Plasmodium falciparum Containment Strategy

World Health Organization (WHO) estimates 1.7-2.5 million deaths and 300-500 million cases of malaria each year globally. As an initiative WHO has announced Roll Back Malaria (RBM) programme aimed at 50% reduction in deaths due to malaria by 2010. The RBM strategy recommends combination approach with prevention, care, creating sustainable demand for insecticide treated nets (ITNs) and efficacious antimalarials in order to achieve sustainable malaria control. Malaria control in India has travelled a long way from National Malaria Control Programme launched in 1953 to National Vector Borne Diseases Control Programme in 2003. In India, the malaria eradication concept was based on indoor residual spraying to interrupt transmission and mop up cases by vigilance. This programme was successful in reducing the malaria cases from 75 million in 1953 to 2 million but subsequently resulted in vector and parasite resistance as well as increase in P falciparum from 30-48%. In view of rapidly growing resistance of Plasmodium falciparum to conventional monotherapies and its spread in newer areas, the programme was modified with inclusion of RBM interventions and revision of treatment guidelines for malaria. Early case detection and prompt treatment, selective vector control, promotion of personal protective measures including ITNs and information, education, communication to achieve wider community participation will be the key interventions in the revised programme.Key Words: Roll Back Malaria, Malaria in India, Plasmodium falciparum containment     

抗恶性疟McAb的筛选与恶性疟免疫诊断研究

用单克隆抗体(McAb)夹心斑点免疫金银染色法(Dot-IGSSA)对11株抗恶性疟McAbs和4株抗食蟹猴疟原虫McAbs进行了筛选,其中McAbs11G5、13A2、13A1可包被到硝酸纤维素膜(NcF)上作为捕获抗体,McAb14D9可用于胶体金探针的标记。此外,为增加胶体金的标记效果和胶体金标记McAb14D9探针的敏感性,还对McAb14D9的等电点(pI)进行了测定,其pI为6.35。同时用筛选出的最佳McAbs对10份恶性疟病人感染血和10份健康人血样品进行了检测,并对这几株McAbs的交叉反应性进行了测定,结果表明McAbs11G5、13A1与14D9夹心时,对云南株和安微株恶性疟原虫红内期抗原呈现交叉反应,而且McAb13A1与14D9夹心时还可以用于检测间日疟抗原。     

Chloroquine-resistant Plasmodium falciparum malaria in Vanuatu

Cases of malaria caused by Plasmodium falciparum resistant to chloroquine treatment have been probably occurring in Vanuatu for many years. In this survey, seven patients with P. falciparum malaria were investigated for evidence of resistance to chloroquine. In-vitro resistance to chloroquine was demonstrated in four. Two further patients who had clinical resistance to chloroquine treatment developed cerebral malaria. It is of interest that one of these patients was subsequently successfully treated with mepacrine. Two additional cases are cited as examples of resistance to chloroquine treatment encountered in the past.     

Subarachnoid haemorrhage in Plasmodium falciparum malaria

A 41 year old man with cerebral malaria was found to have numerous bilateral retinal haemorrhages and very high parasitaemia. Despite intensive treatment his condition deteriorated and he died. Autopsy showed subarachnoid haemorrhage, which has not been previously described in cerebral malaria.     

恶性疟危重病例抢救治疗1例

在非洲加纳感染恶性疟病例回国后发病,患者以全身黄疸表现为主,就诊24h后出现意识障碍,几天的体温观察中均在37.8℃左右,血内原虫密度不高,血小板数值降低。经用青蒿琥酯注射液抢救治疗12h后患者清醒,24h后血内未查见疟原虫,血小板数值恢复正常。     

45例重症恶性疟疾临床分析

目的探讨重症恶性疟疾的临床特点及防治.方法对45例病例的临床资料进行回顾性分析. 结果45例均为外来人口恶性疟疾,以脑型疟居多,占62.2%;黑尿热、妊娠疟疾等分别占13.3%和6.7%.严重并发症是急性肾功能衰竭、呼衰、多器官功能衰竭和冠心痛,经抗疟治疗和辅助治疗后死亡4例,治愈41例,治愈率为91.1%.结论恶性疟痰危重病症原虫治疗是根本措施,及时识别和合理治疗并发症是关键,加强对流动人口疟疾管理,预防为主要手段.     

Guillain-Barr�� syndrome in Plasmodium falciparum malaria.

A patient with Plasmodium falciparum malaria developed peripheral neuropathy. Clinical, cerebro-spinal fluid examination and nerve conduction studies confirmed Guillain-Barré syndrome, not previously reported in P. falciparum malaria.     

恶性疟原虫青蒿素抗疟药抗性研究进展

疟疾是由疟原虫感染引起的一种传染病,是全球最重要的公共卫生问题之一。世界卫生组织（WHO）推荐以青蒿素为基础的联合疗法（artemisinin-based combination therapies, ACTs）作为疟疾流行地区的非复杂性恶性疟的一线治疗。青蒿素及其衍生物的应用在降低全球疟疾发病率方面发挥了不可或缺的作用。但近年来,青蒿素类药物抗性的出现与扩散使全球疟疾的控制与消除面临巨大挑战。目前,与青蒿素抗药性关系最为密切的是恶性疟原虫第13号染色体上K13基因的突变,但近些年不断有研究表明K13并不能解释所有的青蒿素抗性。本文综述近年来恶性疟原虫对青蒿素产生抗性研究领域的相关研究进展,包括青蒿素抗药性的定义、检测方法、抗性相关的分子标记等。此外,本文所讨论的某些问题仍存在争议,还需深入研究。     

用长距PCR法构建恶性疟原虫cDNA表达文库

目的 构建恶性疟原虫cDNA表达库。方法用Trizol试剂盒提取总RNA，以经修饰的SMART寡聚核昔酸引物－CDSⅢ引物直接用总RNA选择性地反转录成单链cDNA，再用长距PCR(LD)方法选择性地扩增出双链cDNA，经蛋白酶K消化和酶切后，用玻璃奶试剂盒回收200bp以上DNA片断，经与载体λTeiplEX2连接和蛋白抽提物体外包装，构建成cDNA库并对库进行了初步的鉴定。结果 构建了高滴度，高重组率的恶性疟原虫cDNA表达库。结论 所构建的疟原虫cDNA库适合进一步筛选抗疟原虫药物结合蛋白基因。     

恶性疟原虫体外抑制实验方法的改进

以恶性疟原虫融合抗原PfCP-2.9免疫兔血清为待测血清,将起始原虫率从1%降至0.2%～0.5%,采用2种方法作对比,即一组每24 h更换培养液、加入免疫血清,另一组72 h内不更换培养液也不加免疫血清试验方法.培养至72 h,涂片,油镜下计数,计算原虫感染率和抑制率.结果2组的抑制率相近,经统计分析无显著差异.测定不同剂量抗原免疫血清的抑制率,结果显示抑制率与免疫血清中特异抗体滴度呈正相关,2种方法的结果无显著差异.研究表明通过降低起始原虫率可将常规体外抑制实验由需每天换液改为72 h不换液.     

恶性疟原虫var基因相关研究新进展

本文通过对恶性疟原虫变异抗原基因var基因家族的相关变异机制,在7号染色体var基因区域(pfemp1)和抗药基因pfcrt的特定区域的相关研究报道,以及变异var基因与妊娠感染疟疾的相关致病机制进行综述。     

恶性疟原虫谷氨酸脱氢酶的表达及免疫活性鉴定

目的在大肠杆菌中表达恶性疟原虫谷氨酸脱氢酶(GDH)与谷胱甘肽S-转移酶融合蛋白,测定重组蛋白的免疫活性。方法采用PCR方法特异性扩增恶性疟原虫(海南株)GDH基因,双酶切后克隆入pGEX-4T-1载体中进行诱导表达,重组蛋白纯化后免疫小鼠制备特异性血清,并用琼脂双向扩散法检测效价,ELISA、Western blotting检测重组抗原的免疫活性。结果获到了重组表达的抗原蛋白,表达产物能与鼠抗恶性疟原虫血清发生特异反应,并能诱导小鼠产生特异性体液免疫应答,免疫琼脂扩散法检测抗体滴度为1∶16。结论恶性疟原虫GDH在大肠杆菌中获得高效表达且表达产物具有良好的抗原性。     

恶性疟原虫红内期体外同步化培养实验观察

本文定时观察了用秋水仙碱处理体外培养恶性疟原虫后的红细胞感染率及环状体、大滋养体和裂殖体各期的比例,并与用山梨醇处理进行了比较。结果发现,秋水仙碱处理后疟原虫可维持2～3个生物周期的同步化发育,并且处理后的红细胞感染率可在14％以上。山梨醇处理后疟原虫可维持2个生物周期的同步化发育,最高红细胞感染率为7.7％。