Contribution of Plasmodium knowlesi to Multispecies Human Malaria Infections in North Sumatera, Indonesia.

Background: As Indonesia works toward the goal of malaria elimination, information is lacking on malaria epidemiology from some western provinces. As a basis for studies of antimalarial efficacy, we set out to survey parasite carriage in 3 communities in North Sumatera Province. Methods: A combination of active and passive detection of infection was carried out among communities in Batubara, Langkat, and South Nias regencies. Finger-prick blood samples from consenting individuals of all ages provided blood films for microscopic examination and blood spots on filter paper. Plasmodium species were identified using nested polymerase chain reaction (PCR) of ribosomal RNA genes and a novel assay that amplifies a conserved sequence specific for the sicavar gene family of Plasmodium knowlesi. Results: Of 3731 participants, 614 (16.5%) were positive for malaria parasites by microscopy. PCR detected parasite DNA in samples from 1169 individuals (31.3%). In total, 377 participants (11.8%) harbored P. knowlesi. Also present were Plasmodium vivax (14.3%), Plasmodium falciparum (10.5%) and Plasmodium malariae (3.4%). Conclusions: Amplification of sicavar is a specific and sensitive test for the presence of P. knowlesi DNA in humans. Subpatent and asymptomatic multispecies parasitemia is relatively common in North Sumatera, so PCR-based surveillance is required to support control and elimination activities

Recurrence of Plasmodium malariae and P. falciparum Following Treatment of Uncomplicated Malaria in North Sumatera With Dihydroartemisinin-Piperaquine or Artemether-Lumefantrine.

BACKGROUND: We assessed the efficacy of artemisinin-based combination therapies for treatment of uncomplicated falciparum malaria, with or without co-infecting Plasmodium spp., in Sumatera, Indonesia. METHODS: Febrile patients aged >6 months with uncomplicated P. falciparum were randomized to receive dihydroartemisinin-piperaquine or artemether-lumefantrine, plus single-dose primaquine, and were followed for 42 days. Mixed Plasmodium infections were included; P. vivax infections received 14 days of primaquine. We retrospectively restricted the analysis to cases with polymerase chain reaction (PCR)-confirmed parasitemia. Recurrent parasitemia in follow-up was identified by species-specific nested PCR. RESULTS: Of the 3731 participants screened, 302 were enrolled and randomized. In the dihydroartemisinin-piperaquine arm, P. falciparum infections were confirmed by PCR in 59 participants, with mixed infections in 23 (39.0%). In the artemether-lumefantrine arm, P. falciparum infections were confirmed by PCR in 55 participants, with mixed infections in 16 (29.0%). Both regimens were well tolerated, and symptoms improved rapidly in all treated participants. In the dihydroartemisinin-piperaquine arm, 1 P. falciparum recurrence (on day 7) and 6 P. malariae recurrences (1 had a mixed infection with P. falciparum) were identified during days 3-42 of follow-up. In the artemether-lumefantrine arm, 1 P. falciparum/P. malariae/P. vivax recurrence occurred on day 35. Submicroscopic persistence occurred during follow-up in 21 (37%) of 57 receiving dihydroartemisinin-piperaquine and 20 (39%) of 51 receiving artemether-lumefantrine. CONCLUSIONS: In Sumatera, both regimens effectively cleared initial parasitemia, but P. falciparum and P. malariae persisted in some individuals. Molecular species detection should be deployed in antimalarial efficacy trials in Indonesia. TRIAL REGISTRATION: NCT02325180

Plasmodium falciparum Isolates Carrying pfk13 Polymorphisms Harbor the SVMNT Allele of pfcrt in Northwestern Indonesia.

Artemisinin-based combination therapy (ACT) is the first-line antimalarial regimen in Indonesia. Susceptibility of Plasmodium falciparum to artemisinin is falling in the Greater Mekong subregion, but it is not known whether the efficacy of current combinations is also threatened in nearby Sumatera. We evaluated the genetic loci pfcrt, pfmdr1, and pfk13, considered to be under selection by artemisinin combination therapy, among 404 P. falciparum infections identified by PCR detection in a cross-sectional survey of 3,731 residents of three regencies. The pfcrt haplotype SVMNT (codons 72 to 76) was the most prevalent and displayed significant linkage disequilibrium with the pfmdr1 haplotype YY (codons 86 and 184) (odds ratio [OR] 26.7; 95% confidence interval [CI], 5.96 to 239.4; P < 0.001). This contrasts with Mekong countries, where the CVIET haplotype of pfcrt predominates. Among 231 evaluable isolates, only 9 (3.9%) showed any evidence of nonsynonymous gene variants in the propeller domain of pfk13 The Thr474Ala variant was seen in six individuals, and Cys580Tyr was identified with low confidence in only a single isolate from an asymptomatic individual. Among a subset of 117 symptomatic P. falciparum-infected individuals randomized to receive either dihydroartemisinin-piperaquine or artemether-lumefantrine, the treatment outcome was not associated with pretreatment genotype. However, submicroscopic persistent parasites at day 28 or day 42 of follow-up were significantly more likely to harbor the pfmdr1 haplotype NF (codons 86 and 184) than were pretreatment isolates (P < 0.001 for both treatment groups). Current ACT regimens appear to be effective in Sumatera, but evidence of persistent submicroscopic infection in some patients suggests further detailed studies of drug susceptibility should be undertaken

Contribution of Plasmodium knowlesi to multi-species human malaria infections in North Sumatera, Indonesia

Background As Indonesia works towards the goal of malaria elimination, information is lacking on malaria epidemiology from some western provinces. As a basis for studies of antimalarial efficacy, we set out to survey parasite carriage in three communities in North Sumatera Province. Methods A combination of active and passive detection of infection was carried out among communities in Batubara, Langkat and South Nias regencies. Finger-prick blood samples from consenting individuals of all ages provided blood films for microscopic examination and blood spots on filter paper. Plasmodium species were identified by nested PCR of rRNA genes, and a novel assay which amplifies a conserved sequence specific for the sicavar gene family of P. knowlesi. Results 614 of 3,731 participants (16.5%) were positive for malaria parasites by microscopy. PCR detected parasite DNA in samples from 1,169 individuals (31.3%). In total, 377 participants (11.8%) harboured P. knowlesi. Also present were P. vivax (14.3%), P. falciparum (10.5%) and P. malariae (3.4%). Conclusions Amplification of sicavar is a specific and sensitive test for the presence of P. knowlesi DNA in humans. Subpatent and asymptomatic multi-species parasitaemia is relatively common in North Sumatera, and so PCR-based surveillance is required to support control and elimination activities

Menuju Perguruan Tinggi Sebagai Badan Hukum Milik Negara : Prospek Dan Masalah

+35hlm.;21c

Efikasi Kinin-Doksisiklin pada Pengobatan Malaria Falsiparum Tanpa Komplikasi

Pengobatan malaria masih merupakan masalah yang sering dihadapi karena terjadinya resistensi terhadap beberapa obat anti malaria. Kombinasi dua macam obat saat ini yang sering dipergunakan, terutama pada daerah hiperendemis, untuk meningkatkan efikasi dari obat tersebut. Kombinasi kinin-doksisiklin adalah salah satu kombinasi obat anti malaria yang dapat diberikan sebagai terapi alternatif untuk pengobatan malaria falsiparum tanpa komplikasi. Pada beberapa penelitian ditunjukkan bahwa kombinasi kedua obat ini mempunyai efikasi yang baik

Enterobiasis pada Anak

Enterobiasis merupakan infeksi yang sering terjadi dalam satu keluarga atau pada orang yang tinggal dalam satu rumah. Infeksi cacing sering diduga pada anak yang menunjukkan rasa gatal di sekitar anus pada waktu malam hari. Anal swab merupakan metode terbaik dalam mendiagnosis enterobiasis. Pemeriksaan periodik disertai dengan pengobatan yang adekuat akan dapat membantu mengurangi kejadian enterobiasis pada anak. Meskipun demikian, masih terdapat kesulitan dalam mengontrol enterobiasis oleh karena mudahnya penularan dan reinfeks

Treatment of intestinal helminthiasis: mebendazole only or mebendazole-pyrantel pamoate?

Background Although intestinal helminthiasis causes high morbidity and has a negative impact on children’s growth and development, the efficacy of antihelmintics for multiple helminthiasis in mass treatment is still doubtful. Objective To compare the efficacy of single dose mebendazole and a combination of pyrantel pamoate and mebendazole for the treatment of multiple infections due to Ascaris lumbricoides, hookworm, and Trichuris trichiura. Methods Subjects were elementary school students in Suka Village, Tiga Panah subdistrict, North Sumatera. They were randomized to either receive mebendazole (M Group) or mebendazole- pyrantel pamoate group (MP Group). Stool examinations were perfomed on each subjects on day 7, 14, 21, and 28 after treatment. Analyses were perfomed by using chi-squared and Mann-Whitney U tests. Results The prevalence of intestinal helminthiasis was 95.4%. T. trichiura (88.7%) was the most common cause of infection followed by A. lumbricoides (79.5%), and hookworm (3.1%). Two hundred thirty nine (76.8%) children had multiple infections. Although the egg reduction rate of intestinal helminthiasis in the combination group was faster than that of the mebendazole group, there was no significant difference in the cure rate of both groups. Conclusion A single dose of mebendazole is preferred for mass treatment of multiple intestinal helminthiasis infections

Comparison of the efficacy of artesunate-amodiaquine with quinine ... clindamycin for treatment of uncomplicated falciparum malaria in children

Background Drug-resistant Plasmodium falciparum malaria is a major contributor to increasing malaria-related morbidity and mortality. Artesunate-amodiaquine is a potential combination therapy that shows improved treatment efficacy. Clindamycin in combination with quinine is also a safe and effective treatment for multidrug-resistant P. falciparum malaria. Objectives To compare the efficacy of artesunate-amodiaquine and quinine-clindamycin combination therapies for the treatment of uncomplicated falciparum malaria. Methods This randomized open label trial in 23 2 children aged between one month and 18 years old took place in Mandailing Natal, North Sumatra, from August to September 2006. The AA group received a 3-day oral course of artesunate (4 mg/kg BW once a day) plus amodiaquine (10 mg/kg BW once a day). The QC group received a 3-day course of clindamycin (5 mg of base/kg BW twice a day) plus a 7-day course of quinine (10 mg of salt/kg BW orally for the first four days, then 5 mg of quinine salt/kg BW for the next three days). We performed thin and thick peripheral blood smears on days 0, 2, 7, and 28. Results A total of 232 eligible children were enrolled but only 22 7 completed the study (114 in group AA, 113 in group QC). The cure rates were lOOo/o in both groups by the second day, and there was no recrudescence in either group. We found more side effects in AA group compared with in QC group, i.e., headache and vomiting. Conclusion Artesunate-amodiaquine and quinine-clindamycin combinations showed similar efficacy for the treatment of uncomplicated P. falciparum

Treatment of intestinal helminthiasis: mebendazole only or mebendazole-pyrantel pamoate?

Background Although intestinal helminthiasis causes high morbidity and has a negative impact on children’s growth and development, the efficacy of antihelmintics for multiple helminthiasis in mass treatment is still doubtful. Objective To compare the efficacy of single dose mebendazole and a combination of pyrantel pamoate and mebendazole for the treatment of multiple infections due to Ascaris lumbricoides, hookworm, and Trichuris trichiura. Methods Subjects were elementary school students in Suka Village, Tiga Panah subdistrict, North Sumatera. They were randomized to either receive mebendazole (M Group) or mebendazole- pyrantel pamoate group (MP Group). Stool examinations were perfomed on each subjects on day 7, 14, 21, and 28 after treatment. Analyses were perfomed by using chi-squared and Mann-Whitney U tests. Results The prevalence of intestinal helminthiasis was 95.4%. T. trichiura (88.7%) was the most common cause of infection followed by A. lumbricoides (79.5%), and hookworm (3.1%). Two hundred thirty nine (76.8%) children had multiple infections. Although the egg reduction rate of intestinal helminthiasis in the combination group was faster than that of the mebendazole group, there was no significant difference in the cure rate of both groups. Conclusion A single dose of mebendazole is preferred for mass treatment of multiple intestinal helminthiasis infections