Prospective evaluation of artemether-lumefantrine for the treatment of non-falciparum and mixed-species malaria in Gabon

Mombo-Ngoma, Ghyslain; Kleine, Christian; Basra, Arti; Würbel, Heike; Diop, Daisy Akerey; Capan, Mesküre; Adegnika, Ayôla Akim; Kurth, Florian; Mordmüller, Benjamin; Joanny, Fanny; Kremsner, Peter G.; Ramharter, Michael; Bélard, Sabine

doi:10.1186/1475-2875-11-120

Cited by 37 publications

(29 citation statements)

References 27 publications

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“…The fact that 50% of study participants were infected with P. malariae and 18% with P. ovale indicates that the number of mixed infections receiving ACTs is substantially larger than previously thought. Mombo-Ngoma et al reported, in 38 Gabonese patients, a 28-day cure rate by microscopy of 100% for AL in treatment of P. malariae, P. ovale and mixed infections in Gabon, although post hoc PCR revealed that only 19 of the patients in the study had been correctly diagnosed with non-falciparum malaria (Mombo-Ngoma et al 2012 ). In contrast, Dinko et al detected persistent P. malariae and P. ovale spp.…”

Section: Discussionmentioning

confidence: 99%

Detection of persistent Plasmodium spp. infections in Ugandan children after artemether-lumefantrine treatment

et al. 2014

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SUMMARYDuring a longitudinal study investigating the dynamics of malaria in Ugandan lakeshore communities, a consistently high malaria prevalence was observed in young children despite regular treatment. To explore the short-term performance of artemether-lumefantrine (AL), a pilot investigation into parasite carriage after treatment(s) was conducted in Bukoba village. A total of 163 children (aged 2–7 years) with a positive blood film and rapid antigen test were treated with AL; only 8·7% of these had elevated axillary temperatures. On day 7 and then on day 17, 40 children (26·3%) and 33 (22·3%) were positive by microscopy, respectively. Real-time PCR analysis demonstrated that multi-species Plasmodium infections were common at baseline, with 41·1% of children positive for Plasmodium falciparum/Plasmodium malariae, 9·2% for P. falciparum/ Plasmodium ovale spp. and 8·0% for all three species. Moreover, on day 17, 39·9% of children infected with falciparum malaria at baseline were again positive for the same species, and 9·2% of those infected with P. malariae at baseline were positive for P. malariae. Here, chronic multi-species malaria infections persisted in children after AL treatment(s). Better point-of-care diagnostics for non-falciparum infections are needed, as well as further investigation of AL performance in asymptomatic individuals.

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Section: Discussionmentioning

confidence: 99%

Detection of persistent Plasmodium spp. infections in Ugandan children after artemether-lumefantrine treatment

et al. 2014

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“…CQ treatment of misclassified P. falciparum can have severe or even fatal consequences due to widespread CQ resistance of P. falciparum . Despite internal and external quality assessments for parasitological diagnosis, discrepant results between microscopy and polymerase chain reaction (PCR) can still occur even in experienced laboratories[ 8 ]. Besides, mixed species infections are common[ 9 ] and microscopic diagnosis of mixed-species infections is particularly cumbersome[ 10 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

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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“…have developed resistance against older malaria drugs such as chloroquine, and as a result artemisinin-based combination therapies (ACT) have become the first line of treatment for P. falciparum and mixed malaria infections. This regimen consists of doxycycline 100 mg/BD and artesunate 2.4 mg/kg, delivered intravenously at 0, 12, and 24 hours, then switching to daily for seven days, and the addition of primaquine 30 mg/day on the third day, for a period of three days, in order to eradicate the gametocytes (19,20).…”

Section: Discussionmentioning

confidence: 99%

Mixed Infection of Plasmodium malariae and Plasmodium falciparum: A Case Report

Yasin

Yadegarynia

Mojdehi

et al. 2014

Arch Clin Infect Dis

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Introduction:Malaria is the most important parasitic infection, which is now spread all over the globe. Malaria infections with more than two species, especially Plasmodium falciparum and P. vivax, are common, but infections with P. malariae and P. falciparum are rare. Case Presentation: A 33-year-old man presented with fever and chills for three days, pancytopenia, and abnormal liver function tests, Peripheral blood smear revealed P. falciparum and P. malariae. After artemisinin-based combination therapy, all of his symptoms subsided. Discussion: Mixed malaria infection is not uncommon, and it needs to be diagnosed and treated effectively in order to control the disease. Travel consultations should be given for all travelers before their trip to endemic countries. Implication for health policy/practice/research/medical education:This study could help to determine the risk factors for a mixed malaria infection, the countries where it is possible to contract a mixed malaria infection, and the risks of an undiagnosed or subtherapeutic treatment of a mixed malaria infection. Moreover, coinfections should be considered in any patient with a fever who has returned from an endemic country, and to keep this infection in mind during travel consultations before traveling to endemic countries.

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Prospective evaluation of artemether-lumefantrine for the treatment of non-falciparum and mixed-species malaria in Gabon

Cited by 37 publications

References 27 publications

Detection of persistent Plasmodium spp. infections in Ugandan children after artemether-lumefantrine treatment

Detection of persistent Plasmodium spp. infections in Ugandan children after artemether-lumefantrine treatment

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

Mixed Infection of Plasmodium malariae and Plasmodium falciparum: A Case Report

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