Treatment of COVID-19 with Chloroquine: Implication for Malaria Chemotherapy Using ACTs in Disease Endemic Countries

Preventive Treatment ◽

World Health ◽

Cross Resistance ◽

Drug Resistant ◽

Combination Therapies ◽

Parasite Resistance ◽

Demand And Supply ◽

First Choice ◽

Abstract Based on reports of parasite resistance and on World Health Organization recommendation, chloroquine was replaced with the artemisinin-based combination therapies (ACTs) as the first choice of drugs for the treatment of uncomplicated malaria. Disuse of chloroquine led to restoration of drug-sensitive parasite to some extent in certain countries. Ever since chloroquine and hydroxychloroquine were touted as potential treatment for coronavirus disease 2019 (COVID-19), there has been a dramatic surge in demand for the drugs. Even in areas where chloroquine is proscribed, there has been an unexpected increase in demand and supply of the drug. This situation is quite worrying as the indiscriminate use of chloroquine may produce drug-resistant parasites which may impact negatively on the efficacy of amodiaquine due to cross-resistance. Amodiaquine is a partner drug in one of the ACTs and in some of the drugs used for intermittent preventive treatment. We herein discuss the consequences of the escalated use of chloroquine in the management of COVID-19 on chemotherapy or chemoprevention of malaria and offer an advice. We speculate that parasite strains resistant to chloroquine will escalate due to the increased and indiscriminate use of the drug and consequently lead to cross-resistance with amodiaquine which is present in some drug schemes aforementioned. Under the circumstance, the anticipated hope of reverting to the use of the ‘resurrected chloroquine’ to manage malaria in future is likely to diminish. The use of chloroquine and its derivatives for the management of COVID-19 should be controlled.

Uptake of intermittent preventive treatment for malaria during pregnancy with Sulphadoxine-Pyrimethamine in Malawi after adoption of updated World Health Organization policy: an analysis of demographic and health survey 2015–2016

BMC Public Health ◽

10.1186/s12889-020-08471-5 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Steven Chifundo Azizi

Keyword(s):

World Health Organization ◽

Health Survey ◽

Preventive Treatment ◽

World Health ◽

Organization Policy ◽

Health Organization ◽

Uptake of Intermittent Preventive Treatment for Malaria during Pregnancy with Sulphadoxine-Pyrimethamine in Malawi after adoption of updated World Health Organization policy: An Analysis of Demographic and Health Survey 2015-2016

10.21203/rs.2.20575/v3 ◽

2020 ◽

Author(s):

Steven Chifundo Azizi

Keyword(s):

Health Survey ◽

Preventive Treatment ◽

Malaria Prevention ◽

World Health ◽

Limited Effectiveness ◽

Health Organization ◽

Abstract Background: Malawi adopted the 2012 updated Word Health Organization (WHO) Intermittent preventive treatment of malaria during pregnancy with sulphadoxine-pyrimethamine (IPTp-SP) policy in 2013. This study aimed to estimate the proportion of and identify factors associated with the uptake of at least three doses of IPTp with SP among pregnant women in Malawi after the adoption and operationalisation of updated WHO IPTp-SP policy. Methods: The 2015-16 Malawi Demographic and Health Survey dataset was analysed. Of 1,219 women aged 15-49 years who had live births and the children were born after the date of July 2015, 1,069 women were included in the analysis. Bivariate and multiple logistic regression were used in data analysis. The statistical analysis took into account a complex survey sample design. Results: Of the 1,069 women, 447 (42%, 95% CI: 38.1-45.6) received three (optimal) or more doses of IPTp-SP. Less than half (47%) managed to attend at least four antenatal care (ANC) clinics. Only 52% received optimal SP doses among those who made at least four ANC visits. Only the number of ANC visits was associated with the optimal uptake of SP. Women who attended ANC three times only and those who visited ANC once or twice only were less likely to receive at least three doses of SP than those who managed to attend ANC at least four times during pregnancy (AOR=0.71, 95% CI 0.49-1.02) and (AOR=0.12, 95% CI 0.06-0.21) respectively. Conclusions: To achieve effective malaria prevention in pregnancy, IPTP-SP is used alongside other interventions. However, there is low uptake of optimal SP doses in Malawi, and this seems to be associated with the number of ANC visits. Moreover, there is limited effectiveness of an increased number of ANC visits on the uptake of optimal SP doses. Further research should be done to explore health systems factors affecting uptake of optimal IPTp with SP doses during pregnancy.

Sulfadoxine-pyrimethamine parasitological efficacy against Plasmodium falciparum among pregnant women and molecular markers of resistance in Zambia: an observational cohort study

Malaria Journal ◽

10.1186/s12936-021-03596-3 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Enesia Banda Chaponda ◽

Sungano Mharakurwa ◽

Charles Michelo ◽

Jane Bruce ◽

Daniel Chandramoha ◽

...

Keyword(s):

Plasmodium Falciparum ◽

Pregnant Women ◽

Preventive Treatment ◽

World Health ◽

Treatment And Prevention ◽

Observational Cohort ◽

Gestational Week ◽

Resistance Markers ◽

Abstract Background The World Health Organization recommends the provision of intermittent preventive treatment during pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP) at 4-week intervals from gestational week 13 to delivery in areas of moderate to high malaria transmission intensity. However, the effect of IPTp-SP has been compromised in some areas due to parasite resistance, raising the importance of parasitological and chemoprophylactic surveillance, and monitoring SP-resistance markers in the Plasmodium falciparum population. Methods Between November 2013 and April 2014 in Nchelenge, Zambia, 1086 pregnant women received IPTp-SP at antenatal-care bookings. Blood samples were collected on day 0, and on day 28 post-treatment to test for malaria parasites and to estimate SP parasitological efficacy in the treatment and prevention of parasitaemia. A random sample of 96, day 0 malaria-positive samples were analysed to estimate the prevalence of SP-resistance markers in the P. falciparum population. Results The overall parasitological and prophylactic failure among women who had paired day 0 and day 28 blood slides was 18.6% (95% CI 15.5, 21.8; 109 of 590). Among pregnant women who had asymptomatic parasitaemia on day 0, the day 28 PCR-uncorrected parasitological failure was 30.0% (95% CI 23.7, 36.2; 62 of 207) and the day 28 PCR-corrected parasitological failure was 15.6% (95% CI: 10.6, 20.6; 32 of 205). Among women who tested negative at day 0, 12.3% (95% CI: 9.0, 15.6; 47 of 383) developed parasitaemia at day 28. Among the 96 malaria-positive samples assayed from day 0, 70.8% (95% CI: 60.8, 79.2) contained the DHPS double (Gly-437 + Glu-540) mutation and 92.7% (95% CI: 85.3, 96.5) had the DHFR triple (Asn-108 + Ile-51 + Arg-59) mutation. The quintuple mutation (DHFR triple + DHPS double) and the sextuple mutant (DHFR triple + DHPS double + Arg-581) were found among 68.8% (95% CI: 58.6, 77.3) and 9.4% (95% CI: 4.2, 16.0) of samples, respectively. Conclusion The parasitological and chemoprophylactic failure of SP, and the prevalence of resistance markers in Nchelenge is alarmingly high. Alternative therapies are urgently needed to safeguard pregnant women against malarial infection.

Uptake of Intermittent Preventive Treatment for Malaria during Pregnancy with Sulphadoxine-Pyrimethamine (IPTp-SP) in Malawi after adoption of updated World Health Organization policy: An Analysis of Demographic and Health Survey 2015-2016

10.21203/rs.2.20575/v1 ◽

2020 ◽

Author(s):

Steven Chifundo Azizi

Keyword(s):

Health Survey ◽

Preventive Treatment ◽

Malaria Prevention ◽

World Health ◽

Limited Effectiveness ◽

Health Organization ◽

Abstract Background Malawi adopted the 2012 updated Word Health Organization (WHO) Intermittent preventive treatment of malaria during pregnancy with sulphadoxine-pyrimethamine (IPTp-SP) policy in 2013. This study aimed to estimate the proportion of and identify factors associated with the uptake of at least three doses of IPTp-SP among pregnant women in Malawi after the adoption of updated WHO IPTp-SP policy.Methods The 2015-16 Malawi Demographic and Health Survey dataset was used. Of 1,219 women aged 15-49 years who had live births and the children were born after date of July 2015, 1,069 women were included in the analysis. Bivariate and multiple logistic regression were used in data analysis. The statistical analysis took into account complex survey sample design.Results Of the 1,069 women, 447 (42%, 95% CI: 38.1-45.6) received three (optimal) or more doses of IPTp-SP. Less than half (47%) managed to attend at least four antenatal care (ANC) clinics. Only 52% received optimal SP doses among those who made at least four ANC visits. Only the number of ANC visits was associated with the optimal uptake of SP. Women who attended ANC three times only and those who visited ANC once or twice only were less likely to receive at least three doses of SP than those who managed to attend ANC at least four times during pregnancy (AOR=0.71, 95% CI 0.49-1.02) and (AOR=0.12, 95% CI 0.06-0.21) respectively.Conclusions To achieve effective malaria prevention in pregnancy, IPTP-SP is used alongside other interventions. However, there is low uptake of optimal SP doses in Malawi, and this seems to be associated with the number of ANC visits. There is limited effectiveness of increased number of ANC visits on the uptake of optimal SP doses. Further research should be done to explore health systems factors affecting uptake of optimal IPTp-SP doses during pregnancy.

Intermittent Preventive Sulfadoxine-Pyrimethamine Treatment of Primigravidae Reduces Levels of Plasma Immunoglobulin G, Which Protects against Pregnancy-Associated Plasmodium falciparum Malaria

Infection and Immunity ◽

10.1128/iai.72.9.5027-5030.2004 ◽

2004 ◽

Vol 72 (9) ◽

pp. 5027-5030 ◽

Cited By ~ 27

Author(s):

Trine Staalsoe ◽

Caroline E Shulman ◽

Edgar K. Dorman ◽

Ken Kawuondo ◽

Kevin Marsh ◽

...

Keyword(s):

Plasmodium Falciparum ◽

Immunoglobulin G ◽

Protective Immunity ◽

Preventive Treatment ◽

Plasmodium Falciparum Malaria ◽

World Health ◽

Variant Surface Antigens ◽

Specific Igg ◽

ABSTRACT Pregnancy-associated malaria (PAM) is an important cause of maternal and neonatal suffering. It is caused by Plasmodium falciparum capable of inhabiting the placenta through expression of particular variant surface antigens (VSA) with affinity for proteoglycans such as chondroitin sulfate A. Protective immunity to PAM develops following exposure to parasites inhabiting the placenta, and primigravidae are therefore particularly susceptible to PAM. The adverse consequences of PAM in primigravidae are preventable by intermittent preventive treatment (IPTp), where women are given antimalarials at specified intervals during pregnancy, but this may interfere with acquisition of protective PAM immunity. We found that Kenyan primigravidae receiving sulfadoxine-pyrimethamine IPTp had significantly lower levels of immunoglobulin G (IgG) with specificity for the type of parasite-encoded VSA—called VSAPAM—that specifically mediate protection against PAM than did women receiving a placebo. VSAPAM-specific IgG levels depended on the number of IPTp doses received and were sufficiently low to be of clinical concern among multidose recipients. Our data suggest that IPTp should be extended to women of all parities, in line with current World Health Organization recommendations.

Uptake of Intermittent Preventive Treatment for Malaria during Pregnancy with Sulphadoxine-Pyrimethamine in Malawi after adoption of updated World Health Organization policy: An Analysis of Demographic and Health Survey 2015-2016

10.21203/rs.2.20575/v2 ◽

2020 ◽

Author(s):

Steven Chifundo Azizi

Keyword(s):

Health Survey ◽

Preventive Treatment ◽

Malaria Prevention ◽

World Health ◽

Limited Effectiveness ◽

Health Organization ◽

Abstract Background Malawi adopted the 2012 updated Word Health Organization (WHO) Intermittent preventive treatment of malaria during pregnancy with sulphadoxine-pyrimethamine (IPTp-SP) policy in 2013. This study aimed to estimate the proportion of and identify factors associated with the uptake of at least three doses of IPTp-SP among pregnant women in Malawi after the adoption and operationalisation of updated WHO IPTp-SP policy. Methods The 2015-16 Malawi Demographic and Health Survey dataset was used. Of 1,219 women aged 15-49 years who had live births and the children were born after date of July 2015, 1,069 women were included in the analysis. Bivariate and multiple logistic regression were used in data analysis. The statistical analysis took into account complex survey sample design. Results Of the 1,069 women, 447 (42%, 95% CI: 38.1-45.6) received three (optimal) or more doses of IPTp-SP. Less than half (47%) managed to attend at least four antenatal care (ANC) clinics. Only 52% received optimal SP doses among those who made at least four ANC visits. Only the number of ANC visits was associated with the optimal uptake of SP. Women who attended ANC three times only and those who visited ANC once or twice only were less likely to receive at least three doses of SP than those who managed to attend ANC at least four times during pregnancy (AOR=0.71, 95% CI 0.49-1.02) and (AOR=0.12, 95% CI 0.06-0.21) respectively. Conclusions To achieve effective malaria prevention in pregnancy, IPTP-SP is used alongside other interventions. However, there is low uptake of optimal SP doses in Malawi, and this seems to be associated with the number of ANC visits. There is limited effectiveness of increased number of ANC visits on the uptake of optimal SP doses. Further research should be done to explore health systems factors affecting uptake of optimal IPTp-SP doses during pregnancy.

World Health Organization treatment guidelines for drug-resistant tuberculosis, 2016 update

European Respiratory Journal ◽

10.1183/13993003.02308-2016 ◽

2017 ◽

Vol 49 (3) ◽

pp. 1602308 ◽

Cited By ~ 169

Author(s):

Dennis Falzon ◽

Holger J. Schünemann ◽

Elizabeth Harausz ◽

Licé González-Angulo ◽

Christian Lienhardt ◽

...

Keyword(s):

World Health Organization ◽

Treatment Guidelines ◽

Lung Resection ◽

Patient Data ◽

World Health ◽

Patient Treatment ◽

Drug Resistant ◽

Second Line ◽

First Choice ◽

Antimicrobial resistance is a major global concern. Tuberculosis (TB) strains resistant to rifampicin and other TB medicines challenge patient survival and public health. The World Health Organization (WHO) has published treatment guidelines for drug-resistant TB since 1997 and last updated them in 2016 based on reviews of aggregated and individual patient data from published and unpublished studies. An international expert panel formulated recommendations following the GRADE approach. The new WHO guidelines recommend a standardised 9–12 months shorter treatment regimen as first choice in patients with multidrug- or rifampicin-resistant TB (MDR/RR-TB) strains not resistant to fluoroquinolones or second-line injectable agents; resistance to these two classes of core second-line medicines is rapidly detectable with molecular diagnostics also approved by WHO in 2016. The composition of longer regimens for patients ineligible for the shorter regimen was modified. A first-ever meta-analysis of individual paediatric patient data allowed treatment recommendations for childhood MDR/RR-TB to be made. Delamanid is now also recommended in patients aged 6–17 years. Partial lung resection is a recommended option in MDR/RR-TB care. The 2016 revision highlighted the continued shortage of high-quality evidence and implementation research, and reiterated the need for clinical trials and best-practice studies to improve MDR/RR-TB patient treatment outcomes and strengthen policy.

IL-10-592 A/C Gene Polymorphism and Cytokine Levels are Associated with Susceptibility to Drug Resistance in Tuberculosis

Turkish Journal of Immunology ◽

10.25002/tji.2020.1235 ◽

2020 ◽

Vol 8 (3) ◽

pp. 103-112

Author(s):

Atefeh SADEGHI SHERMEH ◽

Majid KHOSHMIRSAFA ◽

Ali-Akbar DELBANDI ◽

Payam TABARSI ◽

Esmaeil MORTAZ ◽

...

Keyword(s):

Serum Levels ◽

World Health ◽

Control Group ◽

Drug Resistant ◽

Nucleotide Polymorphisms ◽

Genotype Frequencies ◽

Cytokine Levels ◽

Ifn Γ ◽

Health Organization ◽

And Function

Introduction: Tuberculosis (TB) and especially resistant forms of it have a substantial economic burden on the community health system for diagnosis and treatment each year. Thus, investigation of this field is a priority for the world health organization (WHO). Cytokines play important roles in the relationship between the immune system and tuberculosis. Genetic variations especially single nucleotide polymorphisms (SNPs) impact cytokine levels and function against TB. Material and Methods: In this research SNPs in IFN-γ (+874 T/A) and IL-10 (-592 A/C) genes, and the effects of these SNPs on cytokine levels in a total of 87 tuberculosis patients and 100 healthy controls (HCs) were studied. TB patients divided into two groups: 1) 67 drug-sensitive (DS-TB) and 2) 20 drug-resistant (DR-TB) according to drug sensitivity test using polymerase chain reaction (PCR). For the genotyping of two SNPs, the PCR-based method was used and IFN-γ and IL-10 levels were measured by ELISA in pulmonary tuberculosis (PTB) and control group. Results: In -592A/C SNP, only two genotypes (AA, AC) were observed and both genotypes showed statistically significant differences between DR-TB and HCs (p=0.011). IL-10 serum levels in PTB patients were higher than HCs (p=0.02). The serum levels of IFN-γ were significantly higher in DS-TB patients than that of the other two groups (p<0.001); however, no significant differences were observed for allele and genotype frequencies in IFN-γ +874. Conclusions: Our results suggest that the SNP at -592 position of IL-10 gene may be associated with the susceptibility to DR-TB. However, further investigation is necessary. Keywords: Polymorphism, IFN-γ, IL-10, tuberculosis, drug-resistant tuberculosis

Severity of Oral Mucositis in Children following Chemotherapy and Radiotherapy and Its Implications at a Single Oncology Centre in Durango State, Mexico

International Journal of Pediatrics ◽

10.1155/2018/3252765 ◽

2018 ◽

Vol 2018 ◽

pp. 1-5 ◽

Cited By ~ 2

Author(s):

Ramón G. Carreón-Burciaga ◽

Enrique Castañeda-Castaneira ◽

Rogelio González-González ◽

Nelly Molina-Frechero ◽

Enrique Gaona ◽

...

Keyword(s):

Adverse Effect ◽

Oral Mucositis ◽

Preventive Treatment ◽

World Health ◽

Clinical Evaluations ◽

Severity Scores ◽

Therapeutic Protocols ◽

Number Of Cycles ◽

Oncology Centre ◽

Background. Mucositis is an adverse effect of chemotherapy (QT) and/or radiotherapy (RT). The purpose of this study was to investigate the occurrence of oral mucositis in children undergoing cancer treatment. Methods. Fifty-one children with cancer who had received QT, RT, or both (QT-RT) underwent clinical evaluations; World Health Organization criteria were used to establish the degree and severity of mucositis. The correlations between the clinical data, type of cancer, and therapy were statistically analysed. Results. Mucositis was present in 88.23% of the patients; 57.78%, 7.78%, and 24.44% received QT, RT, and QT-RT, respectively. Severity scores of 1 and 2 were the most common; scores of 3-4 were observed in patients who received QT-RT or more than 7 treatment cycles. There was a significant association between mucositis, the type of treatment, and the number of cycles received (p<0.05). Conclusion. It is important to implement therapeutic protocols that help maintain excellent oral health and reduce the risk of oral mucositis. Stomatologists should be consulted to assess patients’ oral cavities and provide preventive treatment prior to QT and/or RT administration. It is important to integrate a stomatologist into the oncological working group to focus on preventing and managing oral mucositis.

TB Elimination Requires Discovery and Development of Transformational Agents

Applied Sciences ◽

10.3390/app10072605 ◽

2020 ◽

Vol 10 (7) ◽

pp. 2605 ◽

Cited By ~ 1

Author(s):

Christian Lienhardt ◽

Mario C. Raviglione

Keyword(s):

Rapid Detection ◽

Susceptibility Testing ◽

Drug Susceptibility ◽

Drug Susceptibility Testing ◽

New Drugs ◽

World Health ◽

Drug Resistant ◽

The World ◽

Health Organization ◽

Combination Regimens

The World Health Organization (WHO) End Tuberculosis (TB) Strategy has set ambitious targets to reduce 2015 TB incidence and deaths by 80% and 90%, respectively, by the year 2030. Given the current rate of TB incidence decline (about 2% per year annually), reaching these targets will require new transformational tools and innovative ways to deliver them. In addition to improved tests for early and rapid detection of TB and universal drug-susceptibility testing, as well as novel vaccines for improved prevention, better, safer, shorter and more efficacious treatments for all forms of TB are needed. Only a handful of new drugs are currently in phase II or III clinical trials, and a few combination regimens are being tested, mainly for drug-resistant TB. In this article, capitalising on an increasingly rich medicine pipeline and taking advantage of new methodological designs with great potential, the main areas where progress is needed for a transformational improvement of treatment of all forms of TB are described.