We evaluated the efficacy and safety of halofantrine in 19 patients with acute uncomplicated falciparum malaria. Each patient received oral halofantrine hydrochloride 500 mg every 6 hours for 3 doses (total 1.5 g). In almost all the patients clinical symptoms of malaria and parasitaemia disappeared within 2 and 3 days, respectively, of starting treatment. We observed no recurrence of parasitaemia during 14 days of follow-up. Tolerance to halofantrine was good except for minor and self-limiting gastrointestinal side-effects. Haematological and biochemical indices were not seriously affected. Halofantrine-induced prolongation of Q-T/Q-Tc intervals was the consistent cardiac manifestation in 84% of patients. The Q-T/Q-Tc interval prolongation increased with each dose; it reached a maximum between 18 and 24 hours and thereafter returned to baseline. These preliminary data indicate that, apart from the cardiac side-effects, halofantrine is an effective and safe drug, well tolerated by most of the patients in the study. PIP: The authors evaluated the efficacy and safety of halofantrine in 19 patients with acute uncomplicated falciparum malaria. Each patient received oral halofantrine hydrochloride 500 mg every 6 hours, for a total of 3 doses (total 1.5 g). In almost all the patients clinical symptoms of malaria and parasitemia disappeared within 2 and 3 days, respectively, of starting treatment. They observed no recurrence of parasitemia during 14 days of follow-up. Tolerance to halofantrine was good except for minor and self-limiting gastrointestinal side effects. Hematological and biochemical indices were not seriously affected. Halofantrine-induced prolongation of Q-T/Q-Tc intervals was the consistent cardiac manifestation in 84% of patients. The Q-T/Q-Tc interval prolongation increased with each dose; it reached a maximum between 18 and 24 hours and thereafter returned to baseline. These preliminary data indicate that, apart from the cardiac side effects, halofantrine is an effective and safe drug, well tolerated by most of the patients in the study.
Antimalarials - administration & ; dosage ; Antimalarials - therapeutic use ; Electrocardiography ; Malaria, Falciparum - blood

Antimalarials ; therapeutic use ; Artemisinins ; therapeutic use ; Drug Discovery ; Humans ; Public Health

A 7-day in vivo test system was applied to assess the parasitological response to chloroquine treatment in patients with falciparum malaria in the Central Province and National Capital District of Papua New Guinea. 30 patients were investigated but only 23 took a full course of chloroquine and were completely followed up. Of the 23 patients, 13 (57%) were negative for malaria parasites on day 2, 4 (17%) had significantly reduced parasitaemia by day 2 and cleared parasites by day 7, and 1 (4%) showed a partial response (R2). In 5 (22%) of the patients resistance at the R3 level was observed. The indication from this study is that chloroquine should continue to be the first-line drug for the treatment of uncomplicated falciparum malaria. However, judicious use of chloroquine in uncomplicated falciparum malaria is required to halt the spread of chloroquine-resistant strains of Plasmodium falciparum.
Antimalarials - therapeutic use ; Chloroquine - therapeutic use ; Drug Resistance ; Malaria, Falciparum - drug therapy ; Malaria, Falciparum - parasitology

Antimalarials ; therapeutic use ; Artemisinins ; therapeutic use ; Child ; Drug Therapy, Combination ; Humans ; Malaria, Falciparum ; drug therapy

Eighteen day old neonate presented with features of early neonatal sepsis. History of mother revealed a travel from non-endemic area of malaria to endemic area, and on the 7th gestational age mother detected as having malaria. She was treated with quinine and cured. Baby was also evaluated for congenital malaria in first few neonatal days and discharged. Now the baby on evaluation shows anemia, hepatosplenomegaly and diagnosed with a Plasmodium vivax infection on peripheral smear. The quinine failed to prevent transplacental transmission. Prolonged interval between birth and onset of symptoms may be explained by transmission late in pregnancy or during delivery or by presence of transplacentally acquired maternal antibody (IgG). Mother acquired malarial infection after travel to an endemic area and transmitted to the baby. A high level of suspicion is warranted in babies of malaria infected mothers even when the neonate peripheral smear shows no evidence of infection.
Antimalarials/therapeutic use ; Chloroquine/therapeutic use ; Infectious Disease Transmission, Vertical ; Malaria, Vivax/*congenital ; Malaria, Vivax/*epidemiology

Peripheral gangrene, characterized by distal ischemia of the extremities, is a rare complication in patients with falciparum malaria. Patients with this complication have generally undergone early amputation of the affected areas. In this report, we describe 3 adult Thai patients presented at the Hospital for Tropical Diseases, Bangkok, with high grade of fever ranged 6-9 days, jaundice, acute renal failure, respiratory failure, alteration of consciousness and shock. Two patients had gangrene developed at the lower extremities on day 1 of hospitalization and 1 patient had gangrene developed on day 3. Blood smears revealed hyperparasitemia with Plasmodium falciparum. These patients were diagnosed as having severe malaria with peripheral gangrene. The resolution of gangrene was successfully achieved by treatment with artesunate and conservative treatment in 2 of 3 cases.
Middle Aged ; Male ; Malaria, Falciparum/*complications/drug therapy ; Humans ; Gangrene/*etiology ; Female ; Antimalarials/therapeutic use ; Adult

As a unicellular organism, Plasmodium displays a panoply of lipid metabolism pathways that are seldom found together in a unicellular organism. These pathways mostly involve the Plasmodium-encoded enzymatic machinery and meet the requirements of membrane synthesis during the rapid cell growth and division throughout the life cycle. Different lipids have varied synthesis and meta-bolism pathways. For example, the major phospholipids are synthesized via CDP-diacylglycerol-dependent pathway in prokaryotes and de novo pathway in eukaryotes, and fatty acids are synthesized mainly via type Ⅱ fatty acid synthesis pathway. The available studies have demonstrated the impacts of artemisinin and its derivatives, the front-line compounds against malaria, on the lipid metabolism of Plasmodium. Therefore, this article reviewed the known lipid metabolism pathways and the effects of artemisinin and its derivatives on these pathways, aiming to deepen the understanding of lipid synthesis and metabolism in Plasmodium and provide a theoretical basis for the research on the mechanisms and drug resistance of artemisinin and other anti-malarial drugs.
Antimalarials/pharmacology* ; Artemisinins/therapeutic use* ; Humans ; Lipid Metabolism ; Malaria/drug therapy* ; Plasmodium

Antimalarials ; therapeutic use ; Disease Eradication ; economics ; Humans ; Malaria ; diagnosis ; drug therapy ; prevention & control

This article presents a severe cerebral malaria patient in shock with a close contact of COVID-19 that was successfully cured in a negative pressure ward during the global pandemic of COVID-19. The patient experienced a sudden onset of high fever and coma in a designated isolation hotel after returning from Africa, and was transferred to a designated hospital. Following antimalarial therapy, blood pressure elevation, increase of blood volume, bedside hemodialysis, mechanical ventilation, plasma and platelet transfusions, the case gradual recovered.
Humans ; COVID-19 ; Malaria/drug therapy* ; Antimalarials/therapeutic use* ; Africa ; Travel

The in vivo response of Plasmodium falciparum parasites to amodiaquine or chloroquine was assessed in children with symptomatic malaria attending different health facilities in the Madang area. Among the 27 subjects who were completely followed up, 4 (15%) were infected with parasites fully susceptible and 23 (85%) with parasites exhibiting some degree of resistance. Out of the latter group, 52% were of RI level, 26% RII and 22% RIII. 14 subjects out of 42 (33%) failed to clear their parasitaemia by day 7 and 92 out of 134 (69%) had persistent or recrudescent parasitaemia at day 21. The level of in vivo resistance was similar for amodiaquine and chloroquine. 86% of the isolates tested in vitro showed resistance to amodiaquine, 86% to chloroquine and 7% to quinine. In ten years the prevalence of resistant isolates in vivo has increased from 47% to 85%. Of more concern is the shift from RI level of resistance to RII and RIII: the proportion of resistant strains that were RI dropped from 90% to 52% over the ten-year period. To determine if the standard antimalarial regimens are still appropriate, there is a need not only to assess the level of parasite resistance but also the prevalence of treatment failure in different parts of Papua New Guinea. PIP: The in vivo response of Plasmodium falciparum parasites to amodiaquine and chloroquine was assessed in children 1-9 years of age with symptomatic malaria recruited from health centers in Papua New Guinea's Madang area. Among the 27 children who were completely followed up, 4 (15%) were infected with fully susceptible parasites; in the remaining 23 cases (85%), there was some degree of resistance. 52% of parasites in the latter group were RI level, 26% RII, and 22% RIII. There was no correlation between level of resistance and age. 14 out of 42 children (33%) failed to clear their parasitemia by day 7 and 92 out of 134 (69%) had persistent or recrudescent parasitemia at day 21. Both amodiaquine and chloroquine had similar levels of in vivo resistance. 86% of isolates tested in vitro showed resistance to amodiaquine, 86% to chloroquine, and 7% to quinine. In 10 years, the prevalence of resistant isolates in vivo has increased from 47% to 85%. Of particular concern is the finding that the proportion of resistant strains that were RI dropped from 90% to 52% over this decade. The increase of resistance is attributed to indiscriminate use of 4-aminoquinolines in all cases of fever. Needed, to assess whether standard antimalarial regimens are still appropriate, is a review of treatment failure in different parts of Papua New Guinea.
Acute Disease ; Amodiaquine - therapeutic use ; Animals ; Antimalarials - therapeutic use ; Case-Control Studies ; Child ; Papua New Guinea ; Treatment Failure