Navegando por Assunto "Plasmodium vivax"

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Adesão ao tratamento da malária vivax em crianças
(Universidade Federal do Pará, 2016-04-01) SANTOS, José Alberto Gomes dos; ANDRADE, Marcieni Ataíde de; http://lattes.cnpq.br/8514584872100128
Malaria is an infectious disease endemic in 104 countries and vivax malaria accept responsibility for 25 to 40% of the global burden of disease worldwide. The South America has high transmission rates shown by the annual parasite incidence (API) greater than 1% of the population. In recent years it has been observed in Brazil the prevalence of infection with P. vivax. The treatment protocol isased on the combination of chloroquine and primaquine, however, treatment failures have been reported worldwide including in Brazil with adherence as one of the causes. Several factors can interfere in the adherence between them: education, sex, absence of signs and symptoms and socioeconomic profile. This study evaluated the adherence to malaria treatment from determining the profile demographic partner of children with vivax malaria in Anajás and determined the plasma concentrations of chloroquine and primaquine of the study patients. For the profile of the participants was used questionnaire was complete source of information. To measure adherence to treatment was used indirect test Morisky-Green assessing the patient's attitude towards treatment. The plasma concentration of primaquine and its metabolite was made by collecting paper filter venous blood on day D1 and D7 and determined HPLC. The profile of patients showed that most of the children were male, with the primary caregiver mother, education and income were considered low, despite the distribution the use of mosquito nets it is irregular, 92.4% of households have no sewage system, and 33.3% use water from the river for consumption .The indirect test Morisky- Green classified 42 children as adherent and 08 as no adherent The plasma concentration of PQ in D7 adherent and no adherent were related and showed no significant difference, since the CPQ concentrations in D7 Adherent showed statistically significant result, with higher values in adherent patients.
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Alterações clínicolaboratoriais em pacientes com malária por Plasmodium vivax e deficiência de glicose-6-fosfato desidrogenase tratados com 0,50mg/kg/dia de primaquina
(2004-06) SILVA, Mônica Cristina de Moraes; SANTOS, Eliane Barbosa; COSTA, Elenild de Góes; SILVA FILHO, Manoel Gomes da; GUERREIRO, João Farias; PÓVOA, Marinete Marins
The adverse effects of primaquine (0.50mg/kg/day) were investigated in eleven patients with vivax malaria (three patients with glucose-6-phosphate dehydrogenase deficiency). Clinical and laboratorial alterations indicated acute hemolysis in only the enzymopenic patients and treatment was interrupted. Our results suggest that screening for G6PD deficiency should be carried out in patients with vivax malaria infection in order to avoid complications due to primaquine.
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Avaliação da adesão ao tratamento preconizado para malária: determinação da primaquina em pacientes diagnosticados com Plasmodium vivax
(Universidade Federal do Pará, 2016-03-31) GONÇALVES FILHO, Wilson Vieira; VIEIRA, José Luiz Fernandes; http://lattes.cnpq.br/2739079559531098; ANDRADE, Marcieni Ataíde de; http://lattes.cnpq.br/8514584872100128
Malaria is a disease that threatens 50% of the world population living in endemic areas such as Africa, Asia and Latin America. Concerning malaria caused by Plasmodium vivax in Brazil, which treatment is based on primaquine and chloroquine, it is a major public health issue that hinders the development of the Amazon region and adherence to drug therapy is one of the main factors that influence the effectiveness of the drug. This study uses indirect methods assess treatment adherence, correlating it with plasma concentrations of primaquine and carboxyprimaquine. Thus, a cross-sectional observational controlled study was conducted with 27 patients in Anajás, Pará before (D0), during (D1) and after (D7) treatment using the antimalarials, followed by the assessment of the patients with questions based on Morisky-Green test at the end of the treatment. Higher prevalence of vivax malaria was observed in males (70.4%) and age group of 20-39 years (55.56%), Morisky-Green test indicated adherence of 75%, 15 out of 20 patients, with hit rates of 80%, 65%, 70% and 65% to the questions. Mean-value of primaquine concentration on D1 was 134.8 ng/mL, and 131.9 ng/mL on D7, values for carboxyprimaquine are 408 ng/ml and 529.4 ng/mL respectively. It is possible to observe a statistically significant difference in the carboxyprimaquine values between D1 and D7 in the acceding group defined by the Morisky-Green tests, showing that carboxyprimaquine accumulates in the body; therefore being more suitable for assessing adherence to treatment. Therefore, it is important to point out these concentrations of primaquine and carboxyprimaquine consist as the first determination study of drugs and metabolites found for the short-course treatment suggested by the Ministry of Health for vivax malaria in the Amazon region, supporting the studies of adherence surveys regarding antimalarials.
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Avaliação da resposta aos esquemas de tratamento reduzidos para malária vivax
(Universidade Federal do Pará, 2001-08) ABDON, Nagib Ponteira; PINTO, Ana Yecê das Neves; SILVA, Rita do Socorro Uchôa da; SOUZA, José Maria de
Relapses may occur with long standard treatment of vivax malaria, and these are caused by incomplete patient’s compliance. The use of reduced schedules may further better patient compliance, while maintaining the same efficacy, tolerance and minimal adverse reactions. The objective of this study was to test two schedules with reduced doses of chloroquine for vivax malaria and comparing these with the classical schedule. The authors studied 120 outpatients, with vivax malaria, aged over 12 years, submitted to three therapeutic schemes: scheme I: chloroquine phosphate (150mg) in a dose of 25mg/kg/day for three days (10mg/kg/ day in the first day, 7.5mg/kg/day in the second and third day), plus primaquine (15mg) in a dose of 0.25mg/kg/day for fourteen days; scheme II: chloroquine, in a single dose of 10mg/kg, plus primaquine in a dose of 0.5mg/kg/day for seven days; scheme III: chloroquine, 10mg/kg in a single dose plus primaquine in a dose 0.5mg/kg/ day for five days. The clinical response to all three therapeutic schemes was satisfactory. The disappearance of malarial symptoms occurred after a maximum 96 hours of treatment, while the assexual parasitaemia clearance occurred within 72 hours, in all therapeutic schemes.
Acesso aberto (Open Access)
Avaliação da terapêutica da malária por Plasmodium vivax: perfil cinético da cloroquina e primaquina
(Universidade Federal do Pará, 2011) TEIXEIRA, José Ribamar Mesquita; VIEIRA, José Luiz Fernandes; http://lattes.cnpq.br/2739079559531098; SOUZA, José Maria de; http://lattes.cnpq.br/6459204248879587
Today search - new strategies for improving the treatment and control of malaria. The monitoring of plasma concentrations of drugs is an important tool that aims to provide more knowledge on the kinetics of several antimalarial drugs, aiming to achieve rapid therapeutic effect with reduced risk of toxicity. Thus, this study aimed to evaluate the therapeutic response to chloroquine and primaquine for vivax malaria patients, the plasma concentrations correlate with parasitemia, epidemiological data and evaluation of liver and kidney function, aiming at the optimization of various therapeutic regimens employed, evaluating if the responses are due to ineffective treatment of Plasmodium resistance to chloroquine or the presence of sub-therapeutic concentrations of drugs. Thus, we evaluated 40 patients with vivax malaria in the Program in Clinical Trials of Malaria Institute Evandro Chagas (Belém, Pará) in the period 2008 to 2010. Hemogram and other biochemical parameters were performed. The research of plasmodia in blood smear was performed and the parasitemia averaged 7187.5 ± 6732.7 parasitos/mm3. The prevalence of males with 67.5% of cases. The locations of malaria infection ranged from 14 municipalities in the state of Pará, most of which originates in the city of Anajás. For 42.5% of patients it was the first episode of the disease and 57.5% of applicants. In the evaluation of anemia by hemoglobin, there - if the levels below reference values in 60% of patients and hematological and biochemical parameters showed that the mean values of hematocrit and red blood cells showed highly significant difference between subgroups of patients and non-anemic anemic. The determination of chloroquine and primaquine in patients on D0, D2, D7, D14 and D30 were performed. The mean values of 0, 1102.1, 546.7, 185.8 and 98.6 ng / ml for chloroquine and 0, 210.2, 345.0, 91.7 and 0 ng/ml for primaquine.
Acesso aberto (Open Access)
Avaliação do nível de concordância do teste imunocromatográfico OptiMAL-IT® e a gota espessa no diagnóstico da malária, no município de Mazagão-AP, Brasil
(Universidade Federal do Pará, 2007) FADUL, Danielle Scerne; COUTO, Álvaro Augusto Ribeiro D'Almeida; http://lattes.cnpq.br/3800209721205388
The precocious diagnosis and the opportune treatment of the cases of malaria is one of the main strategies for the control of the disease. Several alternatives for the traditional microscopic diagnosis were proposed in the last years, the Immunochromatographic tests that capture white antigens of the parasites of the malaria they are being proposed, as the test OptiMAL-IT® that captures the lactic desidrogenase of the Plasmodium sp.. The study had as objective the evaluation of the level of agreement between the Immunochromatographic test (OptiMAL-IT®) and the thick drop for the diagnosis of the malaria in the City of Mazagão – Amapá, Brazil. 413 individuals were analyzed with malaria sintomatology that had looked for the service of the unit of health service of the city, with age among 01-68 years. The results of the OptiMAL-IT® test were compared with the obtained results, of the same samples, through the thick drop red-faced by the Giemsa. Of the 413 patients suspicious to present malaria, 317(76.8%) were positive through GE and 311 (75.3%) were positive for TDR OptiMAL-IT®. Of the positive blades of GE, had been found 27.4% of P. falciparum and 72.6% of P. vivax . The OptiMAL-IT® test detected 27.7% of P. falciparum and 72.3% of P. vivax. The sensibility obtained with TDR for P. falciparum was of 97.7% and for P. vivax was of 98.2%, the global sensibility of TDR was of 98.1% and the global specificity for both the species was of 100%. They were found preditivos values positive and negative of 100% and 94.1%, respectively. The OptiMAL-IT® test had a high agreement with thick drop, it is specific and efficient. It can be used in the diagnosis of malaria in the situations where microscopy is not available.
Acesso aberto (Open Access)
Comparative recognition by human IgG antibodies of recombinant proteins representing three asexual erythrocytic stage vaccine candidates of Plasmodium vivax
(2007-06) BARBEDO, Mayara de Brito; RICCI, Ricardo; JIMENEZ, Maria Carolina Sarti; CUNHA, Maristela Gomes da; YAZDANI, Syed S; CHITNIS, Chetan E; RODRIGUES, Mauricio Martins; SOARES, Irene da Silva
In previous immuno-epidemiological studies of the naturally acquired antibody responses to merozoite surface protein-1 (MSP-1) of Plasmodium vivax, we had evidence that the responses to distinct erythrocytic stage antigens could be differentially regulated. The present study was designed to compare the antibody response to three asexual erythrocytic stage antigens vaccine candidates of P. vivax. Recombinant proteins representing the 19 kDa C-terminal region of MSP-1(PvMSP19), apical membrane antigen n-1 ectodomain (PvAMA-1), and the region II of duffy binding protein (PvDBP-RII) were compared in their ability to bind to IgG antibodies of serum samples collected from 220 individuals from the state of Pará, in the North of Brazil. During patent infection with P. vivax, the frequency of individuals with IgG antibodies to PvMSP119, PvAMA-1, and PvDBP-RII were 95, 72.7, and 44.5% respectively. Although the frequency of responders to PvDBP-RII was lower, this frequency increased in individuals following multiple malarial infections. Individually, the specific antibody levels did not decline significantly nine months after treatment, except to PvMSP119. Our results further confirm a complex regulation of the immune response to distinct blood stage antigens. The reason for that is presently unknown but it may contribute to the high risk of re-infection in individuals living in the endemic areas.
Acesso aberto (Open Access)
Comprometimento pulmonar na malária: associação com fatores epidemiológicos, imunológicos e variantes do Plasmodium vivax
(Universidade Federal do Pará, 2014-11-20) OHNISHI, Maria Deise de Oliveira; LIBONATI, Rosana Maria Feio; http://lattes.cnpq.br/3818175484709618
Malaria is a disease caused by protozoan parasites of the genus Plasmodium and transmitted to humans by mosquitoes of the genus Anophelis. In 2011, the Brazilian Amazon reported 266.348 cases. In Brazil, the most prevalent species is Plasmodium vivax (80%). It´s considered responsible for benign forms of malaria, reports have shown severe forms of pulmonary malaria and deaths. The pathophysiological mechanisms are not well understood.Thus, we analyzed 247 patients with vivax malaria recruited from the Clinical Trials Program in Malaria Institute Evandro Chagas (IEC) Belém / PA) and malaria diagnosis service of the Secretariat of Health of the city of Goianésia / Pará between April / 2011 to October / 2013 to evaluate clinical, epidemiological, parasitological, radiological, genetic and immune (variants of P. vivax) parameters, associating them to the pulmonary involvement in vivax malaria. The project was approved by the Research Ethics Committee of the Instituto Evandro Chagas.Hematological parameters (blood count, transaminases, bilirubin), parasite density were analyzed as were measured at D0 and D14 serum levels of cytokines (TNF-, IL-10 and INFγ), relating to the pulmonary manifestations. D0 was determined prevalence of P. vivax variants (VK210 and VK247 and P. vivax-like) and established association of these variants with patients who had an abnormal chest X-ray and / or spirometry. The study was longitudinal, prospective analytical type involving clinical, immunological, hematological, and radiological aspects of respiratory function. Patients with pulmonary involvement confirmed by clinical and / or radiological and / or functional findings constituted the study group, and patients without such findings, the control group. Participants: those with vivax malaria diagnosed by thick blood, confirmed by PCR, 15-60 years old, both genders, with no chronic diseases, no use of corticosteroids at diagnosis and who signed the consent form. Project approved by the CEP of the IEC. Observed: 69.2% were males; mean age 35 years old; 64.4% lived in Belém; 79.8% contracted malaria in the state of Pará; First infection 42.5%; mean duration of disease 7.5 ± 5.9 days; average of 6979.25 ± 8692.22 parasitaemia parasites / mm3; 46.8% were overweight or obese I; smoking and previous lung disease were not risk factors for worsening of the disease in this sample; 92.3% had headache from malaria triad; among respiratory symptoms, cough was the most frequent (53.4%); hepatomegaly and splenomegaly was more frequent among naïve malaria; Thrombocytopenia was significant in D0; radiological abnormalities in 9.7% of cases; changes in X-ray were related to malaria shortness of breath and cough had statistical significance in those with changes in the X-ray and / or spirometry; IL-10 INFγ and cytokines were significantly higher compared D0 to D14, unlike that serum TNF levels were low in D0. VK210 P. vivax variant was more frequent (69.1%); there was no significant correlation in the appearance of changes in RX in this sample and / or spirometry related to any of the P. vivax subspecies. Among the cytokines, INFγ was significantly elevated in D0 associated to variants in the following situations: (VK210, VK247, VK210 / 247). IL-10 also significantly increased in D0 only when the subspecies was VK210. Lung malaria is a reality still underestimated, especially less prominent pulmonary manifestations, being necessary to investigate potential mechanisms involved linked to the host and the parasite, emphasizing the importance of early diagnosis, avoiding unfavorable outcome.
Acesso aberto (Open Access)
Concentrações plasmáticas de primaquina e metemoglobinemia em pacientes com malária por Plasmodium vivax
(Universidade Federal do Pará, 2010) FERREIRA, Michelli Erica Souza; VIEIRA, José Luiz Fernandes; http://lattes.cnpq.br/2739079559531098
The vivax malaria is a disease that effects around 40% of the world, to treat it, chloroquine (150 mg) and primaquine (15 mg). This is an 8-aminoquinoline with tissue schizonticide action. Among the adverse effects enhance the capacity to hemoglobin oxidation, dose-dependent, which is exacerbated in individuals with glucose-6-phosphate dehydrogenase deficiency. When considering the lack of studies concerning the methemoglobin levels and its correlation with primaquine concentrations plasma in patients with vivax malaria, is justified this study using as tools to monitor the plasma primaquine concentrations and its correlation with methemoglobin levels. In this sense, it was followed up clinically and laboratory findings of 20 patients with vivax malaria before (D0) and after three (D3), seven (D7) and fourteen (D14) days starting the treatment, as well as validation of the method for primaquine determination by high performance liquid chromatography (HPLC). Methemoglobinemia was evaluated using the method of Hegesh et al. (1970) and glucose-6-phosphate dehydrogenase by colorimetric method of Brewer et al. (1962 ). The methodology validated was demonstrated efficient for primaquine determination, whose average levels at D3, D7 and D14 were 227 ± 106 ng / mL, 191 ± 97 ng / mL and 160 ± 128 ng/mL. In the analysis according to gender was not observed differences significant in the drug levels in several days of study. The average methemoglobin levels in D0, D3, D7 and D14 were 1.15 ± 0.9%, 4.1 ± 2%, 5.7 ± 2% and 3 ± 1.4%, respectively. There was an increase in the methemoglobin level after drug administration, without difference by gender. There was not significant correlation between the methemoglobin levels and primaquine concentrations plasma in both sexes. The coefficients of Pearson correlation for males and females were 0.8296 and 0.8137, respectively. We observed impaired expression of the enzyme glucose-6-phosphate dehydrogenase in six male patients without differences between the methemoglobin levels and primaquine concentrations plasma, compared with patients with expression normal of the enzyme.
Desconhecido
Eletrorretinografia multifocal: desenvolvimento de método avaliativo e aplicação em pacientes com toxoplasmose ocular e investigação funcional da função retiniana em pacientes com malária, infectados pelo P. Vivax
(Universidade Federal do Pará, 2014-11-03) CARVALHO, Aline Correa de; SOUZA, Givago da Silva; http://lattes.cnpq.br/5705421011644718; SILVEIRA, Luiz Carlos de Lima; http://lattes.cnpq.br/9383834641490219
The current thesis was composed by two studies performed in parallel. The first purpose was the development of a reliable method to classify the electroretinographic responses and to validate this method in ocular toxoplasmosis. The second purpose was to investigate the effect of the acute use of chloroquine in the retina of vivax malaria patients, which received the standard treatment of the Ministry of Health of Brazil. The experimental tool of both studies was the multifocal electroretinogram (mfERG). In the first study the Veris system was used to test 10 healthy subjects to calculate a signal to noise ratio analysis in order to find the best values to separate normal responses from impaired retinal responses. The final results of this analysis were applied in three patients with visual loss due ocular toxoplasmosis. The results showed an optimal signal to noise ratio of 0.47 to separate waveforms with and without signal. The signal to noise ratio of 0.47, 0.44, 0.48, 0.57, 0.78, 1.21 were optimal to separate normal responses from progressively attenuated responses. The application of the signal to noise ratio analysis into ocular toxoplasmosis patients was able to map the retinal area with no activity evoked by the light. The second study was performed using mfERG to evaluate 48 vivax malaria patients which received chloroquine-based treatment. Their data were compared to 37 healthy subjects. The results showed that number of infections ranged between from 01 to 18 times. During the treatment, the mean dosage of intaken chloroquine was 5429 ± 782.3 mg. The cumulative dosage normalized to the body mass ranged from 14.58 to 545.45 mg/kg. No difference was observed in the mfERG amplitude and implicit time obtained from malaria patients and control group at any concentric rings of the visual field. There was no significant correlation between the retinal activity with the chloroquine cumulative dosage. It was concluded that the signal to noise analysis developed in this thesis can be used as a reliable method to study impaired retinal function, including the mapping of ocular toxoplasmosis consequences; and the acute use of chloroquine for malaria treatment caused no impairments to retinal activity recorded by mfERG.
Desconhecido
Estado nutricional na malária: influência nos aspectos clínicos e laboratoriais de pacientes naturalmente infectados por Plasmodium vivax
(Universidade Federal do Pará, 2015-11-10) MONTE, Carlos Rodrigo Souza do; VENTURA, Ana Maria Revorêdo da Silva; http://lattes.cnpq.br/0682511755329264; LIBONATI, Rosana Maria Feio; http://lattes.cnpq.br/3818175484709618
Malaria is considered by the World Health Organization a global public health problem. In Brazil, most cases occur by P. vivax. This study aimed to evaluate the influence of obesity on inflammatory markers, biochemical, hematological, parasitological profiles and clinical manifestations in vivax malaria patients at Pará State. Seventy-eight (37 eutrophic, 25 overweight and 14 obese) patients positive to P. vivax were included. Chills, headache, malaria triad (fever, chills and headache), myalgia, cough and diarrhea were more frequent, whereas the clinical score were higher in obese compared to normal weight patients. Obese patients had a higher level of count of total leukocytes, neutrophils, monocytes, triglycerides, total cholesterol, VLDL, AST, ALT compared to lean patients. Parasitaemia was similar among nutritional status, although was observed trend to higher parasitaemia (> 5.000 parasites/μL) in obese patients. Serum levels of TNF-α and IL-10 did not differ among nutritional groups, though there was a negative correlation between TNF-α and waist circumference. Among overweight and obese was observed a positive correlation between IL-10 and parasitemia, neutrophils, urea and a negative correlation with red blood cells, lymphocytes, platelets. Throughout, TNF-α was correlated negativity with the clinical score. Nutritional status influences immune response against the infection and it has been an important risk factor in this findings. However, further studies are required to understand the malaria in this context.
Desconhecido
Estimativas da dose e dos parâmetros farmacocinéticos da cloroquina em pacientes com malária por Plasmodium vivax na amazônia brasileira
(Universidade Federal do Pará, 2019-10-07) FERREIRA, Michelle Valéria Dias; VIEIRA, José Luiz Fernandes; http://lattes.cnpq.br/2739079559531098; https://orcid.org/0000-0003-4842-8762
Malaria caused by Plasmodium vivax is still an important public health issue in the Brazilian Amazon basin, with 169,000 cases recorded in 2018. The treatment is based on the concurrent administration of chloroquine and primaquine. Despite the efficacy and tolerability over 60 years of use, there are several issues related to chloroquine uses that should be elucidated in the Brazilian Amazon. The aims of the present study were to estimate the doses administered and to assess the pharmacokinetics parameters of chloroquine by a no-compartmental approach associating with patients age and gender. A prospective study of cases was carried out in the municipality of Anajas, PA, with 161 patients diagnosed with malaria caused by P. vivax, 81 children and 80 adults. The geometric mean of parasites at admission were 2,644 in children and 1,210 per mm3 of blood in adults. Parasites were cleared from the peripheral blood within 28 days. The doses of chloroquine administered ranged from 20,2 to 28,9 mg/kg in children and 16,3 to 34,09 mg/kg in adults. The proportions of patients with chloroquine doses below 25 mg/kg ranged from 29,4% to 63,6% in children and 59% in adults. The required doses were lower than the given doses in ages ranges of 4-8 years (U=64; p=0,007), 9-11 years (U=32; p<0,001) and 12-14 years (U=18; p<0,0001). Blood chloroquine concentrations in 168h in ng/ml ranged from 107 to 440 in children and 201 to 582 in adults. Blood levels of desethylchloroquine ranged from 167 to 412 in children and 178 to 482 in adults. The pharmacokinetics parameters derived from no-compartmental approach were elimination rate constant, area under the curve at day 28, extrapolated to infinite, maximum concentration, total clearance, elimination half-life, volume of distribution and meantime of residence. Overall, the data were similar to those found in other population groups and confirmed the high elimination half-life and a large volume of distribution of the drug. There was no significant influence of gender, but the age decreased significantly the clearance and the volume of distribution. The results permit to conclude that chloroquine is yet effective in the research area. Most of the patients received sub-doses of chloroquine. The pharmacokinetics parameters were not influenced by gender, but the age promoted a significant decrease in the volume of distribution and in the clearance, with the lower values in children.
Desconhecido
Malária em mulheres na idade reprodutiva: análise dos aspectos clínico-epidemiológicos na região de Itaituba, 2005 a 2007
(Universidade Federal do Pará, 2010) MELO, Wilson Franco de; PINHEIRO, Maria da Conceição Nascimento; http://lattes.cnpq.br/6353829454533268
A malária na gestação representa uma ameaça à vida da mãe e do concepto além de influenciar na evolução da gravidez. Visando esclarecer aspectos da malária que acomete gestantes de áreas hiperendêmicas na Amazônia, este estudo se propõe avaliar aspectos clínico-epidemiológicos da doença em mulheres na idade reprodutiva, com ênfase em gestantes internadas em hospital público de referencia para a região de Itaituba. O estudo foi conduzido no HMI de Itaituba no período de 2005 a 2007, através do levantamento de prontuários de mulheres hospitalizadas e com diagnóstico de malária confirmado pela gota espessa, e da análise documental baseada nos dados do SIVEP-Malária. Os resultados evidenciaram que no Pará, em 2007, mais de 51% dos casos notificados foram oriundos de apenas nove municípios, dois deles (Itaituba e Jacareacanga), pertencentes à microrregião de Itaituba, área onde foi registrada maior Incidência Parasitária Anual (IPA). Os dados dos prontuários de 30 pacientes (sete, gestantes) revelaram, em sua maioria, que eram procedentes da área rural do município de Itaituba e haviam sido infectadas por P. falciparum; que as gestantes eram as mais jovens (p<0,05); e que o tempo de internação foi similar entre gestantes e não-gestantes. As intercorrências sobre o curso gestacional foram um óbito fetal (malária por P. vivax, segundo trimestre) e um parto prematuro (malária por P. falciparum, terceiro trimestre). Concluiu-se, a partir dessas observações, que casos graves de malária podem ocorrer tanto associados à espécie vivax como falciparum fazendo-se necessário constante vigilância epidemiológica, especialmente no município de Itaituba, onde está concentrado o maior número de casos da doença. As medidas de vigilância epidemiológica a serem adotadas devem privilegiar o diagnóstico precoce e tratamento imediato das pacientes, sobretudo das gestantes, já que estão sujeitas a maior risco de complicações com sérias conseqüências para o concepto.
Desconhecido
Malária no Pará: estudo do quadro clínico e laboratorial nas infecções causadas pelo Plasmodium vivax, na atualidade
(Universidade Federal do Pará, 2002) NEVES, José Joaquim de Oliveira; SOUZA, José Maria de
Nowadays malaria is considered one of the most iInportant problem of public health the World Health Organization. Recent studies showed changes in clinical and laboratory pattern. The aim of this work was to study the clinical manifestations and laboratory pattern of malaria infection due to Plasmodium vivax. This longitudinal and prospective study was carried out in Evandro Chagas Institute, in Belem City, from November 2001 to June 2002. The methodology was: diagnosis, treatment and follow-up of P. vivax parasites carries diagnosed by thick smear during all period of the treatment. Were evaluated the epidemiologycal, clinical and laboratory aspects including sex, skin color, profession, origin of infection, period of incubation and persistence of headache, chills and fever, and another symptoms during the treatment. Laboratory investigation included the parasite count and data related to blood exmnination (coagulation tests, hemoglobin rates, erythrocytes, leukocytes), aminotransferases, bilirrubin, alcaline phosphatase, urea and creatinine. Preliminary data of the present study showed changes in epidemiologycal aspects related to the kind of occupation of malaria-infected patients living in urban area. The incidence of malaria cases was higher aIllong students and housewives. This study corroborates the fonner studies related to chloroquine schizonticide action in an average time of 48/72 hours and also it showed significant thrombocytopenia that still now is not very well studied in malaria due to P. vivax. Plateletes fall do not change the blood coagulation tests. On day seven, 124 patients among 127, showed paleness, but as wek now, it has not a good correlation with anelnia occurrence.
Acesso aberto (Open Access)
Malária por Plasmodium vivax na infância e na adolescência - aspectos epidemiológicos, clínicos e laboratoriais
(Universidade Federal do Pará, 1997-12-16) VENTURA, Ana Maria Revorêdo da Silva; SOUZA, José Maria de
Worldwide malaria affects both children and adults, and it is known that clinical picture varies considerably in severity depending upon the immune status (particularly among children) and the infecting Plasmodium species. In the present investigation it was attempted to assess epidemiological, clinical, and laboratorial parameters of Plamodium vivax malaria during childhood and adolescence. In this study, between January, 1995 and November, 1996, it was enrolled 100 patients (both sexes), aged 0 to 14 years, who sought for medical treatment in the attendance outpacient unit of the Malaria Program of Evandro Chagas Institute, in Belem, Para State. All patients had a P. vivax-positive thick blood film. Regarding age, malaria were more frequently seen in adolescents, accounting for 37.0% of them. The fact that 34.0% of patients were identified as autochthonous cases of malaria indicates that disease is progressing in urban settings of the Amazon Region. Fever was found to be the earliest more frequent symptom in the course of illness, being recorded in 88.0% of children. At the first patients's attendance (Day 0, DO), fever, chill and headache (malarial triad) were noted in 97.0%, 91.0% and 85.0% of cases, respectively; while, hepatomegaly and splenomegaly were recorded in 29.0% and 46.0% of them, respectively. Pallor was found to be significantly associated with anaemia (p< 0.05), in that 89.2% of pale children had low haemoglobin values. It is likely that anaemia has developed mainly as a result of haemolysis; although the delay in making the malaria diagnosis (an average of 12.5 days after onset of clinical symptoms) and concurrent hookworm intestinal parasitism may also have played a role in its pathogenesis. An additional finding from this study was that malnutrition seemed not to be associated with anaemia. Once treatment had iniciated, the malarial triad began to subside and asexual parasitaemia levels tended to decrease. The former parameter, however, was shown to be more evident than the latter one. Other clinical symptoms such as pallor, weakness, arthralgia, headache and dark urine lasted longer than did malarial triad, usually persisting for up to 14 days. During or soon after finishing treatment, complications were noted in 5.0% of children including: pneumonia, bronchopneumonia, impetigo, gastroenteritis and a rash of unknown etiology. A finding of practical interest is that ultrasonography was shown to be more sensitive than abdominal palpation in the detection of hepatoesplenomegaly. The start of drug therapy was followed by a progressive increase in haemoglobin levels, reticulocyte count and mean corpuscular haemoglobin concentration (MCHC) from DO (first day of treatment) to 07 (eighth day of treatment). Conversely, the mean corpuscular haemoglobin concentration values decreased significantly from D0 to 07, probably because iron was present in bone marrow in decreased amounts.
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Marcadores de estresse oxidativo e concentrações de primaquina e carboxiprimaquina em pacientes com malária por Plasmodium vivax
(Universidade Federal do Pará, 2014-11-06) RODRIGUES, Luiz Carlos de Souza; VIEIRA, José Luiz Fernandes; http://lattes.cnpq.br/2739079559531098
The changes in redox cycle has been associated with the physiopathology of severity of malaria in experimental models and in humans. However, a few studies evaluated the changes in redox equilibrium of patients with no severe malaria by P.vivax, which comprise the majority of the cases of disease. The variations of oxidative damage and the respective antioxidant response of human host were not compared before, during and after chemotherapy. Also, the mechanisms responsible by the generation of free radical in each phase that is, the heme degradation, respiratory burst of macrophages or antimalarials uses, were not determined. The objective of this study was to estimate the levels of biomarkers of oxidative damage and the respective antioxidant response, as well as primaquine and carboxyprimaquine whole blood levels in malaria by P. vivax. Therefore, were enrolled 38 patients with slide confirmed infection by P. vivax followed by 28 days. Serial blood samples were collected on pre-doses samples (D0) and on D2, D7 and D14. The oxidative damage and the antioxidant defense were estimated by the spectrophotometric measures of thiobarbituric acid reatives substances and methemoglobinemia, and by total antioxidant capacity and reduced glutathione, respectively. The control group consisted of 19 healthy volunteers matched for age and gender ratio. Primaquine and its major metabolite were determined by high performance liquid chromatography. The results revealed that the disease occurred in male patients of working age. Haematological parameters remained constant during the study. Biochemical evaluation showed a significant decrease in HDL-cholesterol levels during the study. Methemoglobinemia was associated with antimalarials uses, because the levels were similar to control group and increased significantly during the treatment. The levels of thiobarbituric acid reatives substances were associated with plasmodium and probably respiratory burst of macrophages, because they were higher than control group on D0, and no significant changes were observed after antimalarials usage. Total antioxidant capacity and oxidative stress levels were similar during the study as well as in the control group. The levels of reduced glutathione decreased significantly during the study and doesn’t be associated with both parasitaemia. Primaquine does not show a significant accumulation, and the concentrations of parent drug and its carboxyl metabolite were not associated with methemoglobinemia and thiobarbituric acid reatives substances levels.
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Marcadores de estresse oxidativo em pacientes com malária por Plasmodium vivax, durante o tratamento com primaquina e cloroquina
(Universidade Federal do Pará, 2012-07-02) MELLO, Amanda Gabryelle Nunes Cardoso; LIBONATI, Rosana Maria Feio; http://lattes.cnpq.br/3818175484709618; VIEIRA, José Luiz Fernandes; http://lattes.cnpq.br/2739079559531098
In Brazil, P. vivax accounts for the majority of malaria cases, totaling almost 90% of the records in the Amazonian states. Several studies aimed to understand the relationship of oxidative stress in patients infected with Plasmodium spp clinical and parasitological responses because the plays role deleterious or protective of reactive oxygen species and nitrogen generated by different mechanisms during infection is controversial in the pathogenesis of human malaria . However, no studies involving oxidative damage and antioxidant defenses of the host uncomplicated vivax malaria in the Amazon. Therefore, the aim of this study was to evaluate oxidative stress markers during the acute phase of malaria by P. vivax, characterizing pathways involving redox response of the human host and the influence of chemotherapy in order to test the hypothesis that biomarkers of oxidative stress are not changed during the acute phase of vivax malaria and uncomplicated introduction of chemotherapy does not contribute for oxidative stress in these subjects. It was conducted quantitative study longitudinal case consisting of 38 subjects with malaria by P. vivax adults of both gender, which were analyzed before, during and after the introduction of therapy (D0, D7 and D2), compared to control group of 15 healthy volunteers, matched for gender and age. Were determined by spectrophotometric techniques levels of methemoglobin, lipid peroxidation, total non-enzimatic antioxidant capacity, the activity of superoxide dismutase, erythrocyte levels of reduced glutathione and total glutathione in bloodstone. Compared to the control group, significantly, the levels of reduced glutathione (p = 0.004) was lower and lipid peroxidation (p <0.001) was higher, respectively. However, no significant changes were observed in the levels of methemoglobin, in total non-enzimatic antioxidant capacity and activity of superoxide dismutase compared to the control group. However, with the course of treatment were noted significant increase in the levels of methemoglobin (p <0.001) and superoxide dismutase activity (p = 0.038), but erythrocyte levels of reduced glutathione was reduced (p = 0.007). Furthermore, no significant changes in the levels of total non-enzimatic antioxidant capacity and glutathione in bloodstone with the introduction of antimalarials. The level of oxidative stress was not obtained, since there was no significant correlation between lipid peroxidation with the total non-enzimatic antioxidant capacity during all treatment. It was concluded that increased lipid peroxidation resulting from oxidative damage is opposed by the use of glutathione before the introduction of the therapy, suggesting the involvement of redox pathways in uncomplicated vivax malaria. The institution of chemotherapy, probably, interfered in intraerythrocyte redox cycle, which was characterized by a continuous increase in methemoglobin and the activity of superoxide dismutase, as well as by the reduction of the levels of reduced glutathione in erythrocytes.
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Metemoglobinemia em pacientes com malária por Plasmodium vivax em uso oral de primaquina
(2011-02) FERREIRA, Michelli Erica Souza; GOMES, Margarete do Socorro Mendonça; VIEIRA, José Luiz Fernandes
Primaquine can produce adverse reactions as toxicity to blood when used in the treatment of vivax malaria. This work aimed to determine methemoglobinemia in patients with vivax malaria receiving oral therapy with primaquine. Methods: Spectrophotometric quantification of methemoglobinemia and qualitative assay for glucose-6-phosphate dehydrogenase. Results: Methemoglobinemia ranged from 2.85 to 5.45% in male patients and 3.77 to 7.34% in female patients. Conclusions: A statistically significant increase in methemoglobinemia was observed following oral therapy with primaquine, with no clinical manifestations, and independent of sex and the qualitative expression of glucose-6-phosphate dehydrogenase.
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Nova proposta de tratamento para malária por Plasmodium vivax
(Universidade Federal do Pará, 1997) ABDON, Nagib Ponteira; SOUZA, José Maria de; http://lattes.cnpq.br/6459204248879587
Relapses that may occur with long standard treatment of vivax malaria might be in part due to an incomplete patient compliance. Therefore, the employment of short treatment schemes leading to a better patient compliance, and the same time having efficacy, tolerance and minimal or none adverse reactions is a matter of serious concern. In order to attain this objective, between july, 1994 to june, 1995, an open, comparative, prospective and randomized study was made in the attendance outpatient unit of Malaria Program of Evandro Chagas Institute, in Belem, Para State. Just patients aged up 12 years, from both sexes, which stayed in Belem during all the period control were enrolled. All patients were from Amazon Region, being the great majority of them from Para (85.8%). Autochthonous cases from the metropolitan area of Belem represented 39.2% of the sample. In this study, 120 patients were divided into 3 groups of 40 patients according to the following therapeutic schemes : Scheme I - chloroquine phosphate tablets with 150 mg of base substance in a total dose of 25 mg / kg / day for 3 days, that is, 10 mg / kg / day in the first day, 7.5 mg / kg / day in the second and third day, plus primaquine phosphate tablets with 15 mg of base substance in a dose of 0.25 mg / kg / day for 14 days. Scheme II - chloroquine phosphate tablets with 150 mg of base substance, 10 mg / kg in a single dose plus primaquine phosphate tablets with 15 mg of base substance in a dose of 0.50 mg / kg / day for 7 days. Scheme III - chloroquine phosphate tablets with 150 mg of base substance, 10 mg / kg in a single dose plus primaquine phosphate tablets with 15 mg of base substance in a dose of 0.50 mg / kg/ day for 5 days. Drugs were administered orally, under medical supervision to all outpatients.Clinical diagnosis was based upon history, epidemiology and physical examination of patients, while the laboratory finding of the hematozoa plasmodium in a thick blood film established the definitive malaria diagnosis. All 3 therapeutic schemes were effective, with a cure rate up to 80%. In the II therapeutic scheme, relapses were not observed. The disappearance of malarial symptoms occurred until 96 hours of treatment, while the assexual parasitaemie clearance occurred until 72 hours, considering all 3 therapeutic schemes. When present, adverse reactions were observed in a short period of time. Even in the cases of primaquine in double dose, there were no toxicity.
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Perfil lipídico e aspectos nutricionais de crianças e adolescentes com malária por Plasmodium vivax, no município de Anajás-PA
(Universidade Federal do Pará, 2017) DIAS, Rosa Maria; ANDRADE, Marcieni Ataide de; http://lattes.cnpq.br/8514584872100128; VIEIRA, José Luiz Fernandes; http://lattes.cnpq.br/2739079559531098
Objective: To evaluate the social-demographic and epidemiologic aspects of children and adolescents residents in the municipality of Anajás-PA, with P. vivax Malaria and to associate the lipid profile to the nutritional status, parasitemia and number of episodes of the disease. Methods: An observational, analytical-prospective study with children and adolescents aged 2-16, between January, 2014 and September, 2016. It was selected two groups of study: a) Cases (n=58): children and adolescents with a positive diagnosis to P. vivax and; b) Control (n=61): healthy children and adolescents without any history of Malaria and with two negative exam for Malaria. Social-demographic and anthropometric (weight, height) data were collected and it was carried out a clinical examination. The lipid profile (cholesterol and fractions, triglycerides) was determined in venous blood collected after 12 hours of fast. In the participants of the Case group, collection has occurred in three moments: D0 (day of diagnosis and admission to the study), D7 and D14 (post -treatment). Results: Most participants of the Case group was male (65,5%), whose mothers or legal tutors presented a maximum of four years of formal education, lived with minimum wage and had the government benefit program of “Bolsa Família”. The evaluation of the nutritional status pointed out a high percentage of linear growth deficits for children (25,0%), as well as for the adolescents (22,2%) in the Case group, when compared to the Control group (p<0.05). The BMI has indicated and adequacy of weight and height, independently from the group of study. It was not observed significant associations between the nutritional status (independently from the index used) with the history of Malaria, levels of parasitemia and clinical manifestations. The evaluation of the lipid profile has indicated that the Case group has presented the levels of total cholesterol and LDL-c in its wished limits and low level of HDL-C (p<0.05), when compared to the Control group. All participants presented hyper-triglyceridemia, independently from the group studied. Sex, age, parasitemia at admission and history of Malaria did not significantly influence the levels of serum lipids. It was observed significant alterations in the lipid levels in the cases follow up, characterized by the significant reduction (p<0.05) of the levels of triglycerides and VLDL between D0 and D14 and significant raise (p<0.05) of the total cholesterol, HDL and LDL-c. The serum levels of total cholesterol and LDL-c were similar at admission and D7. However, the levels of triglycerides and VLDL have quickly decreased so that they were similar between D7 and D14. Conclusion: Malaria has predominated in male children and adolescents with unfavorable socioeconomic conditions. The cases presented a high percentage of linear growth deficits, though it was with a low significance when compared to the Control group. There is a modification of the lipid profile in the acute phase of the disease.