Plasmodium falciparum and Schistosoma mansoni coinfection and the side benefit of artemether-lumefantrine in malaria patients.

INTRODUCTION: The distribution of both malaria and schistosomiasis exhibits a large geographical overlap in tropical environments, particularly in sub-Saharan Africa. This part of the world currently harbours more than 85% of the estimated global burden of these diseases. Studies showed that artemisinin derivatives used for the treatment of malaria also have an antischistosomal effect. This study aimed to investigate the extent of malaria-schistosomiasis co-infection and the antischistosomal effect of artemether-lumefantrine when administered to treat falciparum malaria in Kemise, Northeast Ethiopia. METHODOLOGY: Stool samples were collected from 152 microscopically confirmed malaria patients and diagnosed for schistosomiasis using the Kato-Katz technique before treatment. The schistosomiasis cure rate and egg reduction were determined in co-infected patients, who were treated with artemether-lumefantrine,. RESULTS: Twenty-eight out of 152 malaria patients were co-infected (18.4%, n = 152) with schistosomiasis. All 28 co-infected patients were found stool-negative for Schistosoma mansoni eggs four weeks after treatment. The extent of co-infection was associated with age, sex and educational level. Cure rate and egg reduction rate following the treatment of artemether-lumefantrine were 100%. CONCLUSION: The co-infection rate was associated with patient characteristics. Artemether-lumefantrine was effective against S. mansoni in co-infected patient. Multicenter and randomized trials, however, are needed for a better understanding of the efficacy of artemether-lumefantrine against schistosome infection with ranges of intensity.

Therapeutic Efficacy of Artemether-Lumefantrine for the Treatment of Uncomplicated Plasmodium falciparum Malaria in Northern Ethiopia.

Introduction. Multidrug resistance of Plasmodium falciparum is spreading throughout Africa. This has posed major challenges to malaria control in sub-Saharan Africa. Objective. The aim of the study was to evaluate the efficacy of artemether-lumefantrine for the treatment of uncomplicated Plasmodium falciparum malaria in North Ethiopia. Methods. This prospective study was undertaken during August-November 2009 on 71 malaria patients that fulfilled the inclusion criteria set by the WHO. Patients were followed up for 28 days. Thick and thin blood films were prepared by Giemsa stain for microscopy to determine parasite density. A standard six-dose regimen of artemether-lumefantrine was administered over three days and was followed up with clinical and parasitological evaluations over 28 days. Results. The cure rate (ACPR) was found to be high (97.2%) in this study. The parasite and fever clearance time was also rapid. Artemether-lumefantrine for the treatment of acute uncomplicated Plasmodium falciparum malaria in the study area showed 97.2% cure rate and only 2.8% failure rate. Conclusion. The result showed that the drug could continue as first line for the treatment of uncomplicated Plasmodium falciparum malaria in the study area. The efficacy of artemether-lumefantrine needs to be carefully monitored periodically in sentinel sites representing different areas of the country.

Diagnosis and treatment of microsporidial keratoconjunctivitis: literature review and case series.

PURPOSE: The purpose of this study is to describe the clinical characteristics, microscopic findings, and treatment response to albendazole of microsporidial keratoconjunctivitis among immunocompromised individuals with HIV/AIDS. METHODS: This is a retrospective case series. Diagnosis of microsporidial keratoconjunctivitis was confirmed by subspecialist examination and conjunctival swabs examined by light microscopy. HIV infection was documented, and absolute CD4+ T cell count was determined. Patients were treated with albendazole and followed for clinical response. RESULTS: Light microscopy from the conjunctival swabs demonstrated myriad small, round to oval microsporidial organisms that stained positively with modified acid-fast methods. Two of the patients initially not taking highly active antiretroviral therapy (HAART) and presenting with an absolute CD4+ T cell count less than 100 cells/µL had a more severe form of keratoconjunctivitis than the third patient (receiving HAART, with a CD4+ T cell count of 259 cells/µL). All patients were started or continued on HAART. Two of the patients responded to oral albendazole, with resolution of symptoms and signs. The third patient did not initially respond, perhaps because of an immune recovery inflammatory syndrome, but subsequently had temporary improvement with albendazole. CONCLUSIONS: Microsporidial keratoconjunctivitis is a rare ocular complication of HIV/AIDS. Light microscopic evaluation of conjunctival swabs may be a useful minimally invasive first step toward diagnosis of microsporidial keratoconjunctivis in settings where electron microscopy is not available. Based on the limited available information, albendazole often is effective for this condition, and is widely available in developing countries at low cost.