Deployment of ACT antimalarials for treatment of malaria: challenges and opportunities

Following a long period when the effectiveness of existing mono-therapies for antimalarials was steadily declining with no clear alternative, most malaria-endemic countries in Africa and Asia have adopted artemisinin combination therapy (ACT) as antimalarial drug policy. Several ACT drugs exist and others are in the pipeline. If properly targeted, they have the potential to reduce mortality from malaria substantially. The major challenge now is to get the drugs to the right people. Current evidence suggests that most of those who need the drugs do not get them. Simultaneously, a high proportion of those who are given antimalarials do not in fact have malaria. Financial and other barriers mean that, in many settings, the majority of those with malaria, particularly the poorest, do not access formal healthcare, so the provision of free antimalarials via this route has only limited impact. The higher cost of ACT creates a market for fake drugs. Addressing these problems is now a priority. This review outlines current evidence, possible solutions and research priorities

Ventricular encephalitis associated with leukaemic lymphosarcoma in a bovine calfEncephalite ventriculaire liee au lymphosarcome leucemique chez un veau

A female Ayrshire calf aged three months was referred to the clinic with a history of generalized lymph node enlargement and failure to thrive. Physical examination revealed enlargement of all peripheral lymph nodes and haemonodes. A lymph node biopsy showed many immature lymphocytes in various phases of mitosis. Examination of a blood sample revealed normocytic normochromic anaemia, with many immature and abnormally shaped red blood cells. Although leukocyte count was within the normal range, lymphocytes were the majority (94%), with neutrophils constituting only 6%. Other leukocytes were absent. There were many immature and abnormal lymphocytes, similarly, there were immature and abnormal neutrophils. As a result, a clinical diagnosis of leukaemic lymphosarcoma was made. The calf died two weeks after admission. Postmortem examination revealed emaciation, enlargement of all lymph nodes, with involvement of the haemonodes, liver, kidneys and bone marrow. Microscopically, there were lymphocytic infiltrations in the liver, kidneys, spleen, lungs, abomasum, leptomeninges of the brain and in the subependymal areas of the ventricular system. Bulletin of Animal Health and Production in Africa Vol. 54(2) 2006: 100-10