Population pharmacokinetics and pharmacodynamics of lumefantrine in young Ugandan children treated with artemether-lumefantrine for uncomplicated malaria

Background. The pharmacokinetics and pharmacodynamics of lumefantrine, a component of the most widely used treatment for malaria, artemether-lumefantrine, has not been adequately characterized in young children. Methods. Capillary whole-blood lumefantrine concentration and treatment outcomes were determined in 105 Ugandan children, ages 6 months to 2 years, who were treated for 249 episodes of Plasmodium falciparum malaria with artemether-lumefantrine. Results. Population pharmacokinetics for lumefantrine used a 2-compartment open model with first-order absorption. Age had a significant positive correlation with bioavailability in a model that included allometric scaling. Children not receiving trimethoprim-sulfamethoxazole with capillary whole blood concentrations <200 ng/mL had a 3-fold higher hazard of 28-day recurrent parasitemia, compared with those with concentrations >200 ng/mL (P =. 0007). However, for children receiving trimethoprim-sulfamethoxazole, the risk of recurrent parasitemia did not differ significantly on the basis of this threshold. Day 3 concentrations were a stronger predictor of 28-day recurrence than day 7 concentrations. Conclusions. We demonstrate that age, in addition to weight, is a determinant of lumefantrine exposure, and in the absence of trimethoprim-sulfamethoxazole, lumefantrine exposure is a determinant of recurrent parasitemia. Exposure levels in children aged 6 months to 2 years was generally lower than levels published for older children and adults. Further refinement of artemether-lumefantrine dosing to improve exposure in infants and very young children may be warranted. © 2016 The Author.

Perfil de memória e ativação de linfócitos T na leishmaniose visceral

Visceral leishmaniasis (VL) in Brazil is a disease caused by Leishmania infantum chagasi (L.i.chagasi). The clinical evolution post-infection depends on the vertebrate host immune response, which is genetically mediated. This study aimed to evaluate the immune response of individuals living in endemic area for VL in the state of the Rio Grande do Norte, considering individuals with VL under treatment (n = 9), recovered VL <1 year post treatment (n = 10), > 10 years posttreatment (n = 9), uninfected individuals living in endemic areas (n = 7), individuals that lost DTH response (n=6) and asymptomatic individuals for VL (n=9). Peripheral blood cells were evaluated in the presence and absence of soluble Leishmania antigens (SLA) and ex vivo, to determine activation, presence of regulatory cells and memory cells. The Leishmania parasitemia and anti-Leishmania antibodies were determined respectively by qPCR and ELISA. Cells from individuals with VL under treatment showed less cell activation after stimulation with SLA for the markers CD4/CD69, CD8/CD69 and CD8/CD25 compared with VL post treatment treatment (p <0.001). Apparently uninfected individuals have a higher cell activation than symptomatic VL (p <0.001), with the exception of CD8/CD25 marker (p = 0.6662). On the other hand, in the ex-vivo group, significant differences were observed for CD4/CD69, CD8/CD69 and CD8/CD25 between the 4 groups due to increased cell activation present in cells of individuals symptomatic LV (p <0.001). VL cells under treatment, ex vivo, have a lower percentage of memory cells (CD4/CD45RO and CD8/CD45RO) than individuals VL post-treatment or control group (p = <0.01). Likewise, individuals with symptomatic VL have fewer regulatory cells when stimulated by SLA [CD4/CD25 (p = 0.0022) and CD4/FOXP3 (p = 0.0016)] and in the ex-vivo group (p = 0.0017). Finally, DNA isolated from recovered VL contained Leishmania DNA, supporting the hypothesis of non-sterile clinical cure for Leishmania infection. Recovered VL, even 10 years after treatment have high levels of memory cells, which may be due to the presence of stimulation, either by reexposure to Leishmania or non-sterile cure

Association of ABO blood group and Plasmodium falciparum malaria among Children in the Federal Capital Territory, Nigeria

The ABO and Rhesus blood group systems are very important clinical tools that are commonly used in blood transfusion and their associations with various disease conditions have been widely reported. This study investigated the distribution of these blood group systems and assessed the association of malaria infection with the ABO blood groups among children in Federal Capital Territory, Abuja. Blood specimens from deep finger pricks of 730 children aged between 0-2 years were examined for malaria parasites using Field stains method. ABO and Rhesus blood group antigens tests were also performed using standard tile protocols. Of all the children admitted into the study, 445 were sick while 285 were apparently healthy. The prevalence of malaria parasites was significantly higher (P = 0.00047) among the sick children (69.8%) than the apparently healthy children (30.2%). The most prevalent blood group was O (55.7%) and the Rhesus D antigen was positive for 98.4% of all the children. The prevalence of blood group B among the sick children was significantly lower (P = 0.00373) than the other blood group types. There is no association between malaria infection and ABO blood groups but the prevalence of higher malaria parasite density was significantly greater (P = 0.0404) in children with blood group A (7.7%). In conclusion, blood group O was the most prevalent blood group in the study and children with blood group A appeared to be more susceptible to higher level of malaria parasitemia.

Detecção parasitológica e molecular de tripanossomatídeos em triatomíneos sinantrópicos e primatas neotropicais no Brasil central

Tese (doutorado)—Universidade de Brasília, Faculdade de Medicina, Programa de Pós-Graduação em Medicina Tropical, 2016.

Estudo do nível de infecção por Babesia bovis e Babesia bigemina em bovinos da raça canchim naturalmente infestados com o carrapato Rhipicephalus (Boophilus) microplus.

Entre as principais causas de perdas produtivas em bovinos criados nos trópicos está a infestação pelo carrapato Rhipicephalus (Boophilus) microplus e, consequentemente, dos hemoparasitas transmitidos por ele. A resistência dos zebuínos e de animais cruzados com raças taurinas à infestação por esse ácaro é amplamente conhecida. Entretanto, no que se refere à suscetibilidade às babesioses bovinas, existem evidências de que o grupo genético também pode interferir na resistência, seguindo o mesmo padrão observado para o carrapato vetor, com os taurinos apresentando maior sensibilidade. Assim, este estudo teve por objetivo avaliar a parasitemia por Babesia bovis e Babesia bigemina em 50 novilhas da raça Canchim ( Charolês + Zebu) naturalmente infestadas pelo R. (B.) microplus nas quatro estações do ano durante 24 meses, além de caracterizar o perfil de citocinas que podem estar associados ao fenótipo de resistência e suscetibilidade aos hemoparasitas do gênero Babesia spp. Foram realizadas contagens de fêmeas adultas de carrapatos com tamanho igual ou superior a 4,5 mm de diâmetro, presentes no lado esquerdo de cada bovino. As amostras de DNA extraídas foram submetidas à amplificação por meio da Reação em Cadeia da Polimerase Quantitativa em Tempo Real (qPCR), utilizando iniciadores que flanqueiam fragmentos dos genes mitocondriais do citocromo b (mt-cyt B), específicos para B. bovis e B. bigemina. O RNA extraído do sangue, foi usado para sintetizar o DNA complementar (cDNA) para análise de expressão dos genes do IFN- , TNF- , IL-10 e IL-12B por meio da quantificação relativa (RTqPCR). Foram observadas diferenças significativas (P<0,05) entre os meses das avaliações para a contagem de carrapatos. Entretanto, não houve efeito significativo (P>0,05) nas colheitas realizadas entre novembro de 2013 a janeiro de 2014 e entre os meses janeiro e fevereiro de 2015. A frequência da parasitemia no rebanho foi de 98%. Dentre as amostras de DNA que puderam ser quantificadas pela qPCR, 98% e 95,4% foram positivas para B. bovis e B. bigemina, respectivamente. Com relação ao número de cópias (NC) dos fragmentos dos genes mt-cyt B específicos para B. bovis e B. bigemina foram observados efeitos significativos (P<0,05) para ambas as espécies e interação das mesmas com as colheitas realizadas nas diferentes estações do ano. A análise do nível de expressão de mRNA do IFN- , TNF- e IL-12B revelou que houve um efeito siginificativo (P<0,05) da interação entre animais dos extremos de resistência/suscetibilidade e estações do ano, exceto para IL-10. Conclui-se que, a qPCR apresenta alta sensibilidade e especificidade para o diagnóstico das babesioses bovinas em amostras de sangue e que a oscilação na carga parasitária nas diferentes estações do ano pode estar associada com o perfil de expressão de citocinas apresentada.