Antipyretic effect of ibuprofen in Gabonese children with uncomplicated falciparum malaria: a randomized, double-blind, placebo-controlled trial

<p>Abstract</p> <p>Background</p> <p>Antipyretic drugs are widely used in children with fever, though there is a controversy about the benefit of reducing fever in children with malaria. In order to assess the effect of ibuprofen on fever compared to placebo in children with uncomplicated <it>Plasmodium falciparum </it>malaria in Gabon, a randomized double blind placebo controlled trial, was designed.</p> <p>Methods</p> <p>Fifty children between two and seven years of age with uncomplicated malaria were included in the study. For the treatment of fever, all patients "received" mechanical treatment when the temperature rose above 37.5°C. In addition to the mechanical treatment, continuous fanning and cooling blanket, patients were assigned randomly to receive ibuprofen (7 mg/kg body weight, every eight hours) or placebo.</p> <p>Results</p> <p>The fever clearance time using a fever threshold of 37.5°C was similar in children receiving ibuprofen compared to those receiving placebo. The difference was also not statistically significant using a fever threshold of 37.8°C or 38.0°C. However, the fever time and the area under the fever curve were significantly smaller in the ibuprofen group compared to the placebo group.</p> <p>Conclusion</p> <p>Ibuprofen is effective in reducing the time with fever. The effect on fever clearance is less obvious and depends on definition of the fever threshold.</p> <p>Trial registration</p> <p>The trial registration number is: NCT00167713</p

Nycteria and polychromophilus parasite infections of bats in central Gabon

Haemosporida are arthropod-borne blood parasites that infect a wide range of vertebrate hosts, including numerous species of bats. Here, we present data of haemosporidian infections in different bat species that were surveyed in Ngounié province, Gabon. We detected Nycteria parasites in Rhinolophus bats and Polychromophilus in Miniopterus minor, a rare and poorly known bat species. Strikingly, no Hepatocystis parasites, which are abundant in epauletted fruit bats elsewhere in Africa, were detected. Our findings suggest that Hepatocystis infections in bats display diverse regional patterns of distribution and transmission dynamics, that cannot be predicted from host abundance. Nycteria parasites are widely distributed in several African rhinolophid species and Polychromophilus parasites of diverse Miniopterus species worldwide belong to the same parasite species

Classification of Rhinoentomophthoromycosis into Atypical, Early, Intermediate, and Late Disease: A Proposal

<div><p>Background</p><p>Rhinoentomophthoromycosis, or rhino-facial conidiobolomycosis, is a rare, grossly disfiguring disease due to an infection with entomophthoralean fungi. We report a case of rhinoentomophthoromycosis from Gabon and suggest a staging system, which provides information on the prognosis and duration of antifungal therapy.</p><p>Methods</p><p>We present a case of rhinoentomophthoromycosis including the histopathology, mycology, and course of disease. For the suggested staging system, all cases on confirmed rhinoentomophthoromycosis published in the literature without language restriction were eligible. Exclusion criteria were missing data on (i) duration of disease before correct diagnosis, (ii) outcome, and (iii) confirmation of entomophthoralean fungus infection by histopathology and/or mycology. We classified cases into atypical (orbital cellulitis, severe pain, fever, dissemination), early, intermediate, and late disease based on the duration of symptoms before diagnosis. The outcome was evaluated for each stage of disease.</p><p>Findings</p><p>The literature search of the Medpilot database was conducted on January 13, 2014, (updated on January 18, 2015). The search yielded 8,333 results including 198 cases from 117 papers; of these, 145 met our inclusion criteria and were included in the final analysis. Median duration of treatment was 4, 3, 4, and 5 months in atypical, early, intermediate, and late disease, respectively. Cure rates were clearly associated with stage of disease and were 57%, 100%, 82%, and 43% in atypical, early, intermediate, and late disease, respectively.</p><p>Conclusion</p><p>We suggest a clinical staging system that underlines the benefit of early case detection and may guide the duration of antifungal treatment. The scientific value of this classification is its capacity to structure and harmonize the clinical and research approach towards rhinoentomophthoromycosis.</p></div

Portrait of the patient before, during and after treatment.

<p>(A) The patient is shown as a healthy young adult. (B) Before treatment (month 0). (C) After treatment with fluconazole and terbinafine (month 18). (D) After 14 months without therapy (month 32).</p

Typical course of rhinoentomophthoromycosis.

<p>(A) In early disease (cure rate: 100%) patients complain about rhinitis, intermittent epistaxis, nasal obstruction, or sinus pain. A nodule at the nostrils indicates invasion into the subcutaneous fat. Tissue invasion follows anatomical barriers causing facial tumefaction. (B) History of the disease of not more than 12 months is classified as intermediate disease (cure rate: 82%). (C) In late disease, patients present with facial deformity (cure rate: 43%). Patients with facial elephantiasis, as defined by Choon et al., might have an even poorer prognosis (cure rate: 37.5%) [<a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0003984#pntd.0003984.ref002" target="_blank">2</a>].</p

Histopathology.

<p>Histopathological picture of hyphae of Entomophthorales after KOH-staining (A), after hematoxylin eosin stain (HE-stain) (B and C), and after Grocott-Gomori's methenamine silver stain (GMS-stain) (D). The pauci-septated, right-angled branching fungal hyphae have an irregular diameter of 5–12 μm with drumstick-like distended ends (A). The “Splendore-Hoeppli phenomenon” is characterized by a peri-hyphal amorphous eosinophilic material (B). Fungal hyphae are visible in transversal (C) or longitudinal cuts (D).</p

Suggested staging system of rhinoentomophthoromycosis.

<p>^a The duration of disease can overlap between early and intermediate disease. See <a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0003984#pntd.0003984.g004" target="_blank">Fig 4</a> for the definite association of a case to the corresponding stage.</p><p>^b Cure rates in atypical disease could be misleading. The lethality rate (43%) might be more conclusive.</p><p>Suggested staging system of rhinoentomophthoromycosis.</p