Showing papers on "Plasmodium vivax published in 1994"

Identification of the erythrocyte binding domains of Plasmodium vivax and Plasmodium knowlesi proteins involved in erythrocyte invasion

Abstract: Plasmodium vivax and the related monkey malaria, P. knowlesi, require interaction with the Duffy blood group antigen, a receptor for a family of chemokines that includes interleukin 8, to invade human erythrocytes. One P. vivax and three P. knowlesi proteins that serve as erythrocyte binding ligands in such interactions share sequence homology. Expression of different regions of the P. vivax protein in COS7 cells identified a cysteine-rich domain that bound Duffy blood group-positive but not Duffy blood group-negative human erythrocytes. The homologous domain of the P. knowlesi proteins also bound erythrocytes, but had different specificities. The P. vivax and P. knowlesi binding domains lie in one of two regions of homology with the P. falciparum sialic acid binding protein, another erythrocyte binding ligand, indicating conservation of the domain for erythrocyte binding in evolutionarily distant malaria species. The binding domains of these malaria ligands represent potential vaccine candidates and targets for receptor-blockade therapy.

Phylogeny of the malarial genus Plasmodium, derived from rRNA gene sequences

Abstract: Malaria is among mankind's worst scourges, affecting many millions of people, particularly in the tropics. Human malaria is caused by several species of Plasmodium, a parasitic protozoan. We analyze the small subunit rRNA gene sequences of 11 Plasmodium species, including three parasitic to humans, to infer their evolutionary relationships. Plasmodium falciparum, the most virulent of the human species, is closely related to Plasmodium reichenowi, which is parasitic to chimpanzee. The estimated time of divergence of these two Plasmodium species is consistent with the time of divergence (6-10 million years ago) between the human and chimpanzee lineages. The falciparum-reichenowi clade is only remotely related to two other human parasites, Plasmodium malariae and Plasmodium vivax, which are also only remotely related to each other. Thus, the parasitic associations of the Plasmodium species with their human hosts are phylogenetically independent. The remote phylogenetic relationship between the two bird parasites, Plasmodium gallinaceum and Plasmodium lophurae, and any of the human parasites provides no support for the hypothesis that infection by Plasmodium falciparum is a recent acquisition of humans, possibly coincident with the onset of agriculture.

Mefloquine Prophylaxis Prevents Malaria during Pregnancy: A Double-Blind, Placebo-Controlled Study

Abstract: A double-blind, placebo-controlled study of mefloquine antimalarial prophylaxis in pregnancy (> 20 weeks of gestation) was conducted in 339 Karen women living in an area of multidrug-resistant malaria transmission on the Thai-Burmese border. Mefloquine gave > or = 86% (95% confidence interval [CI], 59%-94%) protection against Plasmodium falciparum and complete protection against Plasmodium vivax infections. Mefloquine prophylaxis was well tolerated; use of an initial loading dose (10 mg/kg) was associated with transient dizziness, but there were no other significant adverse effects on the mother, the pregnancy, or infant survival or development (followed for 2 years). Falciparum malaria was associated with maternal anemia and a mean reduction in birth weight in gravidae I, II, and III of 225 g (95% CI, 26-423). Maternal anemia at delivery (hematocrit < 30%) was associated with increased infant mortality: 26% versus 15% (relative risk, 1.9; 95% CI, 1.1-3.2). Mefloquine is safe and effective for antimalarial prophylaxis in the second half of pregnancy.

Occurrence of tertian malaria in a male patient who has never been abroad

Abstract: Malaria is estimated to have a worldwide incidence of more than 100 million clinical cases and approximately 1 million deaths per year. Korea, although previously known as an endemic area of tertian malaria (Plasmodium vivax), has been considered free from malaria as there had been no report on indigenous cases since 1984. Recently, however, we experienced an indigenous case of P. vivax infection in a young man who had never been abroad. The patient was a 23-year-old Korean soldier with 18-day history of recurrent fever and chill lasting 4 to 8 hours on alternative days since mid-July 1993. He had lived in Changwon, Kyongsangnam-do, before entering barracks located in Paju-gun, Kyonggi-do on June 1992, and had never been out of Korea. He had no history of blood transfusion nor parenteral use of drugs. The peripheral blood smears showed typical ring forms, trophozoites, and gametocytes of P. vivax, in addition to mild anemia and thrombocytopenia. After confirmation of the diagnosis, he was treated with hydroxychloroquine and primaquine. Follow-up blood smears no more revealed malaria parasites. It is not certain whether the present case is due to a resurgence of indigenous malaria or a secondary infection from introduced malaria. Whichever the source of infection the domestic occurrence of malaria cycle in Korea should be a warning sign in public health point of view.

Clinical trials of artemisinin and its derivatives in the treatment of malaria in China

Abstract: Since 1979 several derivatives of artemisinin have been synthesized and studied in China. Artemisinin suppositories, artesunate (oral or parenteral), intramuscular artemether and dihydroartemisinin tablets have all proved rapidly effective. In all, 2352 patients (2150 with Plasmodium falciparum and 202 with P. vivax) have been included in clinical trials from our centre. All preparations have been well tolerated. These drugs have now replaced chloroquine and quinine for the treatment of malaria in China.

Blood Stage Antimalarial Efficacy of Primaquine in Plasmodium vivax Malaria

Abstract: The blood stage antimalarial efficacy of primaquine (0.25 mg of base/kg of body weight/day over 14 days) and chloroquine (25 mg of base/kg over 3 days) were compared in 85 adult Thai men with acute Plasmodium vivax malaria. Most (75%) had at least one malaria episode previously. Parasite clearance times after primaquine alone (n = 30) were slower than after chloroquine (n = 30) or combined chloroquine-primaquine (n = 25), but all patients had a satisfactory initial therapeutic response. P. vivax malaria recurred in 10 (17%) of 60 patients followed for > or = 2 months and Plasmodium falciparum malaria developed in another 5 (8%) without reexposure to infection. Recurrences occurred or = 5 weeks later, suggesting relapse. Vivax malaria responds well initially to either primaquine or chloroquine. The blood stage antimalarial activity of primaquine may mask chloroquine resistance in combined regimens.

Unstable hypoendemic malaria in Rondonia (western Amazon region, Brazil): epidemic outbreaks and work-associated incidence in an agro-industrial rural settlement

Abstract: A longitudinal study was conducted from January 1991 to January 1992 on the Urupa farm, a rural agro-industrial forestry settlement in Rondonia state (Western Amazon Region, Brazil) to define the parasitologic and clinical profile of malaria. Three cross-sectional, parasitologic, and clinical surveys were performed. In the intervals between surveys, malaria cases were monitored by twice a week medical visits to the farm and permanent local surveillance. The population of residents was approximately 170 and was characterized by high mobility. The slide positive rates found in the cross-sectional surveys were 0.5, 4.2 and 2.1, respectively, for the total population (Plasmodium vivax plus P. falciparum). Spleen rate values in children 2-9 years old were always less than 1%. However, this basically hypoendemic malaria situation was unstable, with occurrence of a typical epidemic outbreak at the end of the dry season. The total number of malaria cases recorded from January to December 1991 was 163, giving an annual parasite index of 970 per 1,000 inhabitants. However, sex and age distribution of cases showed rare incidence of malaria in infants and low incidence in children less than the age of 10. Male adults 16-40 years of age represented the main risk group. The observed clustering of cases allowed us to identify the place of work as a factor responsible for high incidence of malaria among adults. The general epidemiologic profile indicated that indoors transmission of malaria by the local Anopheles vector was low or absent.

Natural variation within the principal adhesion domain of the Plasmodium vivax duffy binding protein.

Abstract: The blood-stage development of malaria parasites is initiated by the invasion of merozoites into susceptible erythrocytes. Specific receptor-ligand interactions must occur for the merozoites to first attach to and then invade erythrocytes. Because the invasion process is essential for the parasite's survival and the merozoite adhesion molecules are exposed on the merozoite surface during invasion, these adhesion molecules are candidates for antibody-dependent malaria vaccines. The Duffy binding protein of Plasmodium vivax belongs to a family of erythrocyte-binding proteins that contain functionally conserved cysteine-rich regions. The amino cysteine-rich regions of these homologous erythrocyte-binding proteins were recently identified for P. vivax, Plasmodium knowlesi, and Plasmodium falciparum as the principal erythrocyte-binding domains (C. Chitnis and L. H. Miller, J. Exp. Med. 180:497-506, 1994, and B. K. L. Sim, C. E. Chitnis, K. Wasniowska, T. J. Hadley, and L. H. Miller, Science 264:1941-1944, 1994). We report that amino acids in this critical ligand domain of the P. vivax Duffy binding protein are hypervariable, but this variability is limited. Hypervariability of the erythrocyte-binding domain suggests that this domain is the target of an effective immune response, but conservation of amino acid substitutions indicates that functional constraints limit this variation. In addition, the amino cysteine-rich region and part of the hydrophilic region immediately following it were the site of repeated homologous recombinations as represented by tandem repeat sequence polymorphisms. Similar polymorphisms have been identified in the same region of the homologous genes of P. falciparum and P. knowlesi, suggesting that there is a common mechanism of recombination or gene conversion that occurs in these Plasmodium genes.

High dose of primaquine in primaquine resistant vivax malaria

Abstract: The efficacy of low dose chloroquine, characteristic pattern of relapse and the relapse rate in vivax malaria after high dose primaquine were investigated in 167 Thai patients. 87 patients were allocated at random to receive 300 mg, and 80 received 450 mg of chloroquine on the first day of admission. All patients in both groups showed a rapid response with comparable fever clearance times (27.3 vs. 26.1 h) and parasite clearance times (67.1 vs. 58.1 h). After recovery and clearance of parasitaemia, the patients were allocated at random (double blind) to receive 2 dosage regimens of primaquine, a daily dose of 15 mg or 22.5 mg for 14 d. Relapses in both groups occurred within 6 months; no patient relapsed beyond that period. The relapse rate in the primaquine 15 mg group was significantly higher than that in the 22.5 mg group (17.5% vs. 2.4%).

A Population-Based Clinical Trial with the SPf66 Synthetic Plasmodium falciparum Malaria Vaccine in Venezuela

Abstract: A phase III malaria vaccine trial in 13 villages in an endemic area, South Venezuela, compared incidence rates of Plasmodium falciparum and Plasmodium vivax infections in 1422 vaccinated and 938 nonvaccinated subjects over 18 months. The SPf66 vaccine was given in three doses, on days 0, 20, and 112. Vaccination was complete in 976 subjects (68.7%). Minor side effects requiring no treatment were reported by 123 (12.6%), with an apparent increase in frequency from the first to the third vaccine dose. No autoimmune evidence was observed in a sample of subjects. Antibodies against SPf66 were present at low titers in 24.7% of tested subjects before vaccination, increasing to 53.6% after the second dose and to 73.6% after the third dose; 26.4% of subjects initially seronegative never seroconverted. The SPf66 malaria vaccine showed a protective efficacy of 55% (95% confidence interval, 21%-75%) against P. falciparum and of 41% (19%-57%) against P. vivax malaria.

Dynamics of malaria parasitaemia associated with febrile illness in children from a rural area of Madang, Papua New Guinea

Abstract: Active community and self-reporting surveillance techniques have been used to describe the dynamics of febrile illness and associated malaria infection in children aged 2 to 15 years from a rural area of Madang Province, Papua New Guinea (PNG). Both history of fever and fever in association with parasitaemia appeared to be reliable indicators of malaria morbidity in this endemic area. Parasite density was observed to be a major determinant of mild malarial disease at both the population level and within an individual. Age-specific prevalence of febrile illness correlated with age-specific patterns of parasite density but not of parasite prevalence. Seasonal changes in fever incidence correlated with parasite density. The transition from afebrile to febrile state within an individual was generally associated with an increase in parasite density. Surveillance and self-reported febrile cases (which differ in severity on the basis of the perceived need for treatment) could be distinguished on the basis of parasite density. Thus surveillance techniques divide clinical malaria in rural PNG into 'mild' and 'very mild' forms. The age-specific pattern of decline of prevalence of malaria-associated febrile illness and parasite density is best explained by induction of strain-specific anti-disease immunity upon infection with a given strain of Plasmodium falciparum. The fever threshold in self-reporting febrile cases was seen to decrease with age and can be explained by an age-specific decline in anti-toxic immunity.

Malaria in US Marines returning from Somalia.

Abstract: Objective. —To identify malaria in US Marines returning from Somalia and to determine their compliance with chemoprophylaxis. Design. —Case series. Setting. —The US Navy health care system. Patients. —Consecutive sample of 106 US Marines diagnosed with malaria after returning from Somalia in 1993. Main Outcome Measures. —Identification of the incidence and clinical features of imported malaria. Determination of compliance with chemoprophylaxis in this cohort. Results. —As of December 20,1993, there were 112 cases of imported malaria in 106 US Marine Corps personnel returning from Somalia. Plasmodium vivax accounted for 97 (87%) of 112 malaria cases, and Plasmodium falciparum accounted for eight (7%) of 112 cases. Mixed infection with P vivax and Pfalciparumwas noted in six (5%) of 112 cases, and a single case of Plasmodium malariae was identified. Patients with P falciparum malaria were diagnosed a mean of 20.9 days (range, 1 to 82 days) after returning to the United States compared with 91.8 days (range, 7 to 228 days) for P vivax infection ( P Conclusions. —Noncompliance with personal protective measures and chemoprophylaxis contributed to the largest outbreak of imported malaria in US military personnel since the Vietnam conflict. Since military personnel frequently go on leave after deployment, health care providers throughout the United States must be aware of the presence of imported malaria from Somalia. ( JAMA . 1994;272:397-399)

Antimalarial effects of rifampin in Plasmodium vivax malaria.

Abstract: The antimalarial effects of rifampin in 60 adults with Plasmodium vivax malaria were assessed. There were three treatment groups: rifampin (20 and 15 mg/kg of body weight per day for 1 and 4 days, respectively; n = 5); rifampin followed by primaquine (15 mg of base per day for 14 days; n = 25), and chloroquine (25 mg of base per kg over 3 days) followed by primaquine (n = 30). All patients were hospitalized till clearance of fever and parasites, and 45 patients stayed in the hospital for 1 month. Despite initial clearance of fever in all patients and a > or = 6-fold reduction in parasitemia per 48-h life cycle, rifampin alone was not effective: all five patients had subsequent R2-like parasitological responses. All patients treated with rifampin-primaquine cleared both fever and parasitemia, but the therapeutic responses were slower than those following treatment with chloroquine-primaquine. Final fever clearance times were significantly longer (mean [standard deviation] = 43 [35] versus 27 [19] h; P = 0.046), and the parasite clearance times (to 50 and 90% of admission parasite counts and to a level undetectable in a peripheral blood smear) were also significantly greater (P = 0.053 to

A highly sensitive, rapid, and simple polymerase chain reaction-based method to detect human malaria (Plasmodium falciparum and Plasmodium vivax) in blood samples.

Abstract: A highly sensitive, rapid and simple method to detect human malaria in blood samples was developed. Malaria parasite DNA in blood from a fingerprick was directly amplified by the polymerase chain reaction (PCR) using two sets of primers to yield a 206-basepair (bp) product for Plasmodium falciparum and a 183-bp product for P. vivax. Both were easily visualized in an ethidium bromide-stained agarose gel, allowing identification of the two human malaria species in a single amplification reaction. As little as a one P. falciparum and/or P. vivax parasite per microliter of blood was detectable by this method, a sensitivity superior to that of thick blood film microscopy. The total time required for diagnosis of 48 blood samples, starting from fingerprick blood collection, was approximately 4 hr. When compared with microscopic examination by an expert microscopist, results showed a sensitivity of 89% for P. falciparum and 91% for P. vivax and an overall specificity of 94%. Six infected blood samples classified by microscopy as single species were diagnosed by the PCR method as being mixed P. falciparum and P. vivax infections. The high sensitivity, rapidity, and simplicity of the method should make it attractive for a large-scale epidemiology study, follow-up of drug treatment, and immunization trials.

Convulsions in childhood malaria.

Abstract: A retrospective survey was conducted of all 2911 children admitted with malaria to 4 provincial hospitals in eastern Thailand between 1977 and 1987. 96 (3.3%) had cerebral malaria of whom 21 (22%) died, 225 (7.7%) had convulsions but were not comatose (4 died), and 2590 were conscious and had no fits (5 died). Thus the relative risk of a fatal outcome associated with convulsions, in the absence of cerebral malaria, was 9.2 (95% confidence interval [CI] = 2.5-34.1), P = 0.004. Overall, Plasmodium falciparum caused 81% of infections, P. vivax 16%, and 3% were mixed. Convulsions without cerebral malaria were more common in children under 3 years old (16%) compared with older children (3%): relative risk 5.6 (95% CI = 4.2-7.5), and were significantly associated with falciparum malaria (8.3%) compared with vivax malaria (4.7%): relative risk 1.7 (95% CI = 1.1-2.7). Convulsions are an important complication of malaria in young children, and are associated specifically with P. falciparum infection, even in otherwise uncomplicated malaria.

A study of polymorphism in the circumsporozoite protein of human malaria parasites.

Abstract: We have characterized the circumsporozoite (CS) gene sequences of Plasmodium malariae China-1 CDC, isolated recently from a person who was infected 50 years ago in China, and P. vivax Chesson, isolated 48 years ago from a patient who had returned from New Guinea. These protein sequences were compared with the CS protein sequences of recently isolated P. vivax and P. malariae parasites. In a similar manner, we compared the previously characterized CS protein gene of P. falciparum clone 7G8, derived from a Brazilian isolate collected in 1980, with the CS protein genes of recent P. falciparum field isolates. In the case of the P. malariae CS protein gene, with the exception of an additional copy of major (NAAG) and minor (NDAG) repeat sequences and the presence of one copy of NDEG sequence, the China-1 CDC P. malariae parasite is similar to the Uganda-1 CDC isolate of 1982. In the nonrepeat region, changes were noted in two amino acid residues, one of which is also seen in a closely related monkey malaria parasite, P. brasilianum. In the case of P. vivax CS proteins, the nonrepeat region of the protein in Chesson strain shares identity with nearly 71% of the CS clones characterized from field isolates. In the P. falciparum CS proteins, the 7G8 CS protein sequence is identical to 75% of the genes of recent field isolates in the Th1R-N1 region. In the Th2R and Th3R regions, 34% and 55% of the CS clones analyzed, respectively, had changes at two amino acid residues.(ABSTRACT TRUNCATED AT 250 WORDS)

Susceptibility of three laboratory strains of Anopheles albimanus (Diptera: Culicidae) to coindigenous Plasmodium vivax in southern Mexico.

Abstract: Three morphologically different pupal phenotypes (green, striped, brown) were selected from a parent strain of Anopheles albimanus Wiedemann collected from the Suchiate region in the state of Chiapas, Mexico. Significant differences in susceptibility to coindigenous Plasmodium vivax Grassi & Feletti were observed when striped was compared with the parent colony as well as with brown and with green phenotypes. Differences in susceptibility were not significant between the other phenotypes and the parent colony.

Malaria in Nonimmune Travelers: A Synopsis of History, Symptoms, and Treatment in 160 Patients.

Abstract: Background: With the current increase of international travel to tropical endemic areas, the incidence of malaria being imported into nonendemic countries has increased significantly. Disagreement concerning malaria chemoprophylaxis and inadequate knowledge of malarious areas, morbidity, and pretravel advise has led to confusion among both health professionals as well as travelers. Therefore, this study was conducted to investigate malaria imported into Germany by identifying the high-risk endemic areas, clinical presentations, and chemoprophylactic and therapeutic regimens related to reported cases. Methods: Between 1990 and 1993, the 160 nonimmune travelers, all German nationals or residents for more than 10 years, presenting to our travel clinic with microscopically confirmed malaria were investigated. For each, the travel history, chemoprophylaxis used during travel, symptoms, pathological diagnosis, and treatment efficacy were analyzed. Results: Africa (73%), Asia (21%), and Central South America (6%) were the endemic countries visited by our patients, of whom only 3% used the chemoprophylaxis recommended for their destination. Plasmodium falciparum was the most common pathogen, found in more than half of our patients, and P. vivax (29%), P. ova le (6%), P. malariae(6%), a mixed infection with P.falciparum and P vivax (3%) were also detected. All patients presented with fever and headaches, a majority with profuse night sweats, insomnia, arthralgias, and myalgias, and diarrhea and abdominal cramps were experienced in 13% and 8%, respectively. In falciparum malaria, a recrudescence was observed in all patients who received chloroquine only, whereas quinine, halofantrine, and mefloquine were highly effective. In vivax malaria, a relapse rate of 14% was noted in the patients treated with the currently recommended regimen of chloroquine and primaquine. Conclusions: Visitors to endemic countries, especially to Africa, are of significant risk. Given the low compliance rate of chemoprophylaxis, a high percentage of malaria in our patients could have been avoided by an appropriate prophylaxis regimen and optimal pretravel counseling.

Life-spans of human T-cell responses to determinants from the circumsporozoite proteins of Plasmodium falciparum and Plasmodium vivax

Abstract: The longevity of specific human memory T-cell responses is largely unknown. However, a knowledge of the duration of memory is important for understanding immunity to an organism and for planning vaccine intervention. To address this, we have examined T-cell memory to malaria by determining T-cell responses by subjects recently exposed to peptides spanning the circumsporozoite (CS) proteins of two species of malaria-causing organisms, Plasmodium falciparum and Plasmodium vivax. Responses to vivax CS peptides by exposed Thai subjects were more frequent than responses by nonexposed individuals, permitting identification of determinants seen by vivax-induced responses. At the population level, there appears to be life-long memory, as the time since individuals were exposed did not diminish responsiveness to these determinants. In contrast, falciparum-exposed subjects were largely indistinguishable from nonexposed controls in responsiveness to falciparum CS determinants. However, a single peptide (F16: DNEKLRKPKHKKLKQPGDGN) was recognized significantly more frequently by P. falciparum-exposed than nonexposed Thai subjects. T cells responsive to this peptide were CD450+ and produced gamma-interferon. In contrast to the response to the vivax determinants and the other falciparum determinants, responsiveness to F16 was undetectable or minimal 2 years after exposure. Our data provide the average life-spans of certain malaria-specific T cells and are consistent with, but do not prove, the hypothesis that antigenic persistence (in the form of P. vivax hypnozoites) correlates with persistence of human T-cell memory.

Pharmacokinetics of primaquine in G6PD deficient and G6PD normal patients with vivax malaria

Abstract: The pharmacokinetics of primaquine have been studied in 13 G6PD normal and 13 G6PD deficient Thai male patients with Plasmodium vivax malaria who were given daily doses of 15 mg of primaquine over 14 d, following a full course of chloroquine. After the first dose (15 mg), primaquine underwent rapid absorption. Mean values (SD in parentheses) of maximum plasma concentration of 57.7 (7.7) vs. 55.7 (7.4) ng/mL were reached at 2.2 (0.6) vs. 2.2 (0.6) h, for the G6PD deficient and G6PD normal groups, respectively. Thereafter, drug levels declined rapidly and monoexponentially with a t1/2 lambda of 6.4 (1.9) vs. 6.3 (2.7) h. The respective mean values (SD in parentheses) for MRT, AUC0-varies; is directly proportional to Cl/f, and Vz/f were 6.8 (0.4) vs. 6.8 (0.5) h, 0.547 (0.070) vs. 0.521 (0.090) micrograms/h/mL, 8.54 (0.37) vs. 8.97 (1.46) mL/min/kg and 4.8 (1.7) vs. 5.1 (1.2) L/kg. There was no difference in the plasma concentrations or pharmacokinetics of primaquine between patients with normal G6PD and G6PD deficiency. In the G6PD deficient group, no relationship between the severity of haemolysis ( 20% haemolysis) and the concentrations/pharmacokinetics of primaquine was observed.

Brief report: malaria probably locally acquired in New Jersey.

Abstract: In September 1991, the New Jersey Department of Health received two case reports of Plasmodium vivax malaria presumed to have been locally acquired in New Jersey. Both patients reported no known exposure to malaria, including travel to areas of endemic disease. Case Reports Patient 1 Patient 1 was a 29-year-old woman who presented to her physician on September 9, 1991, with a four-day history of fevers (temperature, up to 39.9 °C [103.8 °F]), chills, headache, and a petechial rash on her legs. A blood smear, obtained four days earlier as part of a workup for hemochromatosis and just hours before . . .

alphamethrin-impregnated bed nets for malaria and mosquito control in China

Abstract: A community-based intervention trial was carried out to evaluate the effectiveness of alphamethrin-impregnated bed nets for control of Plasmodium vivax malaria and its vector in an area of moderate endemicity in southern Henan province, central China in 1990. Malaria incidence was significantly lower in the intervention group than in the comparison group (2.03 vs. 3.57 per 100 person-years at risk). The protective efficacy for malaria incidence was 43%. The prevalence of malaria parasitaemia among children under 10 years old in the intervention group was about one-quarter of that in the comparison group (0.93% vs. 3.25% and 0.71% vs. 1.96% after one and 4 months use of impregnated nets, respectively). Alphamethrin-impregnated bed nets had a mass killing effect on vector mosquitoes. The outdoor person-biting density of Anopheles anthropophagus and A. sinensis decreased by 70.3% and 29.3% respectively. The density of these 2 mosquito species found resting inside treated nets was close to zero. No side effect was found among users of impregnated bed nets. Impregnation with alphamethrin was more effective on polyester than on cotton netting and residual effects lasted at least one year. Use of alphamethrin is less expensive than permethrin and deltamethrin.

Characterization of naturally acquired human IgG responses against the N-terminal region of the merozoite surface protein 1 of Plasmodium vivax.

Abstract: The primary structure of the merozoite surface protein 1 of Plasmodium vivax (PvMSP-1) revealed the existence of conserved and polymorphic blocks of the protein among different Plasmodium species. To characterize the naturally acquired IgG antibody responses to the PvMSP-1 molecule, the entire N-terminal portion of this protein was expressed as 10 overlapping glutathione S-transferase fusion proteins. The affinity-purified recombinant products were tested by enzyme-linked immunosorbent assay and Western blot against the sera of malaria patients from the state of Rondonia, Brazil. We found that the majority of these sera did not contain IgG antibodies recognizing recombinant proteins expressing exclusively interspecies conserved blocks of the molecule. In contrast, a high proportion of these same sera reacted against recombinant products expressing interspecies polymorphic regions of this protein. The poor B cell immunogenicity of the interspecies conserved blocks of the PvMSP-1 molecule most likely reflects important and unknown structural or functional features of these regions.

Malaria vaccine study site in Irian Jaya, Indonesia: Plasmodium falciparum incidence measurements and epidemiologic considerations in sample size estimation.

Abstract: Malaria epidemiologic and entomologic studies were performed during both the high transmission and low transmission seasons to characterize the Plasmodium falciparum malaria transmission at a proposed malaria vaccine trial site in Irian Jaya, Indonesia The study population consisted of two subsets: native Irianese men with lifelong exposure to malaria and transmigrants who arrived from a nonmalarious area 25 years before the start of the study All subjects received a radical cure for malaria and were then monitored weekly by blood film Both P falciparum malaria attack rates and incidence densities were calculated; transmigrants had a significantly higher rate (P = 0003) than the Irianese during the low transmission season study (20-weeks long) but not during the high transmission season study (12-weeks long) Lack of exposure-induced immunity left the transmigrants at a minimum 17-25% greater relative risk of becoming parasitemic compared with the Irianese during the low transmission season study During the high transmission season study, 50% of the transmigrants were P falciparum positive by week 6 and 50% of the Irianese by week 9 During the low transmission season, 50% of the transmigrants were positive by week 10 and 43% of the Irianese were positive by week 17 Entomologic studies showed that Anopheles koliensis was the predominant vector (> 98% of anopheline catch) Entomologic inoculation rates for P falciparum were 0018 and 039 infective bites/person/night for the low and high transmission seasons, respectively New P vivax cases represented between 16% and 42% of all initial malaria cases(ABSTRACT TRUNCATED AT 250 WORDS)

Imported malaria in the 1990s. A report of 59 cases from Houston, Tex.

Abstract: Objective To determine the frequency, the clinical features, and the response to therapy of imported malaria that was diagnosed in the 1990s in a major North American city. Method A retrospective case series from Houston, Tex, of 59 cases of imported malaria presenting between January 1990 and April 1993. Results Malaria was diagnosed in 59 patients, consisting of 12 cases among patients who had acquired the infection while they were living in endemic areas prior to immigration to the United States, 32 cases among US residents who were originally from endemic areas, and 15 cases among patients originally from North America or Europe. Only 12 patients had received malarial prophylaxis: eight with chloroquine, one with chloroquine and chloroguanide (proguanil), two with chloroquine and primaquine, and one with mefloquine taken intermittently. Eight presented with Plasmodium falciparum infection after receiving chloroquine, and one, after receiving chloroquine and chloroguanide. Two presented with malaria caused by Plasmodium vivax despite receiving chloroquine and primaquine as prophylaxis. In 25 cases, malaria was not considered as an initial diagnosis. Five patients presented with severe disease (three with severe hemolysis, two each with cerebral malaria and renal failure, and one with adult respiratory distress syndrome). Four of the five had initially received a misdiagnosis. Two patients died despite treatment with intravenous quinidine and exchange transfusions. Two patients with P vivax infection had multiple relapses despite courses of chloroquine and primaquine. Six patients were pregnant (including one with a fatal case), one congenital infection was identified. Six patients had not traveled outside of the United States in over 1 year. Conclusion Imported malaria occurs frequently and usually results from the failure to use appropriate prophylaxis. Delayed diagnosis and misdiagnosis are common. Severe disease and fatal cases continue to be seen despite aggressive treatment. Drug resistance has continued to spread and now occurs with P vivax as well as P falciparum.