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Steroids for treating cerebral malaria

CiteULike malaria tags - 21 May 2018 - 10:51am
Cochrane Database of Systematic Reviews, No. 3. (1999), doi:10.1002/14651858.CD000972

Abstract - Background Cerebral malaria is associated with swelling of the brain. Corticosteroid drugs could reduce the harmful effects of this swelling, but they could also suppress host immunity to infection. Objectives To assess the effects of corticosteroid drugs in patients with cerebral malaria on death, life‐threatening complications, and residual disability in survivors. Search methods In March 2008, we searched the Cochrane Infectious Disease Group Specialized Register, CENTRAL ( The Cochrane Library 2008, Issue 1), MEDLINE, EMBASE, LILACS, and m RCT. We also checked reference lists. Selection criteria Randomized controlled trials comparing corticosteroids with no corticosteroids in addition to otherwise identical treatments for patients with cerebral malaria. Data collection and analysis Both authors independently assessed trial eligibility and risk of bias (methodological quality), and extracted data. Outcomes sought included death, death with life‐threatening complications, other complications, and disability. Main results Two trials with 143 participants met the inclusion criteria. There were 30 deaths in the two trials, distributed evenly between the corticosteroid and control groups (risk ratio 0.89; 95% confidence interval 0.48 to 1.68; 143 participants). Clinical complications were reported as the number of events in each trial arm and did not exclude complications occurring in fatalities. This made it difficult to interpret the reports of significantly more episodes of gastrointestinal bleeding and seizures in the corticosteroid group. Neither trial examined disability. Authors' conclusions There is currently no evidence of benefit from corticosteroids, but the small number of participants means it is difficult to exclude an effect on death in either direction. Data on clinical complications are difficult to assess. Plain language summary Corticosteroids for treating cerebral malaria Cerebral malaria is a severe form of the disease that can induce convulsions and coma; about 15% to 50% of patients with cerebral malaria will die, and 5% to 10% of survivors are left disabled as a result of brain damage. In the past decades, health professionals often gave corticosteroids such as dexamethasone and hydrocortisone, as well as antimalarial drugs, to patients with cerebral malaria, with the aim of reducing the effects of swelling and inflammation in the brain. This review assesses the effects of corticosteroid drugs given for cerebral malaria, on death, life‐threatening complications, and residual disability in survivors. The authors included two trials with a total of 143 patients (both adults and children). There were no significant differences in the number of deaths between the corticosteroid and control groups, and data on clinical complications were difficult to assess. Neither trial examined disability.
K Prasad, P Garner
Categories: malaria news feeds

Chloroquine or amodiaquine combined with sulfadoxine‐pyrimethamine for treating uncomplicated malaria

CiteULike malaria tags - 21 May 2018 - 10:51am
Cochrane Database of Systematic Reviews, No. 4. (2005), doi:10.1002/14651858.CD000386.pub2

Abstract - Background Chloroquine (CQ), amodiaquine (AQ), and sulfadoxine‐pyrimethamine (SP) are inexpensive drugs, but treatment failure is a problem. Combination therapy may reduce treatment failure. CQ or AQ plus SP are affordable options of combination treatment, but there is debate about their effectiveness. Objectives To assess the combination of CQ or AQ plus SP compared with SP alone for first‐line treatment of uncomplicated falciparum malaria. Search methods We searched the Cochrane Infectious Diseases Group Specialized Register (April 2005), CENTRAL ( The Cochrane Library Issue 2, 2005), MEDLINE (1966 to April 2005), EMBASE (1974 to April 2005), LILACS (1982 to April 2005), Science Citation Index (1981 to April 2005), African Index Medicus (1993 to 1998), and reference lists. We also contacted researchers at relevant organizations and a pharmaceutical company. Selection criteria Randomized controlled trials in adults or children with uncomplicated Plasmodium falciparum malaria were eligible for inclusion. The main outcomes of interest were total and clinical failure at day 28 follow up and serious adverse events. Data collection and analysis Two people independently applied the inclusion criteria. One author extracted data and another checked them independently. We used risk ratio (RR) and 95% confidence intervals (CI). Main results Twelve trials (2107 participants) met the inclusion criteria. A meta‐analysis of five AQ trials (461 participants) showed a statistically significant reduction in total failure at day 28 with the combination therapy (RR 0.64, 95% CI 0.46 to 0.91), and meta‐analysis of three trials (384 participants) showed a significant reduction in clinical failure at day 28 (RR 0.23, 95% CI 0.11 to 0.49). The statistical significance in the total failure analysis was sensitive to losses to follow up. Data from two CQ trials showed no advantage for total failure with combination therapy at day 28. There was no evidence from the included trials of serious adverse events. Authors' conclusions The evidence base is not strong enough to support firm conclusions. The available evidence suggests that AQ plus SP can achieve less treatment failure than SP, but this might depend on existing levels of parasite resistance to the individual drugs. Addendum, 2008: The World Health Organization (in 2006) recommended that monotherapy should not be used for treating malaria. Therefore the authors do not intend to update this review. Plain language summary Chloroquine or amodiaquine combined with sulfadoxine‐pyrimethamine for treating uncomplicated malaria Using amodiaquine and sulfadoxine‐pyrimethamine together to treat uncomplicated malaria instead of sulfadoxine‐pyrimethamine alone may reduce treatment failure; adding chloroquine to sulfadoxine‐pyrimethamine may not be beneficial Chloroquine, amodiaquine, and sulfadoxine‐pyrimethamine are relatively inexpensive drugs to treat malaria. Treatment failure is a problem when these drugs are used alone because malaria parasites have become resistant to them. Based on evidence from randomized controlled trials, a combination of amodiaquine plus sulfadoxine‐pyrimethamine may reduce treatment failure in some locations. It appears less likely that chloroquine plus sulfadoxine‐pyrimethamine will have a treatment benefit over sulfadoxine‐pyrimethamine alone.
H McIntosh, KL Jones
Categories: malaria news feeds

Drugs for preventing malaria in pregnant women in endemic areas: any drug regimen versus placebo or no treatment

CiteULike malaria tags - 21 May 2018 - 10:51am
Cochrane Database of Systematic Reviews, No. 10. (2014), doi:10.1002/14651858.CD000169.pub3

Abstract - Background Pregnancy increases the risk of malaria and this is associated with poor health outcomes for both the mother and the infant, especially during the first or second pregnancy. To reduce these effects, the World Health Organization recommends that pregnant women living in malaria endemic areas sleep under insecticide‐treated bednets, are treated for malaria illness and anaemia, and receive chemoprevention with an effective antimalarial drug during the second and third trimesters. Objectives To assess the effects of malaria chemoprevention given to pregnant women living in malaria endemic areas on substantive maternal and infant health outcomes. We also summarised the effects of intermittent preventive treatment with sulfadoxine‐pyrimethamine (SP) alone, and preventive regimens for Plasmodium vivax. Search methods We searched the Cochrane Infectious Diseases Group Specialized Register, CENTRAL, MEDLINE, EMBASE, LILACS, and reference lists up to 1 June 2014. Selection criteria Randomized controlled trials (RCTs) and quasi‐RCTs of any antimalarial drug regimen for preventing malaria in pregnant women living in malaria‐endemic areas compared to placebo or no intervention. In the mother, we sought outcomes that included mortality, severe anaemia, and severe malaria; anaemia, haemoglobin values, and malaria episodes; indicators of malaria infection, and adverse events. In the baby, we sought foetal loss, perinatal, neonatal and infant mortality; preterm birth and birthweight measures; and indicators of malaria infection. We included regimens that were known to be effective against the malaria parasite at the time but may no longer be used because of parasite drug resistance. Data collection and analysis Two review authors applied inclusion criteria, assessed risk of bias and extracted data. Dichotomous outcomes were compared using risk ratios (RR), and continuous outcomes using mean differences (MD); both are presented with 95% confidence intervals (CI). We assessed the quality of evidence using the GRADE approach. Main results Seventeen trials enrolling 14,481 pregnant women met our inclusion criteria. These trials were conducted between 1957 and 2008, in Nigeria (three trials), The Gambia (three trials), Kenya (three trials), Mozambique (two trials), Uganda (two trials), Cameroon (one trial), Burkina Faso (one trial), and Thailand (two trials). Six different antimalarials were evaluated against placebo or no intervention; chloroquine (given weekly), pyrimethamine (weekly or monthly), proguanil (daily), pyrimethamine‐dapsone (weekly or fortnightly), and mefloquine (weekly), or intermittent preventive therapy with SP (given twice, three times or monthly). Trials recruited women in their first or second pregnancy (eight trials); only multigravid women (one trial); or all women (eight trials). Only six trials had adequate allocation concealment. For women in their first or second pregnancy, malaria chemoprevention reduces the risk of moderate to severe anaemia by around 40% (RR 0.60, 95% CI 0.47 to 0.75; three trials, 2503 participants, high quality evidence ), and the risk of any anaemia by around 17% (RR 0.83, 95% CI 0.74 to 0.93; five trials,, 3662 participants, high quality evidence ). Malaria chemoprevention reduces the risk of antenatal parasitaemia by around 61% (RR 0.39, 95% CI 0.26 to 0.58; seven trials, 3663 participants, high quality evidence ), and two trials reported a reduction in febrile illness ( low quality evidence ). There were only 16 maternal deaths and these trials were underpowered to detect an effect on maternal mortality ( very low quality evidence ). For infants of women in their first and second pregnancies, malaria chemoprevention probably increases mean birthweight by around 93 g (MD 92.72 g, 95% CI 62.05 to 123.39; nine trials, 3936 participants, moderate quality evidence ), reduces low birthweight by around 27% (RR 0.73, 95% CI 0.61 to 0.87; eight trials, 3619 participants, moderate quality evidence ), and reduces placental parasitaemia by around 46% (RR 0.54, 95% CI 0.43 to 0.69; seven trials, 2830 participants, high quality evidence ). Fewer trials evaluated spontaneous abortions, still births, perinatal deaths, or neonatal deaths, and these analyses were underpowered to detect clinically important differences. In multigravid women, chemoprevention has similar effects on antenatal parasitaemia (RR 0.38, 95% CI 0.28 to 0.50; three trials, 977 participants, high quality evidence )but there are too few trials to evaluate effects on other outcomes. In trials giving chemoprevention to all pregnant women irrespective of parity, the average effects of chemoprevention measured in all women indicated it may prevent severe anaemia (defined by authors, but at least < 8 g/L: RR 0.19, 95% CI 0.05 to 0.75; two trials, 1327 participants, low quality evidence), but consistent benefits have not been shown for other outcomes. In an analysis confined only to intermittent preventive therapy with SP, the estimates of effect and the quality of the evidence were similar. A summary of a single trial in Thailand of prophylaxis against P. vivax showed chloroquine prevented vivax infection (RR 0.01, 95% CI 0.00 to 0.20; one trial, 942 participants). Authors' conclusions Routine chemoprevention to prevent malaria and its consequences has been extensively tested in RCTs, with clinically important benefits on anaemia and parasitaemia in the mother, and on birthweight in infants. Plain language summary The effect of taking antimalarial drugs routinely to prevent malaria in pregnancy Pregnancy increases the risk of malaria and this is associated with poor health outcomes for both the mother and the infant, especially during the first or second pregnancy. For this reason, women are encouraged to try and prevent malaria infection during pregnancy by sleeping under mosquito bed‐nets, and by taking drugs effective against malaria throughout pregnancy as chemoprevention. This Cochrane Review looked at all drug regimens compared to placebo. The review authors sought to summarise and quantify the overall effects of chemoprevention. Seventeen trials were included, all conducted between 1957 and 2008, and all but two in countries of Africa. For women in their first or second pregnancy, malaria chemoprevention prevents moderate to severe anaemia ( high quality evidence ); and prevents malaria parasites being detected in the blood ( high quality evidence ). It may also prevent malaria illness. We don't know if it prevents maternal deaths, as this would require very large studies to detect an effect. In their infants, malaria chemoprevention improves the average birthweight ( moderate quality evidence ), and reduces the number of low birthweight infants ( moderate quality evidence ). We are not sure if chemoprevention reduces mortality of babies in the first week, month and year, as again studies would need to be very large to show these effects.
D Radeva‐Petrova, K Kayentao, FO ter Kuile, D Sinclair, P Garner
Categories: malaria news feeds

Mefloquine for preventing malaria in non‐immune adult travellers

CiteULike malaria tags - 21 May 2018 - 10:51am
Cochrane Database of Systematic Reviews, No. 1. (2008), doi:10.1002/14651858.CD000138.pub2

Reason for withdrawal from publication The Editor withdrew this review as of Issue 1, 2008. This review has been updated and replaced following the publication of a new review: Jacquerioz FA, Croft AM Jacquerioz FA, Croft AM. Drugs for preventing malaria in travellers. Cochrane Database of Systematic Reviews 2009 , Issue 4 . Art. No.: CD006491. DOI: 10.1002/14651858.CD006491.pub2 .
AM Croft, P Garner
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Vaccines for preventing malaria

CiteULike malaria tags - 21 May 2018 - 10:51am
Cochrane Database of Systematic Reviews, No. 4. (2006), doi:10.1002/14651858.CD000129.pub2

Reason for withdrawal from publication This review has been superseded by three reviews that have been published as: 
 Graves P, Gelband H. Vaccines for preventing malaria (SPf66). Cochrane Database of Systematic Reviews 2006, Issue 2. Art. No.: CD005966. DOI: 10.1002/14651858.CD005966. Graves P, Gelband H. Vaccines for preventing malaria (blood‐stage). Cochrane Database of Systematic Reviews 2006, Issue 4. Art. No.: CD006199. DOI: 10.1002/14651858.CD006199. Graves P, Gelband H. Vaccines for preventing malaria (pre‐erythrocytic). Cochrane Database of Systematic Reviews 2006, Issue 4. Art. No.: CD006198. DOI: 10.1002/14651858.CD006198. Vaccines for preventing malaria (SPf66) published in Issue 2, 2006; Vaccines for preventing malaria (blood‐stage); and Vaccines for preventing malaria (pre‐erythrocytic) published in Issue 4, 2006.
PM Graves, H Gelband
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Amodiaquine for treating malaria

CiteULike malaria tags - 21 May 2018 - 9:33am
Cochrane Database of Systematic Reviews, No. 2. (2003), doi:10.1002/14651858.CD000016
PL Olliaro, P Mussano
Categories: malaria news feeds

Artemisinin derivatives for treating severe malaria

CiteULike malaria tags - 21 May 2018 - 9:33am
Cochrane Database of Systematic Reviews, No. 2. (2000), doi:10.1002/14651858.CD000527
H McIntosh, P Olliaro
Categories: malaria news feeds

RTS,S/AS01 malaria vaccine mismatch observed among Plasmodium falciparum isolates from southern and central Africa and globally

CiteULike malaria tags - 10 May 2018 - 12:44pm
Scientific Reports, Vol. 8, No. 1. (26 April 2018), doi:10.1038/s41598-018-24585-8
Julia Pringle, Giovanna Carpi, Jacob Almagro-Garcia, Sha Zhu, Tamaki Kobayashi, Modest Mulenga, Thierry Bobanga, Mike Chaponda, William Moss, Douglas Norris
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Uncovering the essential genes of the human malaria parasite Plasmodium falciparum by saturation mutagenesis

CiteULike malaria tags - 4 May 2018 - 9:11am
Science, Vol. 360, No. 6388. (04 May 2018), eaap7847, doi:10.1126/science.aap7847
Min Zhang, Chengqi Wang, Thomas Otto, Jenna Oberstaller, Xiangyun Liao, Swamy Adapa, Kenneth Udenze, Iraad Bronner, Deborah Casandra, Matthew Mayho, Jacqueline Brown, Suzanne Li, Justin Swanson, Julian Rayner, Rays Jiang, John Adams
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Two complement receptor one alleles have opposing associations with cerebral malaria and interact with α+thalassaemia

CiteULike malaria tags - 3 May 2018 - 12:29pm
eLife, Vol. 7 (25 April 2018), doi:10.7554/elife.31579
Herbert Opi, Olivia Swann, Alexander Macharia, Sophie Uyoga, Gavin Band, Carolyne Ndila, Ewen Harrison, Mahamadou Thera, Abdoulaye Kone, Dapa Diallo, Ogobara Doumbo, Kirsten Lyke, Christopher Plowe, Joann Moulds, Mohammed Shebbe, Neema Mturi, Norbert Peshu, Kathryn Maitland, Ahmed Raza, Dominic Kwiatkowski, Kirk Rockett, Thomas Williams, Alexandra Rowe
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Children with cerebral malaria or severe malarial anaemia lack immunity to distinct variant surface antigen subsets

CiteULike malaria tags - 27 April 2018 - 8:29am
Scientific Reports, Vol. 8, No. 1. (19 April 2018), doi:10.1038/s41598-018-24462-4
Mark Travassos, Amadou Niangaly, Jason Bailey, Amed Ouattara, Drissa Coulibaly, Kirsten Lyke, Matthew Laurens, Jozelyn Pablo, Algis Jasinskas, Rie Nakajima, Andrea Berry, Matthew Adams, Christopher Jacob, Andrew Pike, Shannon Takala-Harrison, Li Liang, Bourema Kouriba, Abdoulaye Kone, Alexandra Rowe, JoAnn Moulds, Dapa Diallo, Ogobara Doumbo, Mahamadou Thera, Philip Felgner, Christopher Plowe
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Implications of insecticide resistance for malaria vector control with long-lasting insecticidal nets: a WHO-coordinated, prospective, international, observational cohort study

CiteULike malaria tags - 19 April 2018 - 10:56am
The Lancet Infectious Diseases (April 2018), doi:10.1016/s1473-3099(18)30172-5
Immo Kleinschmidt, John Bradley, Tessa Knox, Abraham Mnzava, Hmooda Kafy, Charles Mbogo, Bashir Ismail, Jude Bigoga, Alioun Adechoubou, Kamaraju Raghavendra, Jackie Cook, Elfatih Malik, Zinga Nkuni, Michael Macdonald, Nabie Bayoh, Eric Ochomo, Etienne Fondjo, Herman Awono-Ambene, Josiane Etang, Martin Akogbeto, Rajendra Bhatt, Mehul Chourasia, Dipak Swain, Teresa Kinyari, Krishanthi Subramaniam, Achille Massougbodji, Mariam Okê-Sopoh, Aurore Ogouyemi-Hounto, Celestin Kouambeng, Mujahid Abdin, Philippa West, Khalid Elmardi, Sylvie Cornelie, Vincent Corbel, Neena Valecha, Evan Mathenge, Luna Kamau, Jonathan Lines, Martin Donnelly
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List of keywords of the INRMM meta-information database - part 23

CiteULike malaria tags - 13 April 2018 - 3:59pm
(February 2014)

List of indexed keywords within the transdisciplinary set of domains which relate to the Integrated Natural Resources Modelling and Management (INRMM). In particular, the list of keywords maps the semantic tags in the INRMM Meta-information Database (INRMM-MiD). [\n] The INRMM-MiD records providing this list are accessible by the special tag: inrmm-list-of-tags ( http://mfkp.org/INRMM/tag/inrmm-list-of-tags ).
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Alpha-v–containing integrins are host receptors for the Plasmodium falciparum sporozoite surface protein, TRAP

CiteULike malaria tags - 12 April 2018 - 10:24am
Proceedings of the National Academy of Sciences (09 April 2018), 201719660, doi:10.1073/pnas.1719660115
Kirsten Dundas, Melanie Shears, Yi Sun, Christine Hopp, Cecile Crosnier, Tom Metcalf, Gareth Girling, Photini Sinnis, Oliver Billker, Gavin Wright
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