EHP Library Malaria Bulletin 42 – Aug 5-18, 2002


Web-based tool for early warning of malaria epidemics in Africa

Monitoring current rainfall anomalies in zones at epidemic risk  Rainfall is one of the major factors influencing malaria transmission in semi-arid and desert-fringe areas of Africa  Epidemics may occur after excessive rains, usually with a lag time of several weeks during which mosquito vector  populations and malaria infections gradually increase. Epidemics following drought and poor food security can   be especially severe.

During a recent meeting of the Roll Back Malaria (RBM) Technical Support Network (TSN) on Prevention and Control of Epidemics, it was decided to develop a simple tool to monitor epidemic risk in these marginal transmission areas. The tool would be based on the difference between rainfall currently and the short-term expected average; results would be made available on the Web in a frequently updated map format. The purpose would be to provide timely alerts to control programmes and RBM partners working in areas of increased epidemic risk.

Following discussion with members of the RBM-TSN these maps are now available in experimental form through the Africa Data Dissemination Service web site supported by USAID FEWS-NET. They provide a simple indicator of changes in malaria risk in marginal transmission areas, based solely on rainfall, and differences above and below expected levels. The maps are updated every 10 days.

The maps use a mask to exclude areas where malaria is considered to be endemic (as opposed to epidemic) or absent. This mask is based purely on climatic constraints to malaria transmission, and does not yet account for areas
in the northern and southern margins of the continent where control has eliminated epidemic risk. The maps have been tested against laboratory-confirmed malaria incidence figures in districts in Botswana, where they showed a strong association. Their use and validation elsewhere is encouraged.

To access the maps, visit website  select  Data, select  " Current Browse Graphics " Under  " Choose an image "  select  " RFE Anomaly  Malaria, "  and then click on the View button. The maps can also be accessed through the Epidemics page of the Roll Back Malaria website at

Additional information including seasonal climate forecasts and considered impacts to a number of sectors,  including health, may also be found at

Social sciences and malaria

Social Science & Medicine.  55(3):403-13, 2002 Aug.


Medical syncretism with reference to malaria in a Tanzanian community.


Muela SH.  Ribera JM.  Mushi AK.  Tanner M.

Swiss Tropical Institute, Department of Public Health and Epidemiology,

[email protected]


What happens when new health information is introduced into a community?

We have explored this question in a semi-rural community of Southeastern

Tanzania whose population has been in contact with biomedicine for many

decades. With the example of malaria, we illustrate how biomedical

knowledge transmitted in health messages coexists, interacts and merges

with local pre-existing ideas and logics. The results are syncretic

models, which may deviate considerably from what health promoters intended

to transmit. Some of those may have implications for treatment of malaria,

which may include delay in seeking treatment and non-compliance with

therapy. Analysing this medical syncretism clearly demonstrates that even

if comprehension of health messages is accurate, the way in which people

interpret these messages may not be. Disentangling syncretic processes

permits us to understand the dynamics of how information is processed by

the recipients, and provides orientations for health promoters for

adapting messages to the local context.


Ann Trop Med Parasitol  2002 Jun;96(4):405-16 
Unit costs for house spraying and bednet impregnation with residual insecticides
in Colombia: a management tool for the control of vector-borne disease.
Kroeger A, Ayala C, Lara AM.
Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, U.K.
A study of unit costs and cost components of two malaria-control strategies
(house spraying and bednet impregnation with residual insecticides) was
undertaken in 11 malaria-endemic states (departamentos) of Colombia, using data
provided by control staff on self-administered questionnaires. The accuracy of
the data was verified by personal visits, telephone conversations and
complementary information from 10 other states. Allthe financial-cost components
of the malaria-control operations carried out in the previous 6 months and the
results of the control operations themselves (including the numbers of houses
sprayed and numbers of bednets impregnated/day) were recorded. The information
was stratified according to whether the target communities were 'near' or 'far
away' from an operational base, the far-away communities being those that needed
overnight stays by the control staff. The main variables analysed were unit
costs/house treated, and annual cost/person protected. The results show that
house spraying was generally more expensive for the health services than bednet
impregnation. This is particularly the case in 'nearby' communities, where most
of those at-risk live. In such communities, spraying one house was 7.2 times
more expensive than impregnating one bednet. Even if only those sleeping under
an impregnated net were assumed to be protected, the unit costs/person protected
in a 'nearby' community were twice as high for house spraying than for bednet
impregnation. In 'nearby' communities, where technicians could return to the
operational base each evening, insecticides made up 80% of the total spraying
costs and 42% of the costs of bednet impregnation. In 'far-away' communities,
however, salaries and 'per diems' were the most important cost components,
representing, respectively, 23% and 22% of the costs of spraying, and 34% plus
27% of the costs of impregnation. Insecticide wastage and non-use of discounts
on insecticide prices (available through the national Ministry of Health)
increased the overall costs considerably. The multiple uses of these cost
calculations for district health managers are presented.

Trop Med Int Health  2002 Aug;7(8):657-77 
The economic payoffs of integrated malaria control in the Zambian copperbelt
between 1930 and 1950.
Utzinger J, Tozan Y, Doumani F, Singer BH.
Office of Population Research, Princeton University, Princeton, NJ, USA, Woodrow
Wilson School of Public and International Affairs, Princeton University,
Princeton, NJ, USA, World Bank, Washington, DC, USA.
It has long been suggested that malaria is delaying the economic development of
countries that are most severely affected by the disease. Several studies have
documented the economic consequences of malaria at the household level,
primarily in communities engaged in subsistence farming. A missing element is
the appraisal of the economic impact of malaria on the industrial and service
sectors that will probably become the backbone of many developing economies. We
estimate the economic effects of integrated malaria control implemented during
the colonial period and sustained for 20 years in four copper mining communities
of the former Northern Rhodesia (now Zambia). Integrated malaria control was
characterized by strong emphasis on environmental management, while part of the
mining communities also benefited from rapid diagnosis and treatment and the use
of bednets. The programmes were highly successful as an estimated 14 122 deaths,
517 284 malaria attacks and 942 347 work shift losses were averted. Overall, 127
226 disability adjusted life years (DALYs) were averted per 3-year incremental
period. The cumulative costs of malaria control interventions were US$ 11 169
472 (in 1995 US$). Because the control programmes were so effective, the mining
companies attracted a large reservoir of migrant labourers and sustained healthy
work forces. The programmes averted an estimated US$ 796 622 in direct treatment
costs and US$ 5 678 745 in indirect costs as a result of reduced work
absenteeism. Within a few years of programme initiation, Northern Rhodesia
became the leading copper producer in Africa, and mining generated the dominant
share of national income. Copper production and revenues, which increased
dramatically during malaria control interventions, amounted to the equivalent of
US$ 7.1 billion (in 1995 US$). Integrated malaria control in copper mining
communities was a sound investment. It had payoff for public and occupational
health, generally, and without it copper extraction and social and economic
development would have been impossible.
Proc Natl Acad Sci U S A  2002 Aug 12; [epub ahead of print] 
Febrile temperatures induce cytoadherence of ring-stage Plasmodium
falciparum-infected erythrocytes.
Udomsangpetch R, Pipitaporn B, Silamut K, Pinches R, Kyes S, Looareesuwan S,
Newbold C, White NJ.
*Department of Pathobiology, Faculty of Science, Mahidol University, Bangkok
10400, Thailand; Department of Pathology, Faculty of Science, Rangsit
University, Bangkok 12000, Thailand; Faculty of Tropical Medicine, Mahidol
University, Bangkok 10400, Thailand; and Molecular Parasitology Group, Institute
of Molecular Medicine, and paragraph sign Centre for Tropical Medicine, Nuffield
Department of Clinical Medicine, John Radcliffe Hospital, Oxford OX3 9DU, United
Communicated by David Weatherall, University of Oxford, Oxford, United Kingdom,
July 3, 2002 (received for review March 8, 2002) In falciparum malaria, the
malaria parasite induces changes at the infected red blood cell surface that
lead to adherence to vascular endothelium and other red blood cells. As a
result, the more mature stages of Plasmodium falciparum are sequestered in the
microvasculature and cause vital organ dysfunction, whereas the ring stages
circulate in the blood stream. Malaria is characterized by fever. We have
studied the effect of febrile temperatures on the cytoadherence in vitro of P.
falciparum-infected erythrocytes. Freshly obtained ring-stage-infected red blood
cells from 10 patients with acute falciparum malaria did not adhere to the
principle vascular adherence receptors CD36 or intercellular adhesion molecule-1
(ICAM-1). However, after a brief period of heating to 40 degrees C, all
ring-infected red blood cells adhered to CD36, and some isolates adhered to
ICAM-1, whereas controls incubated at 37 degrees C did not. Heating to 40
degrees C accelerated cytoadherence and doubled the maximum cytoadherence
observed (P < 0.01). Erythrocytes infected by ring-stages of the ICAM-1 binding
clone A4var also did not cytoadhere at 37 degrees C, but after heating to
febrile temperatures bound to both CD36 and ICAM-1. Adherence of red blood cells
infected with trophozoites was also increased considerably by brief heating. The
factor responsible for heat induced adherence was shown to be the parasite
derived variant surface protein PfEMP-1. RNA analysis showed that levels of var
mRNA did not differ between heated and unheated ring-stage parasites. Thus
fever-induced adherence appeared to involve increased trafficking of PfEMP-1 to
the erythrocyte membrane. Fever induced cytoadherence is likely to have
important pathological consequences and may explain both clinical deterioration
with fever in severe malaria and the effects of antipyretics on parasite
J Biol Chem  2002 Aug 12;  
Infectivity-associated changes in the transcriptional repertoire of the malaria parasite
sporozoite stage.
Matuschewski K, Ross J, Brown SM, Kaiser K, Nussenzweig V, Kappe SH.
Department of Parasitology, Heidelberg University School of Medicine, Heidelberg
Injection of Plasmodium salivary gland sporozoites into the vertebrate host by
Anopheles mosquitoes initiates malaria infection. Sporozoites develop within
oocysts in the mosquito midgut, and then enter and mature in the salivary
glands. Although morphologically similar, oocyst sporozoites and salivary gland
sporozoites differ strikingly in their infectivity to the mammalian host,
ability to elicit protective immune responses and cell motility. Here, we show
that differential gene expression coincides with these dramatic phenotypic
differences. Using suppression subtractive cDNA hybridization we identified
highly upregulated mRNAs transcribed from 30 distinct genes in salivary gland
sporozoites. Of those genes, 29 are not significantly expressed in the
parasite's blood stages. The most frequently recovered transcript encodes a
protein kinase. Developmental upregulation of specific mRNAs in the infectious
transmission stage of Plasmodium indicates that their translation products may
have unique roles in hepatocyte infection and/or development of liver stages.
Trans R Soc Trop Med Hyg  2002 May-Jun;96(3):327-8 
Haptoglobin genotypes are not associated with resistance to severe malaria in
The Gambia.
Aucan C, Walley AJ, Greenwood BM, Hill AV.
Wellcome Trust Centre For Human Genetics, Roosevelt Drive, Oxford OX3 7BN, UK.
[email protected]
The influence of haptoglobin polymorphisms on severe malaria occurrence was
assessed in 1183 individuals from The Gambia. No significant association was
found between severe malaria and either haptoglobin genotypes or phenotypes. The
advantages of using a deoxyribonucleic acid-based haptoglobin typing method are
Trans R Soc Trop Med Hyg  2002 May-Jun;96(3):310-7 
Intensity of malaria transmission, antimalarial-drug use and resistance in
Uganda: what is the relationship between these three factors?
Talisuna AO, Langi P, Bakyaita N, Egwang T, Mutabingwa TK, Watkins W, Van Marck
E, D'Alessandro U.
Ministry of Health, P. O. Box 7272, Kampala, Uganda. 
[email protected]
We studied (in 1998 and 1999) some factors that may be linked to the spread of
chloroquine (CQ) and sulfadoxine-pyrimethamine (SP) resistance in 7 discrete
communities in Uganda. Exposure to malaria infection was measured by
parasitological surveys in children aged 1-9 years, drug use by community
surveys and drug resistance by in-vivo tests on children aged 6-59 months with
clinical malaria. CQ use was inversely related to parasite prevalence (r =
-0.85, P = 0.01). CQ and SP treatment failure rates varied significantly
according to parasite prevalence (P = 0.001 and 0.04 respectively). The highest
CQ (42.4%, 43.8%) and SP (12.5%, 14.8%) treatment failure rates were observed in sites

characterized by high parasite prevalence. Using areas with medium
parasite prevalence as reference, the relative risk (RR) for CQ treatment
failure was 3.2 (95% CI 1.6-6.4) in high parasite prevalence sites and 3.1 (95%
CI 1.2-7.7) in low parasite prevalence sites. The RR for SP treatment failure
was also higher in sites with high parasite prevalence but low in those with low
parasite prevalence. According to our findings, drug resistance seems to spread
faster in higher transmission areas, regardless of drug pressure. In low
transmission areas, drug pressure seems to be the critical factor. A decrease in
transmission coupled with rational use of drugs may delay the spread of
Trans R Soc Trop Med Hyg  2002 May-Jun;96(3):304-9 
Treatment of uncomplicated malaria in children in Guinea-Bissau with
chloroquine, quinine, and sulfadoxine-pyrimethamine.
Kofoed PE, Co F, Johansson P, Dias F, Cabral C, Hedegaard K, Aaby P, Rombo L.
Department of Paediatrics, Kolding Hospital, Denmark. 
[email protected]
With the increasing resistance to commonly used antimalarial drugs, different
untested 'local' treatment regimens for malaria will arise. We compared commonly
used treatment regimens for children in Guinea-Bissau. Symptomatic children with
Plasmodium falciparum mono-infection were allocated at random to one of 4
treatments: 15 mg/kg quinine twice a day for 3 d (group 1); 10 mg/kg quinine
twice a day for 3 d followed by a total dose of 25 mg chloroquine base given
over 3 d (group 2); a total dose of 50 mg/kg chloroquine base given in 2 daily
doses for 3 d (group 3), or sulfadoxine-pyrimethamine (group 4). On day 28 more
children from group 1 (33%; relative risk [RR] = 2.9, 95% confidence interval
[CI] 1.5-5.7) and group 2 (26%; RR = 2.1, CI 1.0-4.3) had had parasitaemia than
in group 4 (12%), whereas no significant difference was found between group 3
(17%; RR = 1.3, CI 0.6-2.2) and group 4. No severe adverse reaction was observed
in any of the groups. Chloroquine is still effective in Guinea-Bissau at an
increased dose of 50 mg/kg, which appears safe when given orally in 2 daily
doses for 3 d. Sulfadoxine-pyrimethamine could serve as an efficient, cheap and
easy to administer second-line drug, leaving quinine to be used for third-line
treatment. Quinine should not be used in short courses, nor does the combination
of quinine and chloroquine have any advantage.
Trans R Soc Trop Med Hyg  2002 May-Jun;96(3):282-6 
The role of reduced red cell deformability in the pathogenesis of severe
falciparum malaria and its restoration by blood transfusion.
Dondorp AM, Nyanoti M, Kager PA, Mithwani S, Vreeken J, Marsh K.
Department of Infectious Diseases, Tropical Medicine and AIDS, Academic Medical
Centre, Amsterdam, The Netherlands. 
[email protected]
As reduced red cell deformability (RCD) can contribute to derangement of the
microcirculation, a central feature in the pathogenesis of severe malaria, RCD
was measured with a laser diffraction technique in 232 consecutive patients with
falciparum malaria on the Kenyan coast, of whom 99 had severe disease. RCD on
admission (measured as elongation index [EI] at shear stress = 1.7 Pa) was
reduced in proportion with severity of disease (fatal outcome: EI = 0.182 (SD =
0.048), survivors from severe disease: EI = 0.217 (SD = 0.043), uncomplicated
malaria: EI = 0.249 (SD = 0.030), healthy controls: EI = 0.268 (SD = 0.022). All
but 2 survivors with severe malaria and rigid erythrocytes received a blood
transfusion restoring RCD. Reduced RCD may contribute to impaired
microcirculatory flow and a fatal outcome in falciparum malaria. RCD can be
improved by blood transfusion. Since severely reduced RCD has a strong
predictive value for mortality, blood transfusion possibly improves disease
outcome not only through its beneficial effect on anaemia but also on RCD.
Trans R Soc Trop Med Hyg  2002 May-Jun;96(3):278-81 
Severe falciparum malaria in children: a comparative study of 1990 and 
2000 WHO criteria for clinical presentation, prognosis and intensive care
in Dakar, Senegal.
Imbert P, Gerardin P, Rogier C, Ka AS, Jouvencel P, Brousse V, Guyon P.
Service des Maladies Infectieuses et Tropicales, Hopital d'Instruction des
Armees Begin, 69 Avenue de Paris, 94163 Saint-Mande, France.
[email protected]
The relevance of WHO criteria for severe and complicated malaria has been
debated for a while, especially as regards children. Recent data led WHO experts
to modify the definition of severe malaria. The objective of this study was to
evaluate retrospectively the significance of the new definition on severity,
lethality and intensive care distribution in children admitted with falciparum
malaria (in 1997-99) to Hopital Principal de Dakar, Senegal. We used the
paediatric risk of mortality score (PRISM) to compare the 2 definitions, WHO
2000 and WHO 1990. Finally, we evaluated the impact of the new definition in
terms of major therapeutic interventions (MTIs): mechanical ventilation,
haemodynamic support, transfusion, haemodialysis, and the use of sedatives.
Among 311 patients, the frequencies of severe malaria cases and case-fatality
rates thereof were 52% (n = 161) and 17% (n = 28) respectively using the 1990
WHO criteria, and 75% (n = 233) and 12% (n = 28) using the 2000 WHO criteria.
Mean PRISM score among severe cases decreased with the new definition (6.5
versus 8.6). Both definitions predicted neurological sequelae and deaths with
100% sensitivity. One or more MTIs were required in severe malaria cases in 86%
(n = 139) under the 1990 criteria and 73% (n = 170) under the 2000 criteria. In
this area of low and seasonal transmission, the 2000 WHO definition of severe
malaria proved broader and less specific, but was easier to apply and retained
the high sensitivity of the earlier definition in identifying life-threatening
Trans R Soc Trop Med Hyg  2002 May-Jun;96(3):258-65 
Field and laboratory comparative evaluation of ten rapid malaria diagnostic
Craig MH, Bredenkamp BL, Williams CH, Rossouw EJ, Kelly VJ, Kleinschmidt I,
Martineau A, Henry GF.
Malaria Research Programme, Medical Research Council, 491 Ridge Road, P.O. Box
70380, Overport 4067, Durban, South Africa. 
[email protected]
The paper reports on a comparative evaluation of 10 rapid malaria tests
available in South Africa in 1998: AccuCheck (AC, developmental), Cape Biotech
(CB), ICT Malaria Pf (ICT1) and Pf/Pv (ICT2), Kat Medical (KAT), MakroMal (MM),
OptiMAL (OP), ParaSight-F (PS), Quorum (Q), Determine-Malaria (DM). In a
laboratory study, designed to test absolute detection limits, Plasmodium
falciparum-infected blood was diluted with uninfected blood to known parasite
concentrations ranging from 500 to 0.1 parasites per microlitre (P/microL). The
50% detection limits were: ICT1, 3.28; ICT2, 4.86; KAT, 6.36; MM, 9.37; CB,
11.42; DM, 12.40; Q, 16.98; PS, 20; AC, 31.15 and OP, 91.16 P/microL. A field
study was carried out to test post-treatment specificity. Blood samples from
malaria patients were tested with all products (except AC and DM) on the day of
treatment and 3 and 7 days thereafter, against a gold standard of microscopy and
polymerase chain reaction (PCR). OP and PS produced fewer false-positive results
on day 7 (18 and 19%, respectively) than the other rapid tests (38-56%).
However, microscopy, PCR, OP and PS disagreed largely as to which individuals
remained positive. The tests were further compared with regard to general
specificity, particularly cross-reactivity with rheumatoid factor, speed,
simplicity, their ability to detect other species, storage requirements and
general presentation.
Trans R Soc Trop Med Hyg  2002 May-Jun;96(3):254-7 
Validity, reliability and ease of use in the field of five rapid tests for the
diagnosis of Plasmodium falciparum malaria in Uganda.
Guthmann JP, Ruiz A, Priotto G, Kiguli J, Bonte L, Legros D.
Epicentre, 4 rue Saint Sabin, 75011 Paris, France. 
[email protected]
A study was conducted to measure the overall performance of several rapid
diagnostic tests for Plasmodium falciparum infection, in order to select the
most appropriate test to be used in the field. A total of 742 patients attending
the out-patient department of Mbarara Hospital with a clinical suspicion of
malaria were included in the study. For each patient, a thick/thin film and 5
rapid tests based on the detection of histidine-rich protein II (HRP-II)
(Paracheck Pf dipstick and device, ParaHIT f, Malaria Rapid and BIO P.F.) were
performed. Outcomes were validity, inter-reader reliability and 'ease of use in
the field', measured by both the general characteristics of the test and by the
opinion of the readers. About half (57%) of the patients were positive for P.
falciparum. The Paracheck Pf (dipstick and device) was considered as the most
appropriate for the use in the field, being sensitive (97%), moderately specific
(88%), reliable (kappa coefficient = 0.97), easy to use and cheap (about US$
0.5/test). The ParaHIT f represented a good alternative.
Trans R Soc Trop Med Hyg  2002 May-Jun;96(3):225-31 
Traditional use of mosquito-repellent plants in western Kenya and their
evaluation in semi-field experimental huts against Anopheles gambiae:
ethnobotanical studies and application by thermal expulsion and direct burning.
Seyoum A, Palsson K, Kung'a S, Kabiru EW, Lwande W, Killeen GF, Hassanali A,
Knols BG.
International Centre of Insect Physiology and Ecology, P.O. Box 30772, Nairobi,
[email protected]
Ethnobotanical survey in 2 communities in western Kenya revealed that the most
commonly known repellent plants were Ocimum americanum L. (64.1%), Lantana
camara L. (17.9%), Tagetes minuta L. (11.3%) and Azadirachta indica A. Juss
(8.7%) on Rusinga Island, and Hyptis suaveolens Poit. (49.2%), L. camara (30.9%)
and O. basilicum L. (30.4%) in Rambira. Direct burning of plants is the most
common method of application for O. americanum (68.8%), L. camara (100%) and O. 
basilicum (58.8%). Placing branches or whole plants inside houses is most common for
H. suaveolens (33.3 and 57.8% for the respective locations), A. indica (66.7 and 100%),
and T. minuta (54.8 and 56.0%). The repellency of plants suggested by the ethnobotanical
survey and other empirical information was evaluated against the malaria vector Anopheles
gambiae s.s. Giles in experimental huts within a screenwalled greenhouse. Thermal
expulsion and direct burning were tested as alternative application methods for the selected
plants O. americanum, O. kilimandscharicum Guerke, O. suave Willd., L. camara,
A. indica, H. suaveolens, Lippia uckambensis Spreng and Corymbia citriodora Hook.
When thermally expelled,
only H. suaveolens failed to repel mosquitoes, whereas the leaves of C.
citriodora (74.5%, P < 0.0001), leaves and seeds of O. suave (53.1%, P < 0.0001)
and O. kilimandscharicum (52.0%, P < 0.0001) were the most effective. Leaves of
C. citriodora also exhibited the highest repellency (51.3%, P < 0.0001) by
direct burning, followed by leaves of L. uckambensis (33.4%, P = 0.0004) and
leaves and seeds of O. suave (28.0%, P = 0.0255). The combination of O.
kilimandscharicum with L. uckambensis repelled 54.8% of mosquitoes (P < 0.0001)
by thermal expulsion. No combination of plants increased repellency by either
method. The semi-field system described appears a promising alternative to
full-field trials for screening large numbers of candidate repellents without
risk of malaria exposure.
Parasitol Res  2002 Sep;88(9):855-60 
A direct sandwich ELISA to detect antibodies against the C-terminal region 
of merozoite surface protein 1 could be a useful diagnostic method to identify
Plasmodium vivax exposed persons.
Lim J, Park W, Sohn J, Lee S, Oh H, Kim C, Bahk Y, Kim S.
Department of Biochemistry, College of Science, Protein Network Research Center,
Yonsei University, Seoul, 120-749, Republic of Korea.
We expressed a C-terminal 108-aa region of the Plasmodium vivax merozoite
surface protein 1 (PvMSP1c) excluding the C-end transmembrane region in
Escherichia coli in order to evaluate the antibody level to MSP in Korean
malaria patients. We optimized a direct sandwich enzyme-linked immunosorbent
assay (ELISA) method to simultaneously determine the total antibody levels,
including IgG and IgM, to PvMSP1c. If the cut-off for seropositivity was
determined as the mean+3SD of the antibody levels of the negative control group,
the antibody levels were positive in 99.5% of the patient group (sensitivity
199/200). The antibody levels were negative in 99.4% of the negative control
group (specificity 504/507). The positive reactions in the negative control
group came from non-specific reactions, as confirmed by a competition assay.
This direct sandwich ELISA for PvMSP1c antibody could prove to be a useful tool
for the diagnosis of malaria patients and for blood screening in blood banks.
Ann Trop Med Parasitol  2002 Jun;96(4):349-59 
Patterns of rainfall and malaria in Madhya Pradesh, central India.
Singh N, Sharma VP.
Malaria Research Centre, Field Station, I.C.M.R., Medical College Building,
Jabalpur-482003, Madhya Pradesh, India.
Some recent outbreaks of Plasmodium falciparum malaria have been attributed, at
least in part, to increases in the intensity and duration of rainfall caused by
the El Nino southern oscillation (ENSO), a periodic climatic phenomenon. Since
it takes time for unusually heavy rainfall to translate into unusually high
densities of the vector mosquitoes, it has been suggested that data on recent
rainfall might be used to predict climate-related epidemics of malaria. This
possibility was explored by comparing the patterns in the incidence of malaria
in (1) Dungaria, a highly malarious village in the central-Indian district of
Mandla, and (2) Mandla district as a whole, for the periods 1986-2000 and
1967-2000, respectively, with data on rainfall for the same areas and periods.
Unfortunately, no clear relationship was observed between rainfall and malaria
incidence, although a major development project to improve water resources in
the study area (which resulted in local villages being partially or completely
submerged in water) may have masked any significant association. A useful method
for predicting which years are going to be high- or low-risk years for malaria
epidemics, in the present and other epidemiological settings, remains a future
Ann Trop Med Parasitol  2002 Jun;96(4):339-48 
Chloroquine for the treatment of uncomplicated malaria in Guyana.
Baird JK, Tiwari T, Martin GJ, Tamminga CL, Prout TM, Tjaden J, Bravet PP,
Rawlins S, Ferrel M, Carucci D, Hoffman SL.
U.S. Naval Medical Research Unit #2, American Embassy Jakarta, Fleet Post
Office-Asia/Pacific 96520-8132, U.S.A.
At a public hospital in Georgetown, Guyana, 44 patients seeking treatment for
symptomatic, slide-confirmed malaria were given standard chloroquine (CQ)
therapy and followed for 28 days. The patients apparently had pure infections
with Plasmodium falciparum (14), P. vivax (13) or P. malariae (one), or mixed
infections either of P. falciparum and P. vivax (17) or of P. falciparum, P.
malariae and P. vivax (two). Each received supervised treatment with 10 mg CQ
base/kg on each of days 0 and 1, and 5 mg/kg on day 2. On the day of enrollment
(day 0), the patients complained of fever (100%), headache (100%), malaise
(94%), myalgia (79%), nausea (67%), vertigo (49%) and vomiting (33%). Many (39%) were ill enough to confine themselves to bed. On day 4, fewer of the subjects
complained of fever (15%), headache (15%), malaise (6%), myalgia (21%), nausea
(6%), vertigo (24%) or vomiting (0%) despite the relatively high (>48%) risk of
therapeutic failure. The cumulative incidence of parasitological failure against
P. falciparum was 15% at day 4, 33% at day 7 and 48% at day 14. All of the P.
vivax and P. malariae infections cleared before day 4 and none recurred by day
7. Two infections with P. vivax recurred later (on day 14 or 28) but in the
presence of less than adequate, whole-blood concentrations of CQ plus
desethyl-chloroquine (i.e. <100 ng/ml). Taken together, the results indicate a
high risk of therapeutic failure of CQ against P. falciparum but also indicate
that resistance to CQ in P. vivax occurs infrequently in Guyana.
J Commun Dis  2001 Jun;33(2):88-95 
Malaria outbreak in the Indira Gandhi Nahar Pariyojna command area in Jaisalmer
district, Thar Desert, India.
Tyagi BK, Yadav SP, Sachdev R, Dam PK.
Desert Medicine Research Centre (ICMR), New Pali Road, Jodhpur 342005.
A focal outbreak of malaria occurred in the villages situated close to the main
Indira Gandhi canal near Ramgarh in Jaisalmer district, western Rajasthan.
Stagnation of water over a month's period in the main canal as well as long
standing rain water in the form of expansive lakes near these villages formed
vast breeding grounds for the vectors like Anopheles culicifacies, along with A.
stephensi already breeding in the 'tanka' and 'beri' in the epidemichit
villages. Rapid mass blood surveys along with other entomological and
parasitological investigations were conducted in four of the ten affected
villages, viz., Seuva, Raghwa, Raimala and Sadhna. A total of 992 specimens
belonging to four vector species were sampled, namely, A. stephensi (47.4%), A.
culicifacies (41.0%), A. subpictus (11.2%) and A. annularis (0.4%).
Epidemiologically, about one-fourth of the examined persons were positive (SPR
25.5%), although Plasmodium falciparum dominated the parasitaemia (49.5%).
Available data are indicative of changed malariological scenario in the Indira
Gandhi Nahar Pariyojna command area, where epidemics are regular features every

J Commun Dis  2001 Jun;33(2):83-7 
Artemether vs quinine therapy in Plasmodium falciparum malaria in 
Manipur—a preliminary report.
Singh NB, Bhagyabati Devi S, Singh TB, Singh MA, Singh NB.
Regional Institute of Medical Sciences, Imphal, Manipur.
Qinghaosu and its derivatives are rapidly effective antimalarial drugs derived
from a Chinese plant (sweet worm wood). Preliminary studies suggest that these
drugs may be more effective than quinine in the treatment of Plasmodium
falciparum malaria. A randomised double blind trial was conducted in 52 cases of
Plasmodium falciparum malaria cases. In all 26 cases were given artemether and
another 26 were given quinine. There were 2 (7.5%) deaths in artemether group
and 4 (15%) deaths in quinine group. The parasites were cleared more quickly
from the blood in artemether group when compared to quinine group (mean-72 hrs
vs 96 hrs). Resolution of fever was comparable in both artemether and quinine
group (mean-84 hrs vs 78 hrs) and also the average time of recovery from coma
was more earlier in artemether group (mean-60 hrs vs 72 hrs). The only side
effect noticed with artemether therapy was gastrointestinal (GI) intolerance
while quinine therapy was associated with myocarditis, hypotension, hypoglycemia
and GI intolerance.
J Commun Dis  2001 Jun;33(2):116-20 
Comparative toxicity of selected larvicidal formulations against Anopheles
stephensi Liston and Aedes aegypti Linn.
Mittal PK, Adak T, Batra CP.
Malaria Research Centre, 2, Nanak Enclave, Delhi-110 009.
Toxicity of selected larvicidal formulations of Bacillus sphaericus, Bacillus
thuringiensis H-14 israelensis (Bti) and insect growth regulators was determined
against Anopheles stephensi and Aedes aegypti, the two major urban mosquito
vectors of malaria and dengue fever in India respectively. The study revealed
that the formulations of Bacillus thuringiensis H-14 and IGR compounds were
highly toxic against both the mosquito species but Bacillus sphaericus
formulation was less toxic against Aedes aegypti and has a limited potential for
use against Aedes aegypti. Of the two Bti formulations, 'Vectobac' formulation
was more toxic against both the species than 'BMP-1442X' formulation. Bti
formulations were more toxic against Aedes aegypti (LC50 = 0.06 and 0.14
mg/Litre) than against An. stephensi (LC50 = 0.14 and 0.81 mg/Litre), while B.
sphaericus formulation was more toxic against An. stephensi LC50 = 0.031
mg/Litre than Aedes aegypti LC50 = 0.294 mg/Litre. Among different larvicidal
formulations tested in this study, IGR compounds were found to be toxic against
both the mosquito species at very low concentrations (EC50 values ranging
between 0.0001 and 0.0004 ppm).
Biochem J  2002 Aug 8;Pt [epub ahead of print] 
Critical role of amino acid 23 in mediating activity and specificity of
vinckepain-2, a papain-family cysteine protease of rodent malaria parasites.
Singh A, Shenai BR, Choe Y, Gut J, Sijwali PS, Craik CS, Rosenthal PJ.
Cysteine proteases of Plasmodium falciparum, known as falcipains, have been
identified as hemoglobinases and potential drug targets. As antimalarial drug
discovery requires analysis of non-primate malarias, genes encoding related
cysteine proteases of the rodent malaria parasites Plasmodium vinckei
(vinckepain-2) and Plasmodium berghei (berghepain-2) were characterized. These
genes encoded fairly typical papain-family proteases, but they contained an
unusual substitution of Gly23 with Ala (papain numbering). Vinckepain-2 was
expressed in Escherichia coli, solubilized, refolded, and auto-processed to an
active enzyme. The protease shared important features with the falcipains,
including an acid pH optimum, preference for reducing conditions, optimal
cleavage of peptide substrates with P2 Leu, and ready hydrolysis of hemoglobin.
However, key differences between the plasmodial proteases were identified. In
particular, vinckepain-2 showed very different kinetics against many substrates
and an unusual preference for peptide substrates with P1 Gly. Replacement of
Ala23 with Gly remarkably altered vinckepain-2, including loss of the P1 Gly
substrate preference, markedly increased catalytic activity (kcat/Km increased
about 100-fold), and more rapid autohydrolysis. Our studies identify key animal
model parasite targets, indicate that drug discovery studies must take into
account important differences between plasmodial proteases, and shed light on
the critical role of amino acid 23 in catalysis by papain-family proteases.
J Biol Chem  2002 Aug 7; [epub ahead of print] 
Bee venom phospholipase inhibits malaria parasite development in transgenic 
Moreira LA, Ito J, Ghosh A, Devenport M, Zieler H, Abraham EG, Crisanti A, Nolan
T, Catteruccia F, Jacobs-Lorena M.
Department of Genetics, Case Western Reserve University, Cleveland, OH
Malaria kills millions of people every year and new control measures are
urgently needed. The recent demonstration that (effector) genes can be
introduced into the mosquito germ line to diminish their ability to transmit the
malaria parasite offers new hope toward the fight of the disease (Ito et al.,
Nature, 417, 452-455, 2002). Because of the high selection pressure that an
effector gene imposes on the parasite population, development of resistant
strains is likely to occur. In search of additional anti-parasitic effector
genes we have generated transgenic Anopheles stephensi mosquitoes that express
the bee venom phospholipase A2 (PLA2) gene from the gut-specific and
blood-inducible An. gambiae carboxypeptidase (AgCP) promoter. Northern blot
analysis indicated that the PLA2 mRNA is specifically expressed in the guts of
transgenic mosquitoes, with peak expression at ~4 h after blood ingestion.
Western blot and immunofluorescence analyses detected PLA2 protein in the midgut
epithelia of transgenic mosquitoes from 8 to 24 h after a blood meal.
Importantly, transgene expression reduced Plasmodium berghei oocyst formation by
87% on average, and greatly impaired transmission of the parasite to nave mice.
The results indicate that PLA2 may be used as an additional effector gene to
block the development of the malaria parasite in mosquitoes.

Trop Med Int Health  2002 Aug;7(8):652-6 
Plasmodium falciparum: use of a NANP19 antibody-test for the detection of
infection in non-immune travellers.
Knappik M, Peyerl-Hoffmann G, Jelinek T.
Department of Infectious Diseases and Tropical Medicine, University of Munich,
Munich, Germany.
Circumsporozoite (CS) antibodies are a reliable serological marker for the
infection of Plasmodium falciparum. The purpose of this investigation was to
construct and evaluate an enzyme-linked immunosorbent assay test for the
detection of CS antibodies. While the sensitivity of the newly developed test
reached 78%, the specificity was 99%. In addition, the optimized kit was used to
test for infection with P. falciparum in 1903 travellers that were recruited
from a prospective study for malaria chemoprophylaxis. Sixty-six of the 1903
patients (3.5%) showed elevated CS antigen antibody titres. However,
seroconversion could only be demonstrated in 18 (0.95%) patients. Among those
seroconverting, there was a significantly higher percentage of male travellers
(1.28%) than female travellers (0.56%). Positive reactions were more frequent
among returnees from West and East Africa (1.49 and 1.14%, respectively) than
among those from other endemic areas, e.g. South America (n=0). Despite its
limited sensitivity, this newly developed kit for CS antibody testing may be a
valuable tool for the estimation of the risk for travellers in malarious regions
to acquire an infection with P. falciparum. It may also be useful for the
determination of the efficacy of malaria chemoprophylaxis for inhibiting
outbreak of disease.
Mol Biochem Parasitol  2002 Aug;123(1):35 
Identification, expression, and functional characterization of MAEBL, a
sporozoite and asexual blood stage chimeric erythrocyte-binding protein of
Plasmodium falciparum.
Ghai M, Dutta S, Hall T, Freilich D, Ockenhouse C.
Department of Immunology, Walter Reed Army Institute of Research, 20910, Silver
Spring, MD, USA
MAEBL is a chimeric erythrocyte binding protein reported in rodent malaria
parasites Plasmodium yoelii and Plasmodium berghei, that has the gene structure
similar to erythrocyte binding proteins, but N-terminal homology to subdomains I
and II of Apical membrane antigen-1. We report here the sequence analysis and
gene structure of the Plasmodium falciparum maebl gene. We have cloned and
expressed a putative red cell binding domain, M2, of this gene in Escherichia
coli, purified the recombinant protein (r-PfM2) and studied its in vitro binding
specificity to human red cells. Binding of r-PfM2 protein to red cells was
abolished by pretreatment with papain, while increased binding was observed to
neuraminidase-treated red cells. Polyclonal antibodies to r-PfM2 recognized
native MAEBL protein in blood stage schizont extracts of the parasite on Western
blots and within the apical complex of free merozoites, by indirect
immunofluorescent assay (IFA). MAEBL expression in P. falciparum sporozoites was
also detected by reverse transcriptase polymerase chain reaction (RT-PCR) and
IFA. High titer antibodies to r-PfM2 were observed in human sera obtained from a
malaria endemic region some of which inhibited r-PfM2 binding to red cells.
Individuals immunized with irradiated sporozoites tested positive for anti-MAEBL
antibodies by ELISA. The dual stage expression of MAEBL makes it an excellent
pre-erythrocytic and erythrocytic stage vaccine target antigen.
Mol Biochem Parasitol  2002 Aug;123(1):23 
Bacterially expressed and refolded receptor binding domain of Plasmodium
falciparum EBA-175 elicits invasion inhibitory antibodies.
Pandey K, Singh S, Pattnaik P, Pillai C, Pillai U, Lynn A, Jain S, Chitnis C.
Malaria Research Group, International Centre for Genetic Engineering and
Biotechnology (ICGEB), P. O. Box 10504, Aruna Asaf Ali Marg, 110067, New Delhi,
Malaria parasites make specific receptor-ligand interactions to invade
erythrocytes. A 175 kDa Plasmodium falciparum erythrocyte binding antigen
(EBA-175) binds sialic acid residues on glycophorin A during invasion of human
erythrocytes. The receptor-binding domain of EBA-175 lies in a conserved,
amino-terminal, cysteine-rich region, region F2 of EBA-175 (PfF2), that is
homologous to the binding domains of other erythrocyte binding proteins such as
Plasmodium vivax Duffy binding protein. We have developed methods to produce
recombinant PfF2 in its functional form. Recombinant PfF2 was expressed in
Escherichia coli, purified from inclusion bodies, renatured by oxidative
refolding and purified to homogeneity by ion-exchange and gel filtration
chromatography. Refolded PfF2 has been characterized using biochemical and
biophysical methods and shown to be pure, homogenous and functional in that it
binds human erythrocytes with specificity. Immunization with refolded PfF2
yields high titre antibodies that efficiently inhibit P. falciparum invasion of
erythrocytes in vitro. Importantly, antibodies raised against PfF2 block
invasion by a P. falciparum field isolate that invades erythrocytes using
multiple pathways. These observations support the development of recombinant
PfF2 as a vaccine candidate for P. falciparum malaria.
Mol Biochem Parasitol  2002 Aug;123(1):11 
Characterisation of a delta-COP homologue in the malaria parasite, 
Plasmodium falciparum.
Adisa A, Rug M, Foley M, Tilley L.
Department of Biochemistry, La Trobe University, 3086, Vic., Melbourne,
The mature human erythrocyte is a simple haemoglobin-containing cell with no
internal organelles and no protein synthesis machinery. The malaria parasite
invades this cell and develops inside a parasitophorous vacuole (PV). The
parasite exports proteins into the erythrocyte to bring about extensive
remodelling of its adopted cellular home. Plasmodial homologues of two COPII
proteins, PfSar1p and PfSec31p, are exported to the erythrocyte cytosol where
they appear to play a role in the trafficking of proteins across the erythrocyte
cytoplasm [Eur. J. Cell Biol. 78 (1999) 453; J. Cell Sci. 114 (2001) 3377]. We
have now characterised a homologue of the COPI protein, delta-COP. A recombinant
protein corresponding to 90% of the Pfdelta-COP sequence was used to raise
antibodies. The affinity-purified antiserum recognised a protein with an
apparent M(r) of 58x10(3) on Western blots of malaria parasite-infected
erythrocytes but not on blots of uninfected erythrocytes. Pfdelta-COP was shown
to be largely insoluble in non-ionic detergent, possibly suggesting cytoskeletal
attachment. Confocal immunofluorescence microscopy of parasitised erythrocytes
was used to show that, in contrast to the COPII proteins, Pfdelta-COP is located
entirely within the parasite. The location of Pfdelta-COP partly overlaps that
of the endoplasmic reticulum (ER)-located protein, PfERC, and partly that of the
trans-Golgi-associated protein, PfRab6. Treatment of ring-stage
plasmodium-infected erythrocytes with brefeldin A (BFA) inhibited development of
the ER structure within the parasite cytosol and prevented the trafficking of
the P. falciparum erythrocyte membrane protein-1, PfEMP1, to the erythrocyte
cytosol. The Pfdelta-COP and PfSec31p populations each appear to be associated
with the restricted ER structure in brefeldin-treated rings. When more mature
stage parasites were treated with BFA, erythrocyte cytosol-located populations
of parasite proteins were not reorganised, however, the overlap between
Pfdelta-COP and PfERC in parasite cytosol was more complete suggesting a
possible redistribution of the Golgi compartment into the ER. These data support
the suggestion that both COPI and COPII proteins are involved in the trafficking
of proteins within the parasite cytoplasm. However, only COPII proteins are
exported to the erythrocyte cytosol to establish a vesicle-mediated protein
trafficking pathway to the erythrocyte membrane.
Mol Biochem Parasitol  2002 Aug;123(1):1 
Rapid positive selection of stable integrants following transfection of
Plasmodium falciparum.
Wang P, Wang Q, Sims P, Hyde J.
Department of Biomolecular Sciences, University of Manchester Institute of
Science and Technology (UMIST), PO Box 88, M60 1QD, Manchester, UK
With the near-completion of the genome sequence of Plasmodium falciparum,
further understanding of this major human pathogen urgently requires more
effective genetic tools. These must include faster and more reliable gene
replacement or gene knockout techniques, essential for the analysis of gene
function. We describe a serial system which uses the blasticidin S deaminase
(bsd) gene of Aspergillus and the neomycin phosphotransferase II (neo) gene from
transposon Tn5 as selectable markers for, respectively, transient transfection
of malaria parasites and the selection of stable integrants. Challenge with
blasticidin S (BS) enriches the parasite population transiently expressing the
bsd gene, laying the foundation for the subsequent, much less frequent,
integration event. Positive selection for this rare event is enormously
facilitated by fusing the neo gene in frame to the replacement or knockout
targeting gene. The sequence employed for the targeting (the polymorphic
pppk-dhps gene of P. falciparum, as a model system) is truncated at the 5' end
with no promoter located upstream, therefore neo cannot be expressed without
specifically integrating within the genomic copy of the target gene. After BS
selection, the culture is immediately exposed to geneticin (G418), leading to an
apparently homogenous population of mutant parasites. As well as excluding
spurious integrants at non-targeted sequences, this system greatly reduces the
lengthy selection period for obtaining the desired mutants by eliminating the
drug-on and drug-off cycles for the production of stable integrants, which are
normally required by the single marker systems currently in use for transfection
of malaria parasites.
Clin Exp Immunol  2002 Aug;129(2):326-31 
Allelic family-specific humoral responses to merozoite surface protein 2 (MSP2) in
Gabonese residents with Plasmodium falciparum infections.
Ekala MT, Jouin H, Lekoulou F, Mercereau-Puijalon O, Ntoumi F.
Unite de Parasitologie, Centre International de Recherches Medicales,
Franceville (CIRMF) Gabon, Hopital Albert Schweitzer, Unite de Recherches,
Gabon, and Unite Immunologie Moleculaire Des Parasites, Institut Pasteur de
Paris, Paris, France.
Merozoite surface protein 2 (MSP2) expressed by Plasmodium falciparum asexual
blood stages has been identified as a promising vaccine candidate. In order to
explore allelic family-specific humoral responses which may be responsible for
parasite neutralization during natural infections, isolates from individuals
with either asymptomatic infections or uncomplicated malaria and residing in a
Central African area where Plasmodium transmission is high and perennial, were
analysed using MSP2 as polymorphic marker. The family-specific antibody
responses were assessed by ELISA using MSP2 synthetic peptides. We observed an
age-dependence of P. falciparum infection complexity. The decrease of infection
complexity around 15 years of age was observed simultaneously with an increase
in the mean number of MSP2 variants recognized. No significant difference in the
P. falciparum genetic diversity and infection complexity was found in isolates
from asymptomatic subjects and patients with uncomplicated malaria. The
longitudinal follow-up showed a rapid development of immune responses to various
regions of MSP2 variants within one week. Comparing humoral responses obtained
with the other major antigen on the merozoite surface, MSP1, our findings
suggest that different pathways of responsiveness are involved in antibody
production to merozoite surface antigens.
Clin Exp Immunol  2002 Aug;129(2):318-325 
Antibody responses to the repetitive Plasmodium falciparum antigen Pf332 in
humans naturally primed to the parasite.
Ahlborg N, Haddad D, Siddique AB, Roussilhon C, Rogier C, Trape JF,
Troye-Blomberg M, Berzins K.
Department of Immunology, Stockholm University,Stockholm, Sweden; Immunology
Unit, Pasteur Institut de Dakar, Senegal and Unite de Parasitologie Biomedicale,
Institut Pasteur, Paris, France, Institut de Medecine Tropicale de Sante des
Armees, Marseille, France, and Institut de Recherches pour le Developpement,
Montpellier, France.
Antibodies to the degenerate repeats of EB200, a part of the Plasmodium
falciparum antigen Pf332, are protective in monkeys. To analyse the prevalence,
magnitude and specificity of antibodies to EB200 in malaria-exposed humans, the
IgG antibody reactivity with recombinant EB200 protein as well as with crude
malaria antigen was determined in Senegalese donors (n = 100; 4-87 years).
Antibody reactivity with EB200 was low or absent in children below 15 years but
was prevalent and significantly higher in older donors. In comparison, all
individuals displayed reactivity with a crude malaria antigen preparation, which
also increased with age. The reactivity with the crude malaria antigen was
correlated to the reactivity with EB200, suggesting that the low levels of IgG
to EB200 found in some adult donors reflected a limited degree of recent
exposure to parasites rather than a selective non-responsiveness to Pf332.
Comparison of serological and clinical data showed that high levels of
antibodies to crude malaria antigen and to EB200 were predictive of fewer future
clinical attacks of malaria. A reactivity pattern very similar to that found in
Senegalese donors was observed in Liberian adults where 80% of the sera showed
reactivity with EB200 and all peptides were recognized by between 60 and 100% of
the donors. This strong reactivity with EB200-derived overlapping peptides
suggests that the epitopes in EB200, to a large extent, are linear. In the light
of previous data on the parasite neutralizing capacity of antibodies to Pf332,
the present results emphasize the potential interest of Pf332-derived sequences
for inclusion in a subunit vaccine against P. falciparum malaria.

Parasite Immunol  2002 Jul;24(7):387-389 
Increased levels of interleukin-12 in Plasmodium falciparum malaria: correlation
with the severity of disease.
Malaguarnera L, Imbesi RM, Pignatelli S, Simpore J, Malaguarnera M, Musumeci S.
Department of Biomedical Sciences, University of Catania, Italy, Centre Medical
Saint Camille, Ouagadougou, Burkina Faso, Department of Internal Medicine,
University of Catania, Italy, Department of Pediatrics, University of Sassari
and Institute of Population Genetics, National Research Council (CNR), Alghero,
Interleukin (IL)-12, produced by mononuclear phagocytes, activates the T-helper
1 (Th1) cells and helps, as a mediator, the innate immune response to
intracellular microbes. In Plasmodium falciparum infection, this proinflammatory
cytokine has immunoregulatory functions with effects on the immune response to
the blood stage of disease, but also induces protection and reduces malarial
anaemia. In this study, the levels of IL-12 were determined in 73 African
children, aged 2-144 months (median 19.5 months), who had severe or mild P.
falciparum malaria. IL-12 was determined using the enzyme-linked immunosorbent
assay. The levels of IL-12 were found to be significantly elevated (21.6 +/-
18.3 pg/ml) in patients who suffered less severely from the disease. In
contrast, the levels of IL-12 were found to be lower (13.1 +/- 7.11 pg/ml) in
patients who suffered more severely from the disease.
Arch Histol Cytol  2002 Jun;65(2):127-32 
Extrathymic T cells in malaria protection, including evidence for the onset of
erythropoiesis in the liver during infection.
Abo T, Sekikawa H.
Department of Immunology and Medical Zoology, Niigata University Graduate School
of Medical and Dental Sciences, Japan.
[email protected]
This review proposes the possibility that malarial protection might not be
achieved through the process of acquired immunity in which the constituents are
conventional T and B (B-2) cells. On the other hand, malarial protection might
be achieved by the process of innate immunity in which the constituents are
extrathymic T cells and autoantibody-producing B-1 cells. Accordingly, mice
infected with malaria exhibited severe thymic atrophy, and the expansion of
IL-2Rbeta+ CD3int cells and its subset of NK1.1-CD3int cells were simultaneously
induced. In parallel with the expansion of extrathymic T cells in the liver,
extramedullary erythropoiesis was found to begin in the liver of these mice.
Interestingly, malarial protozoa were primarily seen in only these nucleated
erythrocytes in the liver at the early stage of infection. These results suggest
that malaria immunology falls into a new field of immunology, namely, innate
immunity. The similarity of the immune states among malaria, aging, and
autoimmune diseases also suggest that the immunosuppression of a conventional,
acquired immune system is more likely the common mechanism underlying these
diseases or physiological responses.
Am J Trop Med Hyg  2002 Apr;66(4):379-83 
Field evaluation of the ICT Malaria Pf/Pv immunochromatographic test for the 
detection of asymptomatic malaria in a Plasmodium falciparum/vivax endemic
area in Thailand.
Coleman RE, Maneechai N, Rachapaew N, Kumpitak C, Soyseng V, Miller RS,
Thimasarn K, Sattabongkot J.
Department of Entomology, Armed Forces Research Institute of Medical Sciences,
Bangkok, Thailand.
Rapid antigen assays provide an effective tool for the detection of malaria in
symptomatic patients. However, the efficacy of these devices for detecting
asymptomatic malaria, where parasite levels are normally significantly lower
than in symptomatic patients, is less well established. We evaluated the
efficacy of a new combined Plasmodium falciparum-Plasmodim vivax
immunochromatographic test (ICT Malaria Pf/Pv) in a cross-sectional malaria
survey of the village of Ban Kong Mong Tha, Kanchanaburi Provice, Thailand, from
August to December 2000. A total of 1,976 bleeds were made from 559 individuals
over the course of the study. Blinded microscopy of thick and thin blood films
was used as the gold standard; all discordant and 10% of concordant results were
cross-checked. Of 1,976 ICT Malaria Pf/Pv dipsticks tested, 98.3% (n = 1,943)
performed as expected, as evidenced by the appearance of the control line. The
ICT Malaria Pf/Pv test was both sensitive (100.0%) and specific (99.7 %) for the
diagnosis of falciparum malaria with parasitemias of > or = 500
trophozoites/microL; however, only 15.9% (13/82) of infected individuals had
parasitemia rates this high. When P. falciparum parasitemia rates were <
500/microL, the sensitivity of the diagnosis was only 23.3%, with a positive
predictive value (PPV) and a negative predictive value (NPV) of 76.2 and 97.2%,
respectively. The ICT Malaria Pf/Pv test was specific, but not sensitive, for
the diagnosis of vivax malaria with parasite rates of > or = 500
trophozoites/microl, with sensitivity, specificity, PPV, and NPV of 66.7%,
99.9%, 66.7%, and 99.9%, respectively. At parasite rates of < 500/microL,
corresponding values were 0.0%, 99.9%, 0%, and 95.1%. Because of the relatively
high cost of these assays, low parasite rates found in the majority of
asymptomatic individuals, and low sensitivity of this assay with rates of <
500/microl, use of this assay as a tool for active case detection is of limited
value in western Thailand.
Am J Trop Med Hyg  2002 Apr;66(4):372-8 
Lymphocyte proliferation and antibody responses to Plasmodium falciparum
liver-stage antigen-1 in a highland area of Kenya with seasonal variation in
malaria transmission.
John CC, Ouma JH, Sumba PO, Hollingdale MR, Kazura JW, King CL.
Division of Geographic Medicine, Case Western Reserve University School of
Medicine, University Hospitals of Cleveland, Ohio 44106-4983, USA.
[email protected]
Lymphocyte proliferation and antibody responses to five peptides corresponding
to the N- and C-terminal non-repeat and central repeat regions of Plasmodium
falciparum liver-stage antigen-1 (LSA-1) were examined in residents of a
highland area of Kenya where malaria transmission is episodic and varies with
rainfall. The frequency of lymphocyte proliferation responses (stimulation index
> 2) by children (persons > or = 6 years old) and adults (persons > or = 18
years old) was similar and did not differ significantly across seasons. In
contrast, the proportion of individuals with IgG antibodies to LSA-1 peptides
was higher in the rainy than dry season, and the frequency of these responses
was greater for adults than children (39.4% versus 18.7% during the period of
high transmission; P = 0.009). Antibodies to LSA-1 were primarily of the IgG1
and IgG3 subclasses, and these also varied with season (30.1% and 32.5% of
individuals had IgG1 and IgG3 in the rainy season versus none and 10.9% in the
dry season). There was no significant difference in the time to re-infection
between groups of persons with or without IgG antibody or lymphocyte
proliferation responses to LSA-1 peptides. These data indicate that age and
transmission intensity independently affect IgG antibody responses to LSA-1 but
do not influence lymphocyte proliferation in this highland area where malaria
transmission is highly variable.
Bull World Health Organ  2002;80(7):538-45 
Therapeutic efficacy of sulfadoxine-pyrimethamine, amodiaquine and the
sulfadoxine-pyrimethamine-amodiaquine combination against uncomplicated
Plasmodium falciparum malaria in young children in Cameroon.
Basco LK, Same-Ekobo A, Ngane VF, Ndounga M, Metoh T, Ringwald P, Soula G.
Unite de Recherche Paludologie Afro-tropicale, Institut de Recherche pour le
Developpement, Laboratoire de Recherche sur le Paludisme, Organisation de
Coordination pour la Lutte contre les Endemies en Afrique Centrale, Yaounde,
OBJECTIVE: To evaluate the therapeutic efficacy of sulfadoxine-pyrimethamine,
amodiaquine, and the sulfadoxine-pyrimethamine-amodiaquine combination for the
treatment of uncomplicated Plasmodium falciparum malaria in young children in
Cameroon. METHODS: In a randomized study we evaluated the effectiveness and
tolerance of (i) sulfadoxine-pyrimethamine (SP) (25 mg/kg body weight of
sulfadoxine and 1.25 mg/kg of pyrimethamine in a single oral dose), (ii)
amodiaquine (AQ) (30 mg/kg body weight in three divided daily doses), and (iii)
the sulfadoxine-pyrimethamine-amodiaquine combination (SP+AQ) (same doses as
in the other two treatment groups, given simultaneously on day 0) in young children
in southern Cameroon. The parasitological and clinical responses were studied
until day 28 in accordance with the modified 1996 WHO protocol for the
evaluation of the therapeutic efficacy of antimalarial drugs. FINDINGS: Of 191
enrolled patients, 6 and 8 were excluded or lost to follow-up before day 14 and
between day 14 and day 28, respectively. For the AQ-treated patients,
parasitological and clinical evaluation on day 14 showed late treatment failure
in 2 of 61 (3.3%) and adequate clinical response with parasitological failure in
one (1.6%). There was an adequate clinical response in all patients treated with
SP or SP+AQ. Therapeutic failure rates on day 28 were 13.6%, 10.2% and 0% in the
SP, AQ, and SP+AQ groups, respectively. Anaemia improved in all three regimens.
AQ produced faster fever clearance but was associated with more transient minor
side-effects than SP. SP+AQ reduced the risk of recrudescence between day 14 and
day 28 but increased the incidence of minor side-effects. CONCLUSION: SP+AQ can
be recommended as a temporary means of slowing the spread of multidrug
resistance in Plasmodium falciparum in Africa while the introduction of other
combinations, including artemisinin derivatives, is awaited.
J Antimicrob Chemother  2002 Aug;50(2):177-87 
Iron chelators as antimalarial agents: in vitro activity of dicatecholate
against Plasmodium falciparum.
Pradines B, Rolain JM, Ramiandrasoa F, Fusai T, Mosnier J, Rogier C, Daries W,
Baret E, Kunesch G, Le Bras J, Parzy D.
Unite de Parasitologie, Institut de Medecine Tropicale du Service de Sante des
Armees, Le Pharo, 13007 Marseille.
The present study was undertaken to explore the antimalarial effect of a series
of dicatecholate iron chelators. They may be made more or less lipophilic by
increasing or reducing the length of the R substituent on the nitrogen. In vitro
activity against the W2 and 3D7 clones of Plasmodium falciparum, toxicity on
Vero cells and toxicity on uninfected erythrocytes by measure of the released
haemoglobin were assessed for each compound. These findings were compared with
the ability of iron(III), iron(II) and ferritin to reverse the inhibitory effect
of catecholates. This study shows that increased lipid solubility of catecholate
iron chelators does not lead to improved antimalarial activity. However, their
activity is well correlated with their interaction with iron and with their
toxicity against Vero cells. This study demonstrates a potent antimalarial
effect of FR160 (R = C(9)H(19)) on five different strains of P. falciparum in
vitro. FR160 inhibited parasite growth with an IC(50) between 0.8 and 1.5 micro
M. The effects of FR160 on mammalian cells were minimal compared with those
obtained with malaria parasites. FR160 acted on parasites at considerably higher
rates than desferrioxamine, and at all stages of parasite growth. The drug was
more effective at the late trophozoite and young schizont stages, although FR160
affected rings and schizonts as well. Ascorbic acid, a free radical scavenger,
reduced the activities of FR160 and artesunate. FR160 might induce formation of
free radicals, which could explain why FR160 antagonized the effects of
artesunate and dihydroartemisinin.
Curr Opin Microbiol  2002 Aug;5(4):431 
Cross-species regulation of malaria parasitaemia in the human host.
Bruce M, Day K.
Institute of Biomedical and Life Sciences, Division of Infection and Immunity,
Joseph Black Building, University of Glasgow, G12 8QQ, Glasgow, UK
Longitudinal genetic analysis of the composition of malaria parasites infecting
humans has demonstrated that individuals living in endemic areas are chronically
infected with multiple genotypes and species of Plasmodium. The accumulation of
infections is a consequence of superinfection from the bites of many infected
anopheline mosquitoes. The clinical outcome of infection is determined by the
host's ability to regulate the density of malaria parasites in the blood.
Interestingly, most infections do not cause symptoms of malarial disease after a
degree of immunity is acquired. Here, we review data from the first genetic
study of the longitudinal dynamics of multiple Plasmodium species and genotypes
in humans. The data show that the total parasite density of Plasmodium species
oscillates around a threshold and that peaks of infection with each species do
not coincide. We propose that malaria parasitaemia is controlled in a
density-dependent manner in these semi-immune children. This implies that a
cross-species mechanism of parasite regulation exists. A model of how multiple
immune responses could act in concert to explain these within host dynamics is
discussed in relation to known regulatory mechanisms.
Afr J Health Sci  1995 May;2(2):312-315 
Malaria infection, morbidity and transmission in two ecological zones Southern Ghana.
Afari EA, Appawu M, Dunyo S, Baffoe-Wilmot A, Nkrumah FK.
Epidemiology Unit, Noguchi Memorial Institute for Medical Research, P. O. Box
25, Legon, Ghana.
A one year survey was conducted in 1992 to compare malaria infection, morbidity
and transmission patterns between a coastal savannah community (Prampram) and
a community (Dodowa) in the forest zone in southern Ghana. The study population of
6682 at Prampram and 6558 at Dodowa were followed up in their homes once every
two weeks and all episodes of clinical malaria recorded. Blood films for
microscopy were prepared from 600 participants randomly selected in each
community in April and in August representing dry and wet seasons respectively.
Mosquitoes biting humans between 1800 hrs and 0600 hrs, as well as indoor and
outdoor resting mosquitoes were collected weekly. All mosquitoes collected were
classified into species and examined for sporozoites by dissection and ELISA.
The incidence rate of clinical malaria was higher in Dodowa (106.6/1000 pop.)
than in Prampram (68.5/1000 pop.) It was highest in < 10 year age groups in both
communities. It was also higher in the wet season than in the dry season. The
prevalence of patent parasitaemia at Prampram and Dodowa in April in the dry
season. The prevalence of patent parasitaemia at Prampram and Dodowa in April
1992 was 19.8% (117/590) and 42.2% (253/599) respectively. The corresponding
figures for August were 26.6%(160/602)at Prampram and 51.3% (309/602) at Dodowa.
Plasmodium falciparum infection contributed 78-85% of the parasitaemia in April and
93-99% in August. The average man-biting rate for Anopheles gambiae s.l was higher
at Prampram than at Dodowa (1.54 vs 0.79 bites/man/night) but the average sporozoite
rate was higher at Dodowa than at Prampram (2% vs 0.7%). The peak of biting density
at Prampram occurred in June whilst that of Dodowa occurred in November.
Afr J Health Sci  1995 May;2(2):309-311 
In vitro antimalarial activity of extracts of Albizia gummifera, Aspilia
mossambicensis, Melia azedarach and Azadirachta indica against Plasmodium
Ofulla AV, Chege GM, Rukunga GM, Kiarie FK, Githure JI, Kofi-Tsekpo MW.
Biomedical Sciences Research Centre, Kenya Medical Research Institute, P. O. Box
54840, Nairobi, Kenya.
Since chemotherapy is presently the primary strategy of malaria control in the
world, and some malaria parasites are developing resistance to the commonly used
antimalarial drugs, new antimalarial compounds are required. Therefore, it is
important to test antimalarial activities of medicinal plant extracts which most
herbalists claim to cure malaria. We evaluated the antimalarial activities of
extracts of Albizia gummiffera, Aspilia mossambicensis, Melia azedar and
Azadirahchta indica against laboratory adapted isolates of Plasmodium falciparum
using an in vitro radioisotopic uptake technique. Chloroquine was used as a
reference antimalarial drug. Al. gummifera had the highest antimalarial activity
(mean fifty percent inhibitory concentration {IC(50)S} in ug/ml of test culture
=3.5 +1.6SD, n=3) followed by As. mossambicensis (mean IC(50)=29.3+11.8SD, n=4)
and Me. Azedarach (mean IC(50) =299.7+202.0SD, n=4). And lastly Az.
Indica (mean IC(50)=349.9+213.1 SD, n=4). The antimalarial activities of the reference
drug, chloroquine, was far much higher (mean IC(50)=0.065+0.057SD, n=)4). These
findings show that Al. gummifera and As. mossambicensis plant extracts have potent
antimalarial compounds. Phytochemical analyses should be done on these two plants
to isolate the compound(s) containing he active principles(s).
J Health Popul Nutr  2000 Sep;18(2):115-8 
Association of malarial parasitaemia with dehydrating diarrhoea in Nigerian
Ibadin OM, Airauhi L, Omoigberale AI, Abiodun PO.
Records of 402 children--216 (53.7%) males and 186 (46.3%) females--aged 1-36
months, admitted to the Diarrhea Treatment and Training Unit of the University
of Benin Teaching Hospital, Benin city, Nigeria, during July 1993 to June 1996,
were reviewed to document the relationship between dehydration and malaria
parasitemia.  There was significant association between severity of dehydration
and malaria parasitemia (p  0.0001).  Association of parasitemia (p  0.006) with
dehydration (p  0.0001) was significantly more marked in patients with acute
watery diarrhea than in those with persistent and bloody diarrhea.  Parasitemia
was demonstrated in 50.5% of those not initially suspected to have malaria. 
Parasitemia was also significantly associated with fever (p  0.001) and fever
co-existing with vomiting (p  0.01).  The prevalence of malaria-associated
diarrhea was 61.7%.  More infants (75.6%) than older children had diarrhea.  It
was concluded that the prevalence of malaria-associated diarrhea was high and
that children with dehydration are more likely to manifest malaria parasitemia.