Are artemisinin-based combination therapies effective against Plasmodium malariae?

Calleri, Guido; Balbiano, Rosanna; Caramello, Pietro

doi:10.1093/jac/dkt005

Cited by 10 publications

(7 citation statements)

References 5 publications

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“…One other case report is available, which reported good efficacy of intravenous artesunate for mixed P. falciparum / P. malariae infection[ 71 ]. This stands in contrast to a case report from Italy, in which they described a mixed P. falciparum / P. malariae infection in a HIV-infected male and ineffectiveness of artemether/lumefantrine to clear the infection of P. malariae [ 72 ]. This could be explained by the ineffectiveness of AL against the long-lasting schizogonic pre-erythrocytic phase of P. malariae or a natural induced drug resistance of the parasite, which have never been published before in quartan malaria.…”

Section: Resultscontrasting

confidence: 90%

Efficacy and safety of artemisinin combination therapy (ACT) for non-falciparum malaria: a systematic review

Visser

Wieten

Kroon

et al. 2014

Malar J

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BackgroundArtemisinin combination therapy (ACT) is recommended as first-line treatment for uncomplicated Plasmodium falciparum malaria, whereas chloroquine is still commonly used for the treatment of non-falciparum species (Plasmodium vivax, Plasmodium ovale and Plasmodium malariae). A more simplified, more uniform treatment approach across all malaria species is worthwhile to be considered both in endemic areas and for malaria as an imported condition alike.MethodsA PROSPERO-registered systematic review to determine the efficacy and safety of ACT for the treatment of non-falciparum malaria was conducted, following PRISMA guidelines. Without language restrictions, Medline/PubMed, Embase, Cochrane Central Register of Controlled Trials, Web of Science, LILACS, Biosis Previews and the African Index Medicus were searched for studies published up to November 2014.ResultsThe literature search identified 986 reports; 40 publications were found eligible for inclusion, all of them on non-falciparum malaria in endemic areas. Most evidence was available for P. vivax (n = 35). Five clinical trials in total were identified evaluating ACT for P. ovale, P. malariae and Plasmodium knowlesi. Most ACT presentations have high efficacy against P. vivax parasites; artemisinin-based combinations have shorter parasite and fever clearance times compared to chloroquine. ACT is as effective as chloroquine in preventing recurrent parasitaemia before day 28. Artemisinin-based combinations with long half-lives show significantly fewer recurrent parasitaemia up to day 63. The limited evidence available supports both the use of chloroquine and an ACT for P. ovale and P. malariae. ACT seems to be preferable for optimal treatment of P. knowlesi.ConclusionACT is at least equivalent to chloroquine in effectively treating non-falciparum malaria. These findings may facilitate development of simplified protocols for treating all forms of malaria with ACT, including returning travellers. Obtaining comprehensive efficacy and safety data on ACT use for non-falciparum species particularly for P. ovale, P. malariae and P. knowlesi should be a research priority.Trial registrationCRD42014009103Electronic supplementary materialThe online version of this article (doi:10.1186/1475-2875-13-463) contains supplementary material, which is available to authorized users.

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Section: Resultscontrasting

confidence: 90%

Efficacy and safety of artemisinin combination therapy (ACT) for non-falciparum malaria: a systematic review

Visser

Wieten

Kroon

et al. 2014

Malar J

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“…However, others found that the standard treatment for P . falciparum might not be ideal to clear non-falciparum parasites completely 2,29–31 .…”

Section: Discussionmentioning

confidence: 99%

Characterization of Plasmodium infections among inhabitants of rural areas in Gabon

Woldearegai

Lalremruata

Gmeiner

et al. 2019

Sci Rep

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Plasmodium infections in endemic areas are often asymptomatic, can be caused by different species and contribute significantly to transmission. We performed a cross-sectional study in February/March 2016 including 840 individuals ≥ 1 year living in rural Gabon (Ngounié and Moyen-Ogooué). Plasmodium parasitemia was measured by high-sensitive, real-time quantitative PCR. In a randomly chosen subset of P . falciparum infections, gametocyte carriage and prevalence of chloroquine-resistant genotypes were analysed. 618/834 (74%) individuals were positive for Plasmodium 18S-rRNA gene amplification, of these 553 (66.3%) carried P . falciparum , 193 (23%) P . malariae , 74 (8.9%) P . ovale curtisi and 38 (4.6%) P . ovale wallikeri . Non-falciparum infections mostly presented as mixed infections. P . malariae monoinfected individuals were significantly older (median age: 60 years) than coinfected (20 years) or P . falciparum monoinfected individuals (23 years). P . falciparum gametocyte carriage was confirmed in 109/223 (48.9%) individuals, prevalence of chloroquine-resistant genotypes was high (298/336, 89%), including four infections with a new SVMNK genotype. In rural Gabon, Plasmodium infections with all endemic species are frequent, emphasizing that malaria control efforts shall cover asymptomatic infections also including non-falciparum infections when aiming for eradication.

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“…malariae type 2 [ 19 ]. It would be interesting to investigate if the Asian and the Ugandan type differ in their sensitivity to artemisinins, since a reduced sensitivity of an infection in Uganda has been observed [ 28 , 29 ] but all patients in this study responded well to the treatment [ 14 ]. Only few studies have looked at MOI of non-falciparum species.…”

Section: Discussionmentioning

confidence: 99%

Species and genotype diversity of Plasmodium in malaria patients from Gabon analysed by next generation sequencing

Lalremruata

Jeyaraj

Engleitner

et al. 2017

Malar J

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BackgroundSix Plasmodium species are known to naturally infect humans. Mixed species infections occur regularly but morphological discrimination by microscopy is difficult and multiplicity of infection (MOI) can only be evaluated by molecular methods. This study investigated the complexity of Plasmodium infections in patients treated for microscopically detected non-falciparum or mixed species malaria in Gabon.MethodsUltra-deep sequencing of nucleus (18S rRNA), mitochondrion, and apicoplast encoded genes was used to evaluate Plasmodium species diversity and MOI in 46 symptomatic Gabonese patients with microscopically diagnosed non-falciparum or mixed species malaria.ResultsDeep sequencing revealed a large complexity of confections in patients with uncomplicated malaria, both on species and genotype levels. Mixed infections involved up to four parasite species (Plasmodium falciparum, Plasmodium malariae, Plasmodium ovale curtisi, and P. ovale wallikeri). Multiple genotypes from each species were determined from the asexual 18S rRNA gene. 17 of 46 samples (37%) harboured multiple genotypes of at least one Plasmodium species. The number of genotypes per sample (MOI) was highest in P. malariae (n = 4), followed by P. ovale curtisi (n = 3), P. ovale wallikeri (n = 3), and P. falciparum (n = 2). The highest combined genotype complexity in samples that contained mixed-species infections was seven.ConclusionsUltra-deep sequencing showed an unexpected breadth of Plasmodium species and within species diversity in clinical samples. MOI of P. ovale curtisi, P. ovale wallikeri and P. malariae infections were higher than anticipated and contribute significantly to the burden of malaria in Gabon.Electronic supplementary materialThe online version of this article (doi:10.1186/s12936-017-2044-0) contains supplementary material, which is available to authorized users.

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Are artemisinin-based combination therapies effective against Plasmodium malariae?

Cited by 10 publications

References 5 publications

Efficacy and safety of artemisinin combination therapy (ACT) for non-falciparum malaria: a systematic review

Efficacy and safety of artemisinin combination therapy (ACT) for non-falciparum malaria: a systematic review

Characterization of Plasmodium infections among inhabitants of rural areas in Gabon

Species and genotype diversity of Plasmodium in malaria patients from Gabon analysed by next generation sequencing

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