Figure 1

PedroPharmacist

•Follow

Pharmacist

Some actions are only available when you log in.

Report case

Report this to our moderators

Next

You can view up to 4 cases without signing up Sign up for unlimited access

Scientists coordinated by Imperial College London have developed a study that shows how the malaria parasite penetrates the red blood cell by interacting with the receptors, the "glycophorins", of the membrane that separates the cell from the outside world. Parasites that leave the liver have molecular "engines" that aid in the penetration of the red blood cell. However, the study shows that they can still alter cell properties to get input. This allows them to make the cell wall more flexible.

The researchers showed how the parasite protein responsible for cell invasion, the already known EBA175, affects the physical properties of the membrane, weakening the defense of the cell directly. However, the research revealed that differences in membrane stiffness may have an influence on parasite invasiveness. This means that cholesterol can have a protective effect against malaria infection.

According to the results, red blood cells with higher cholesterol levels could be more resistant to invasion and, consequently, to parasite infection. "We found that red blood cell entry is not only due to the ability of the parasite itself, but that changes initiated by parasites in red blood cells appear to contribute to the invasion process," says Marion Koch, the study's first author.

Source: PNAS.


1 comment

Sign up to add a comment

More about this case

Resolved

Why you should join Figure 1

Sign up to explore now

Similar cases

\ \ A new complex presented encouraging results against the parasite that causes Chagas disease, known scientifically as Trypanosoma cruzi. This was the discovery of a group of researchers from the Center for Research on Inflammatory Diseases (Crid), published in the journal Dalton Transactions, through a partnership between the Federal University of the Triângulo Mineiro (UFTM) and the Freie Universität Berlin, Germany.\ The complex consists of gold and an organic compound, thiosemicarbazone. This second molecule, when in contact with the parasite Trypanosoma cruzi, is responsible for crossing the cell membrane and acting directly on the more resistant form in the amastigote.\ According to Carla Lopes, gold is a metal that can play the role of de-structuring the Trypanosoma cruzi DNA or act elsewhere in the metabolic pathway. The idea is that the metal complex acts on multiple targets against it. However, its mechanism of action still needs to be better studied.\ In light of other analyzes of the study, it is known that small amounts of the compound need be used to kill the parasite. In addition, it does not lose its properties when in solid state. This allows it to be transported without the need for cooling, which is important, considering that populations affected by Chagas disease are not always in easily accessible places.\ Source: Dalton Transactions.](https://app.figure1.com/case-detail/00122863-d48f-4413-9dfc-678dcffa50f6)

\ \ Rapid tests for diagnosing malaria caused by Plasmodium vivax in people living in areas where malaria is very common\ What is the aim of the review?\ Malaria infection is caused mainly by two species of malaria parasite: Plasmodium falciparum and Plasmodium vivax. The aim of this review was to evaluate rapid diagnostic tests (RDTs) to diagnose P vivax infection.\ Why are rapid tests for P vivax malaria important?\ For clinical management, knowing which parasite species is causing the malaria is important as the drug treatments differ. For P vivax infection, an additional drug is required to eliminate the infection from the liver. For public health control of malaria, we know that P falciparum is declining over the previous 15 years, and infections from P vivax have therefore increased in importance.\ What was studied in this review?\ RDTs provide results quickly and are often as a dipstick. We studied RDTs that specifically test for P vivax malaria. RDTs are simple to use, point‐of‐care tests. They are suitable for use in rural settings by primary healthcare workers, using drop of blood on the dipstick that causes colour change and a distinct line that indicates a positive test result. Healthcare workers in rural areas can perform RDTs for P vivax without needing a laboratory or special equipment. We wanted to find out which brands of RDTs were the most accurate for diagnosing P vivax malaria. We compared the new tests against the standard form of diagnosis with microscopy, and also more recent methods polymerase chain reaction (PCR): a molecular method to identify P vivax DNA in blood samples.\ What are the main results of the review?\ We included 10 studies that looked at the accuracy of six diagnostic test brands for detecting P vivax malaria in people with suspected malaria symptoms. The studies were conducted in Ethiopia (four studies), India (two studies) and Bangladesh, Brazil, Colombia, and Sudan (one study each).\ Compared with microscopy, the Care Start Malaria Pf/Pv Combo test performed well with 99% sensitivity and specificity (four studies). This means that:\ • for every 100 people tested who have P vivax malaria, one person will have a negative test result, and might not receive the right treatment soon enough;\ • for every 100 people tested who do not have P vivax malaria, one will have a positive result, and might receive unnecessary treatment.\ Compared with microscopy, the Falcivax Device Rapid test had a sensitivity of 77% and a specificity of 99% (two studies). This means that:\ • For every 100 people tested who have P vivax malaria, 23 people will have a negative test result; and,\ • for every 100 people tested who do not have P vivax malaria, one person will have a positive result.\ We are moderately confident (certain) in the accuracy results for the Care Start Malaria Pf/Pv Combo test. The results are from a small number of studies (four), so our findings may change when results from further studies become available.\ We are less confident in the accuracy results for the Falcivax Device Rapid test, because these came from only two studies. Our findings for this test will probably change when results from further studies become available.\ Our results are based on a small number of studies, so we could not reliably assess all six brands of antibody test or compare their accuracy. Most studies included in this review had limitations: it was not clear how people were selected for testing, or how the study results were assessed and checked, which could have affected the results. Some rapid antibody tests were investigated by only one study. Some studies did not report clearly how common P malaria was in the area where the study was done.\ How up‐to‐date is this review?\ The review authors searched for studies published up to 30 July 2019.](https://app.figure1.com/case-detail/04cd14a2-cd8d-4352-935a-48b1862bfe72)

\ \ What was the aim of this review?\ The aim of this review was to see if tafenoquine could prevent relapses of vivax infections and if this effect is equivalent to that of standard‐dose primaquine. Standard‐dose primaquine is defined as 15 mg/day for 14 days for adults.\ Key messages\ Tafenoquine prevents vivax malaria relapses (measured as recurrences of infection in all studies as it is not possible to differentiate a true relapse from a reinfection) in adults compared to no relapse prevention treatment (placebo). There is also probably little or no difference between tafenoquine and primaquine in preventing relapses. The evidence was of moderate certainty due to the low number of studies and few data. There is probably little or no difference in the overall adverse events with tafenoquine compared to placebo or primaquine. However, we are uncertain if tafenoquine causes more serious adverse events such as a drop in blood haemoglobin.\ What was studied in this review?\ Vivax malaria is caused by the parasite Plasmodium vivax. The disease includes a dormant (inactive) stage of liver infection and this can cause relapse (worsening) unless it is treated.\ The most frequently used medicine for relapse prevention until recently was primaquine, but now there is a new alternative named tafenoquine. The US agency responsible for protecting public health, the Food and Drug Administration (FDA), recommends tafenoquine for relapse prevention at a single 300 mg dose. Compared to primaquine, which is usually given daily for 14 days, single‐day dosing provides a significant advantage. However, both primaquine and tafenoquine can cause rupture or destruction of red blood cells (called haemolysis) in people with a hereditary condition called glucose‐6‐phosphate dehydrogenase (G6PD) enzyme deficiency.\ We conducted a Cochrane Review on the effect of tafenoquine on clearing the dormant P vivax parasites in infected people to prevent a relapse. However, it is difficult to differentiate between a true relapse and a new infection in the same individual unless the person was removed from a malaria‐endemic area after initial treatment. All trials included in this review did not do that and have actually measured recurrences as a proxy measure to infer on relapses. While acknowledging this limitation, in giving recommendations and results in this review we used the word 'relapse' as preventing relapses is the intention for using tafenoquine as a single dose in these trials.\ What are the main results of the review?\ We examined the research published up to 3 June 2020. We identified three trials conducted in nine countries in 747 adults with confirmed P vivax malaria. All adults received chloroquine (to clear the parasites from the blood) and some groups received either tafenoquine in a single dose of 300 mg, primaquine or placebo (an inactive tablet matched for the duration of primaquine). All were observed for recurrences of P vivax malaria (up to six months) and all trials tested people for G6PD activity and excluded people who were deficient. Pregnant women and children were also excluded.\ Adults receiving tafenoquine 300 mg had fewer relapses (inferred from the lower number of recurrences of infection) than adults who had placebo (moderate‐certainty evidence). There was probably little or no difference between Tafenoquine 300 mg and primaquine for relapse prevention (moderate‐certainty evidence). There is probably little or no difference in overall side effects between tafenoquine and primaquine (moderate‐certainty evidence). We are uncertain though if tafenoquine causes more serious adverse events compared to placebo or premaquine (for example, haemolysis; very low‐certainty evidence).](https://app.figure1.com/case-detail/162452bb-bc65-4e8a-9c71-79bdd7949586)

\ \ Researchers have found multiresistant forms of Plasmodium falciparum that have developed even higher levels of antimalarial drug resistance and are now rapidly spreading in Southeast Asia.\ The results come from two new studies published in Lancet Infectious Diseases.\ The multi-country randomized clinical trial found that the spread of multiresistant parasites caused malaria treatment failure with the combination of first-line dihydroartemisinin-piperaquine (DHA-PPQ) drugs in half of the cases (50.0%; CI 95% 41.1-58.3) in western and northeastern Cambodia, northeast Thailand and southwest Vietnam over the 2015-2018 time period.\ The genomic epidemiology study showed that by 2016-2018, Plasmodium falciparum represented over 80 per cent of parasites circulating in northeastern Thailand and Vietnam, although they only emerged in western Cambodia in 2008.\ The findings underscore the urgent need to eliminate this parasite collapse with increasing drug resistance, and the importance of genetic surveillance in accelerating malaria elimination efforts, the researchers said.\ At this time, they call for the abandonment of DHA-PPQ use in affected countries. An accelerated malaria elimination program is needed to prevent resistant malaria from spreading further and trigger a global health emergency, similar to the one in which millions of chloroquine resistant malaria died in the 1980s.\ Source: Lancet Infectious Diseases.](https://app.figure1.com/case-detail/1a754489-cf80-423b-b9a9-cf3997002069)

Trending now

\ \ A 52-year-old man presented with a 20-minute history of chest pain radiating to the left shoulder and neck, associated with dyspnea and diaphoresis.\ He had a history of hypertension, long-term smoking, and a sedentary lifestyle.\ On physical examination, bibasilar crackles were noted on lung auscultation. An electrocardiogram (ECG) was performed in the primary care setting, and the patient was promptly referred to the emergency department.](https://app.figure1.com/case-detail/ae0fe999-6875-4474-94f0-ad823dbb9b3a)

\ \ A 28-year-old woman presented with a 3-day history of intense pruritus over the lower back. She reported no recent travel or exposure to new environments. She cares for a small kennel with approximately eight dogs rescued from the streets.\ Physical examination revealed multiple small vesicles, some clustered and others scattered, predominantly involving the lumbar region and the left gluteal area.](https://app.figure1.com/case-detail/c271070f-2bc7-4052-9895-635277e1a7d5)

\ \ A 4-month-old male infant presented with skin lesions localized to the chin for the past 3 days. Physical examination revealed multiple small pustules with surrounding inflammatory signs on the chin, along with a few scattered papules on the chest.](https://app.figure1.com/case-detail/48f41642-b9db-4089-b120-a94ee52328de)

\ \ 70 yo WF with 20y hx HTN lost 21 lbs on a semaglutide but still BMI over 30, shows drop in BP when standing, stabilizing at 102-116 systolic, 65-75 diastolic. Discontinued all HTN meds x 30 days and no episodes of HTN. Could a small weight loss like this cause a drop to normal BP? Has anyone heard of a side effect of lowering BP?](https://app.figure1.com/case-detail/636fd008-29e2-47f4-8ba4-fbee9d527051)