Plasmodium falciparum: induction of resistance to mefloquine in cloned strains by continuous drug exposure in vitro.

A genetically homogeneous population of Plasmodium falciparum prepared by a single erythrocyte micromanipulation technique was used to produce lines of P. falciparum resistant to mefloquine hydrochloride in vitro. Parasites were maintained in a culture medium containing gradually increased concentrations of mefloquine hydrochloride (CMP-mef) starting with 2 ng/ml. One of the mefloquine-resistant culture lines (W2-mef) was obtained after 96 weeks of continuous culture in CMP-mef, the last 4 weeks in medium containing 40 ng/ml of mefloquine hydrochloride. The W2-mef was four to six times more resistant to mefloquine than was the parent clone W2. Means of multiple determinations of 50% inhibitory concentrations (IC-50) of mefloquine hydrochloride against W2-mef and clone W2 were 20.39 +/- 5.08 ng/ml and 4.50 +/- 1.94 ng/ml, respectively.

Plasmodium falciparum: cloning by single-erythrocyte micromanipulation and heterogeneity in vitro.

Natural isolates of Plasmodium falciparum represent a genetically heterogeneous population of parasites. To obtain stable strains of the parasites for long term experiments, a rapid and definitive method of cloning was developed using micropipets and a micromanipulator. Homogeneous parasite clones prepared by this technique were characterized and compared with the parent isolates during 4 years of continuous culture. The process of phenotypic dominance and selection of drug resistance which occur in nature was also simulated in vitro by evaluating population dynamics of two cocultured isolates of P. falciparum.

In vitro activities of and mechanisms of resistance to antifol antimalarial drugs.

Certain drugs that interfere with folate metabolism (sulfones, sulfonamides, and inhibitors of dihydrofolate reductase) play an important role in the chemotherapy and prophylaxis of malaria. The activities and mechanisms of action of these drugs are regarded as similar in most respects to their activities against procaryotic microorganisms. Believed incapable of utilizing intact exogenous folates, plasmodia have been regarded as dependent on de novo synthesis of required folate cofactors. The present investigation, conducted in pursuit of a method for testing the in vitro susceptibility of Plasmodium falciparum to antifol antimalarial drugs, produced evidence that earlier assumptions about the folate metabolism of this organism are not correct. Three of four isolates of P. falciparum were successfully maintained in a culture medium depleted of folic acid and p-aminobenzoic acid. The antimalarial activities of sulfonamides and dihydrofolate reductase inhibitors were, furthermore, variably antagonized by the presence of folic acid and p-aminobenzoic acid in the culture medium. Optimum conditions for assessment of antifol antimalarial activity in vitro therefore require precise control of these factors in the culture medium. Our results suggest that resistance to antifol antimalarial drugs involves a complex of factors related to both the de novo synthesis of active folate cofactors and the ability to utilize exogenous intact folates in various forms.

Use of non-human plasma for in vitro cultivation and antimalarial drug susceptibility testing of Plasmodium falciparum.

Viability, growth rate, and chemotherapeutic susceptibility of the CDC/Indochina III, CDC/Sierra Leone I, and FCR-3 (Subline F-86) isolates of Plasmodium falciparum grown continuously in RPMI 1640 medium supplemented with goat, horse, porcine, bovine, or ovine plasma were evaluated. Results were compared to those obtained from parallel cultures maintained in medium supplemented with non-immune human plasma. Only media supplemented with goat or horse plasma supported significant continuous multiplication of the isolates. Medium supplemented with either ovine or porcine plasma supported continuous multiplication of the CDC/Indochina III isolate, but not the FCR-3 isolate. Medium supplemented with bovine plasma did not support continuous growth of any of the isolates tested. The light microscopic appearance of the isolates during and after continuous culture in medium supplemented with either goat or horse plasma was identical to that of the control parasites maintained in medium supplemented with human plasma. There were no statistically significant differences in the susceptibility to antimalarial drugs of the culture lines maintained in medium supplemented with either human or goat plasma.

Two cases of dipylidiasis (dog tapeworm infection) in children: update on an old problem.

Children in households with dogs and cats may become infected with the dog tapeworm more frequently than suspected. Because of age-appropriate hand-to-mouth exploration, young infants and toddlers, through contact with fleas on pets, floors, and furnishings, are particularly susceptible. Knowledge of the life cycle of this animal parasite and the manner in which children acquire and demonstrate infection can lead to early diagnosis and effective treatment.

Medusa cells: cytostructure and cytochemistry of amoeboid eosinophils with pseudopod-like processes.

Eosinophils having one or more pseudopod-like processes of various lengths are observed in bone marrow, peripheral blood, sputum, nasal smears, and in other exfoliative cytology and tissue specimens after fixation and staining for histochemical study; they are called medusa cells. Although the conformations and lengths of the processes vary, they resemble protozoal pseudopodia. The form which first called our attention to these cells is a conical determinate projection that tapers to a fine tip, much like a protozoal axopod. A basal specialization in the form of a vesicle or thickening may be frequently observed where the process protrudes from, or appears attached to, the cell body. The processes of these eosinophil variants appear morphologically specialized to interact with other cellular elements of the blood and are occasionally seen in contact with, or engulfing, erythrocytes, platelets or other leukocytes. Two hydroperoxidases have been elucidated in eosinophils and medusa cells by virtue of different substrate specificities, subcellular localizations and inhibitor sensitivities. One of these hydroperoxidases is shown by 3,3'-diaminobenzidine, is cyanide resistant, and is never observed in granules or rods in the medusa cell processes; it is frequently polarized to the sites of contact of medusa cells with other cellular elements of the blood. The other hydroperoxidase is revealed by p-phenylenediamine-pyrocatechol, is sensitive to cyanide and is frequently observed in granules and rods in medusa cell processes as well as in a population of larger granules in the cell bodies; the granules in the processes appear to be precursors to the rods, which may be related to Charcot-Leyden crystals. The extrusion of medusa cell processes is facilitated by the divalent cations calcium and magnesium and is inhibited by anions which sequester them such as phosphate, EDTA, citrate and oxalate. Medusa cells have been observed in samples from both rodents and humans and can be very prominent when eosinophilia accompanies allergy, parasitosis and malignancy.

Phospholipase B in the brains and meninges of nonsensitized and sensitized rats after challenge with Angiostrongylus cantonensis.

After a primary infection with 100 Angiostrongylus cantonensis larvae, infected rats showed elevated phospholipase B activity in meningeal and brain homogenates beginning with the first week and continuing through the first month of infection. The rise in phospholipase B values through the first 4 weeks, with a prolonged peak spanning days 30 to 31, coincided with the invasion and maturation of the parasites in the brain, and the ensuing sharp decline in phospholipase B levels, shown by the readings on day 45, coincided in turn with the known migration of the worms from the brain to the lungs, which begins about 5 weeks after infection. In the meninges, the pattern of enzyme elevation was generally similar to that in the brain samples except that the highest activity was seen earlier at days 8 to 9, followed by a gradual decline by days 30 to 31 and a sharper drop by day 45. Rats challenged with 100 larvae 53 days after the primary infection exhibited an almost immediate rise of phospholipase B activity in both the brain and meninges; the peaks of activity occurred at day 1 for the meninges and day 25 for the brain, and levels above control values were still present at day 50. Comparison of the total enzymatic content of the cerebral tissue and meninges revealed that a remarkably high proportion of the phospholipase B activity was contained in the meninges. The inference that elevated levels of this enzyme in the cerebral tissue of A. cantonensis-infected rats are due to inflammatory reactions within the meningeal envelopes was confirmed by histochemical demonstration of specific sites of enzymatic activity limited to the meninges. It is of interest that 80% of the cells positive for the enzyme were clearly identifiable as eosinophils since an association of bone marrow eosinophilia and high phospholipase B levels in rats infected with A. cantonensis was shown in our earlier study of rats infected with this parasite.

Phospholipase B levels in fecal pellets from mice infected with Trichinella spiralis, Hymenolepis nana, and Schistosoma mansoni.

Fecal pellets of mice infected with Trichinella spiralis, Hymenolepis nana, and Schistosoma mansoni have been found to contain high levels of phospholipase B activity. The rise, time course and decline of the enzymatic content of the pellets correlate with the known patterns of intestinal injury and reaction due to the parasites or their eggs. Treatment with drugs (thiabendazole, niclosamide, niridazole) which are effective in suppressing the infection also prevents the rise, or causes an early decline, in the titers of phospholipase B appearing in the excreta. These findings complement the previous reports of a close correlation between accumulation of this enzyme in the intestine and infection of mice with T. spiralis and H. nana. Determination of fecal phospholipase B activity constitutes a relatively simple, quantitative, and blood-free method of following the course of infection and its response to treatment, which might be of particular advantage in long term studies and preliminary therapeutic screening.

Angiostrongylus cantonensis: phospholipase in nonsensitized and sensitized rats after challenge.

Rats given an initial infection with Angiostrongylus cantonensis had moderately elevated phospholipase B activity in the lungs at 8 and 15 days after challenge, and greatly elevated levels were evident at 35, 43, and 49 days. In the brain, the values were elevated at 15 through 35 days. These periods of increased activity in the lungs and brain coincided with the migration patterns of the third stage larvae and the adult worms in this host. The elevated enzyme levels also were were correlated with increased numbers of eosinophils in the bone marrow at 8 and 15 days and again at 36, 43, and 49 days after infection. Similarly infected rats exhibited leukocytosis at 1 through 10 weeks of observation after challenge, and striking eosinophilia at 1, 7, 8, and 9 weeks. Rats reinfected after removal of the worms of the initial infection by thiabendazole treatment showed an anamnestic response characterized by (i) elevated enzyme values in both the lungs and brain at 1 day after reinfection and (ii) eosinophilia in the bone marrow by day 4. These accelerated responses were accompanied by a significant reduction in the worm burden of the rats. The results, which support our hypothesis that inflammation, elevated phospholipase B activity, and reduction in worm burden are causally related, are discussed in light of similar findings reported earlier from our studies with Trichinella spiralis and Nippostrongylus brasiliensis.