93.3%). Toxomoplamosis, isolated or associated to other agents, was the most frequent opportunistic infection (57.7%). Cerebrospinal fluid should always be examined in AIDS patients with or without neurological symptoms.
Desde a puberdade, menarca, desenvolvimento das mamas, gravidez até a menopausa, doenças significativas afetam as mulheres. uma equipe multidisciplinar poderá assistir da melhor forma esta mulher e ser apoio fundamental no trabalho do médico ginecologista. A partir da maturidade, quando os órgãos reprodutivos amadurecem, as mulheres são aconselhadas a fazer um exame de saúde anual ou pelo menos a cada 3 anos com um ginecologista, porém muitas delas não terão esse acesso com facilidade pelos serviços públicos de saúde ou ainda se depararão com profissionais sem a formação adequada. A consciência das funções corporais básicas e a manutenção de um bom bem-estar físico e mental são aspectos vitais da gestão da saúde da mulher e no bom atendimento ginecológico e obstétrico. A detecção precoce de doenças e outros problemas de saúde pode ser importante para ajudar qualquer paciente a ter uma vida mais saudável, feliz e, em alguns casos, mais longa. Na verdade, a detecção precoce e bom manejo da paciente pode aumentar significativamente as chances de sobrevivência de certas doenças, incluindo muitas formas de câncer. É por isso que os especialistas recomendam a adesão a um cronograma regular de exames médicos e exames apropriados com base em seus dados demográficos e fatores de risco. O livro Ginecologia e Obstetrícia aborda capítulos sobre sexualidade, atendimento clínico, cuidados do aparelho genital feminino e intervenções cirúrgicas e medicamentosas para as principais complicações. O leitor encontrará capítulos pré-definidos, construídos por autores convidados e atualizados sobre os principais temas. A Editora Pasteur fica feliz em apresentar esse material de alta qualidade e importância.
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