Showing papers by "Gary M. Brittenham published in 2008"
TL;DR: Treatment of P. vivax malaria with artesunate for 5 days followed by high-dose primaquine, 30 mg twice a day for 7 days, was highly effective, well-tolerated, and equivalent or superior to the standard regimen of primquine therapy.
Abstract: Plasmodium vivax causes debilitating but usually non-lethal malaria in most of Asia and South America. Prevention of relapse after otherwise effective therapy for the acute attack requires a standard daily dose of primaquine administered over 14 days. This regimen has < 90% efficacy in Thailand, and is widely regarded as ineffective because of poor compliance over the relatively long duration of dosing. We evaluated the efficacy, safety, and tolerability of alternative primaquine dosing regimens combined with artesunate among 399 Thai patients with acute, symptomatic P. vivax malaria. Patients were randomly assigned to one of six treatment groups: all patients received artesunate, 100 mg once a day for 5 days. Groups 1-5 then received primaquine, 30 mg a day for 5, 7, 9, 11, and 14 days, respectively. Group 6 received primaquine, 30 mg twice a day for 7 days. The 28-day cure rates were 85%, 89%, 94%, 100%, and 96%, respectively. Treatment of P. vivax malaria with artesunate for 5 days followed by high-dose primaquine, 30 mg twice a day for 7 days, was highly effective, well-tolerated, and equivalent or superior to the standard regimen of primaquine therapy.
86 citations
Journal Article•
TL;DR: It is concluded that Artequick was as effective and well tolerated as artesunate-mefloquine and could be used as an alternative treatment for multidrug-resistant Plasmodium falciparum malaria in Southeast Asia.
Abstract: The objective of this study was to investigate the seroprevalence of toxoplasmosis in dairy cows in Thailand. During 2007, the sera of 445 cows from the three largest dairy farming provinces in northeastern Thailand (Khon Kaen, Udon Thani and Sakon Nakhon Provinces) were collected and analyzed. Antibodies to T. gondii were determined using a latex agglutination test; 99 (22.3%) were seropositive for T. gondii (cutoff, 1:64). The highest titer was 1:1,024. Cows age 1 and 5 years old had the highest seroprevalence (24.7%) followed by those to > 5 years old (21.6%) and those < 1 year old (9.1%). Sakon Nakhon had the highest percentage (26.4%) of dairy cows infected with T. gondii and among herds tested (85.7%). The seroprevalence of dairy cows was highest (37.5%) during the sixth lactation. The prevalence in heifers was the lowest (8.8%). The high incidence of T. gondii infection in cows underlines the risk for humans to become infected by contaminated food or water, particularly from meat or milk.
27 citations
Journal Article•
TL;DR: Results indicate defective Epo production and reticulocyte response in adult patients suffering from acute P. falciparum malaria, which differs from pediatric patients, may provide the basis for further study into the choice of therapeutic strategies to treat acute, uncomplicated malaria.
Abstract: To elucidate the relationship between falciparum malaria-associated anemia and serum erythropoietin (Epo) levels and reticulocyte response during acute malaria infection, 87 adults aged 18-65 years presenting with acute, uncomplicated malaria were examined on enrollment and for 28 days of follow-up. The 87 patients were divided into 2 groups: those with anemia (n = 45) and those without (n = 42). Serum samples were taken on admission (Day 0), then on Days 7, 21, and 28, to measure the reticulocyte count, absolute reticulocyte count, reticulocyte hemoglobin content, and erythropoietin level (Epo). The absolute reticulocyte counts for the anemic patients were significantly higher than for those without anemia on Days 0, 7, 21, and 28. The serum Epo levels for the anemic patients were significantly higher than the non-anemic group only on Day 0 (44.39 +/- 4.06 vs 25.91 +/- 4.86 mlU/ml, p < 0.001). Inadequate Epo production was found in 31.03% (27/87) of patients on Day 0, 37.93% (33/87) on Day 7, 43.67% (38/87) on Day 21, and 39.08% (34/87) on Day 28. These results indicate defective Epo production and reticulocyte response in adult patients suffering from acute P. falciparum malaria, which differs from pediatric patients. Our findings may provide the basis for further study into the choice of therapeutic strategies to treat acute P. falciparum malaria-associated anemia with recombinant human Epo to correct refractory anemia due to malaria.
19 citations
TL;DR: In a retrospective study of 1415 patients aged 15 and over, the incidence of clinically important hyponatraemia and hypokalaemia in adults with uncomplicated malaria was determined and hypovolaemia, blood urea to creatinine ratio and high serum glucose were all independent factors.
Abstract: In a retrospective study of 1415 patients aged 15 and over, we determined the incidence of clinically important hyponatraemia and hypokalaemia in adults with uncomplicated malaria. On admission, serum concentrations of sodium (135-145 mmol/L) and potassium (3.5-5.0 mmol/L) were found outside these reference ranges in 81% of patients. Severe hypokalaemia (K+ 100 mg/dL) were all independent factors (P < 0.001). Other independent predictors for hypokalaemia were Plasmodium vivax infection, female gender; and for hyponatraemia, P. falciparum infection, male gender, concentrations of G-6-PD and serum bicarbonate.
9 citations