129 research outputs found
Intravenous Artesunate Reduces Parasite Clearance Time, Duration of Intensive Care, and Hospital Treatment in Patients With Severe Malaria in Europe: The TropNet Severe Malaria Study
Intravenous artesunate improves survival in severe malaria, but clinical trial data from nonendemic countries are scarce. The TropNet severe malaria database was analyzed to compare outcomes of artesunate vs quinine treatment. Artesunate reduced parasite clearance time and duration of intensive care unit and hospital treatment in European patients with imported severe malari
an 8-year multi-centre observational study
Background Malaria remains one of the most serious infections for travellers
to tropical countries. Due to the lack of harmonized guidelines a large
variety of treatment regimens is used in Europe to treat severe malaria.
Methods The European Network for Tropical Medicine and Travel Health (TropNet)
conducted an 8-year, multicentre, observational study to analyse epidemiology,
treatment practices and outcomes of severe malaria in its member sites across
Europe. Physicians at participating TropNet centres were asked to report
pseudonymized retrospective data from all patients treated at their centre for
microscopically confirmed severe Plasmodium falciparum malaria according to
the 2006 WHO criteria. Results From 2006 to 2014 a total of 185 patients with
severe malaria treated in 12 European countries were included. Three patients
died, resulting in a 28-day survival rate of 98.4%. The majority of infections
were acquired in West Africa (109/185, 59%). The proportion of patients
treated with intravenous artesunate increased from 27% in 2006 to 60% in 2013.
Altogether, 56 different combinations of intravenous and oral drugs were used
across 28 study centres. The risk of acute renal failure (36 vs 17% p = 0.04)
or cerebral malaria (54 vs 20%, p = 0.001) was significantly higher in
patients ā„60 years than in younger patients. Respiratory distress with the
need for mechanical ventilation was significantly associated with the risk of
death in the study population (13 vs 0%, p = 0.001). Post-artemisinin delayed
haemolysis was reported in 19/70 (27%) patients treated with intravenous
artesunate. Conclusion The majority of patients with severe malaria in this
study were tourists or migrants acquiring the infection in West Africa.
Intravenous artesunate is increasingly used for treatment of severe malaria in
many European treatment centres and can be given safely to European patients
with severe malaria. Patients treated with intravenous artesunate should be
followed up to detect and manage late haemolytic events
The antigen presenting potential of VĪ³9VĪ“2 T-cells during Plasmodium falciparum blood-stage infection.
During Plasmodium falciparum infections, erythrocyte-stage parasites inhibit dendritic cell maturation and function; compromising development of effective anti-malarial adaptive immunity. Human VĪ³9VĪ“2 T-cells can act in vitro as APCs and induce Ī±Ī² T-cell activation. However, the relevance of this activity in pathophysiological contexts in vivo has remained elusive. Since VĪ³9VĪ“2 T-cells are activated during the early immune response against P.falciparum infection, we investigated whether they could contribute to the instruction of adaptive immune responses toward malaria parasites. In P.falciparum-infected patients,VĪ³9VĪ“2 T-cells presented an increased surface expression of APC-associated markers HLA-DR and CD86. In response to infected red blood cells in vitro, VĪ³9VĪ“2 T-cells readily up-regulated surface expression of HLA-DR, HLA-ABC, CD40, CD80, CD83 and CD86, induced naive Ī±Ī² T-cell responses, and cross-presented soluble prototypical protein to antigen-specific CD8+ T-cells. Our findings indicate that P. falciparum parasites induce genuine APC properties in VĪ³9VĪ“2 T-cells and qualify this subset as an alternative professional APC in malaria patients, which could be harnessed for therapeutic interventions and vaccine design
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