Used malaria test kits help trace drug resistance malaria too

SciDev.Net reports on a study that shows malaria rapid test kits could be used to assess resistance to antimalarials.

The WHO recommends that countries evaluate the effectiveness of medicines for treating malaria — called artemisinin combination therapy — every two to three years but logistical issues threaten the achievement of this goal in Sub-Saharan Africa, forcing experts to consider other strategies to complement such effectiveness studies.

“We wanted to explore the possibility of systematically collecting rapid diagnostic tests after diagnosis and then using them for routine screening for mutations [changes in the structure of genes] in the parasites that cause resistance to antimalarials,” says Sidsel Nag, lead author of the study and a biologist at the Department of Immunology and Microbiology, University of Copenhagen, Denmark.

According to the study published in the Malaria Journal in July 2019, researchers sampled 2,184 rapid diagnostic tests that had tested positive for malaria between May 2014 and April 2017 in a health centre in Bissau, Guinea-Bissau. The 1,390 kits that were found to be positive for the genetic make-up of malaria-causing parasites were further analysed for evidence that could predict the presence of antimalarial resistance. 

Simon Kariuki, head of the malaria programme at the Kenya Medical Research Institute’s Centre for Global Health Research, says instead of collecting blood samples from people during surveys, which can be expensive, this study shows that you can use rapid diagnostic tests.

august 14, 2019

A drug-resistant strain of malaria is making the disease ‘almost untreatable’ in southeast Asia

The Washington Post reports on two recent studies which have found that the presence of drug-resistant strains of malaria is on the rise in southeast Asia. The research has provoked alarm among scientists who are leading the fight against one of the world’s most stubborn health problems. The disease is “getting close to being untreatable,” said Arjen Dondorp a lead author of one of the studies and the head of malaria research at the Mahidol-Oxford Tropical Medicine Research Unit in Thailand. The studies, published in the Lancet journal of infectious diseases found that resistance to the most common form of anti-malarial drugs has spread and gotten worse since 2013.

There are several drug combinations out there that could still treat the resistant strains. But the treatments themselves can breed more resistance. “The problem with malaria is that the treatment options are very limited,” Dondorp said. “Once you can’t treat the infections very well, malaria will increase again, and once the number increases, the number of deaths will increase.”

Why is this happening in southeast Asia? Patients with malaria may take weaker medication, or stop taking pills once they feel better instead of finishing out the treatment, making the parasites more resistant to the drugs.

What would happen if this resistance were to spread? A major concern is that the strains will spread to sub-Saharan Africa, where malaria is most common and logistically hard to treat. “We really have a great sense of urgency to eliminate malaria from the region,” said Dondorp, “otherwise we will never be able to eliminate malaria. It will come back and spread to other countries.”

august 1, 2019

First Ebola case in Congo city of Goma detected

Reuters reports that the first case of Ebola in the eastern Congo city of Goma was discovered on July 14th, raising concerns the virus could spread quicker in a densely populated area close to the Rwandan border.

Goma, a lakeside city of 1 million people, is more than 350 km (220 miles) south of where the second-largest Ebola outbreak on record was first detected a year ago. But the hemorrhagic fever has gradually spread south, infecting nearly 2,500 people and killing more than 1,600. The patient was a priest who became infected during a visit to the town of Butembo, 200 km (124 miles) north of Goma, where he interacted with Ebola patients, Congo’s health ministry said in a statement. He developed symptoms last week before taking a bus to Goma on Friday. When he arrived in Goma on Sunday he went to a clinic where he tested positive for Ebola.

“Due to the speed with which the patient has been identified and isolated, as well as the identification of all bus passengers from Butembo, the risk of spreading to the rest of the city of Goma remains low,” the ministry said. Goma has been preparing for the arrival of Ebola for a year, setting up hand-washing stations and making sure mototaxi drivers do not share helmets.

But in more rural areas, the virus has been hard to contain. Local mistrust of health officials and militia violence have hobbled containment efforts and caused the number of new cases to spike.

july 16, 2019

Worryingly High’ Number of People Infected with Latent Form of Drug Resistant TB

More than 19 million people around the globe are infected with one of the most complex forms of dormant tuberculosis, reports The Guardian.

In the first study to estimate the number of people living with latent multi-drug resistant tuberculosis (MDR-TB), published in Lancet Infectious Diseases, experts found that three people in every 1,000 carry the hard-to-treat bacteria – a “worryingly high” figure that “threatens elimination goals”. TB is one of the deadliest diseases in the world, killing roughly 1.7 million people and infecting 10 million every year. 

But almost a quarter of the world’s population is unwittingly living with the latent form of the disease – meaning the bacteria are lying inactive inside their body, with the potential to trigger symptoms at any time. Eradicating latent TB is central to efforts to control the ancient illness, as between five and 10 per cent of those with the dormant infection go on to develop active symptoms.“Latent TB is a significant reservoir of disease,” Dr Gwen Knight, assistant professor at the London School of Hygiene and Tropical Medicine and lead author of the report, told The Telegraph.“Our research suggests that in the future the level of latent MDR-TB will rise, which could overwhelm our targets to control TB and is only going to make this disease a bigger threat on the world stage," she said. 

july 8, 2019

June 27, 2019

Australian man appears to have cleared his HIV infection

Researchers in Sydney, Australia have identified a patient who appears to have spontaneously cleared his own HIV infection without any medication, many years after he was first infected, reports aidsmap. However “Subject C135”, as the patient is called, appears to have a unique combination of fortunate circumstances that only serve to show how difficult it is to eliminate HIV infection once it is established. Subject C135 was infected in 1981, aged 34, when he needed a blood transfusion after a car accident. Now 72, he belongs to a group of eight people who were all infected by the same donor; these, plus the donor, form a group called the Sydney Blood Bank Cohort (SBBC).

The researchers warn that we do not yet know if the same characteristics could be re-created in other people with HIV by artificial means such as genetic engineering and vaccines. A very specific chain of characteristics had to come together and act sequentially to ensure that the immune response to what was already a weakened virus in one person’s system was strong, specific and fast enough to do what has never been seen before: enable someone to spontaneously clear all the HIV from his body, without the need for medicine.

“However, C135’s case does offer us something that the case of Timothy Ray Brown also did in 2008: a proof of concept. It shows that circumstances can arise, however rarely, which allow for a spontaneous cure or profound remission of HIV – and the proof that it can happen is what spurs cure researchers on to make it happen more often.

Ebola in headline news

This week, we heard that the DRC Ebola outbreak is still not officially a global emergency. The World Health Organization says the outbreak does not meet the criteria for a public health emergency of international concern. This is despite the fact that cases have been confirmed in neighbouring Uganda. A suspected case was also reported in Kenya on Monday, 17th June.

Al Jazeera reports that the virus has killed more than 1,400 people in DRC since its outbreak - the second-deadliest in history.  To be declared a global emergency, an outbreak must constitute a risk to other countries and require a coordinated response. The declaration typically triggers more funding and political attention.

On Thursday, the WHO acknowledged that it had been unable to track the origins of nearly half of new Ebola cases in the DRC, suggesting it did not know where the virus was spreading. Opinion is divided on whether the declaration of a global emergency helps or harms. The New York Times reports on the ways in which a global emergency backfires for the regional economy, as border crossing and flights become severely restricted under those conditions.

June 17, 2019

Global concern over first Ebola case in Uganda, in Spillover from Congo

A 5-year-old Congolese boy who traveled with his family into Uganda has received a diagnosis of Ebola, international health officials said Tuesday — the first confirmed case of the highly contagious disease outside the Democratic Republic of Congo since an outbreak began there a year ago.

According to The New York Times, the case, reported by the World Health Organization, appeared to have been caught soon after the child entered Ugandan territory. Nonetheless, it represented a new threat that the Congo outbreak had crossed into a neighboring country.

June 12, 2019

GM Fungus: a Malaria Breakthrough

SciDevNet reports that a fungus genetically engineered to produce spider toxin can crush populations of malaria-spreading mosquitoes. This is according to a breakthrough study by international scientists battling to combat malaria. In trials undertaken in Burkina Faso, mosquito numbers were reduced by 99 per cent within 45 days, according to researchers from the University of Maryland (UMD) and the West African nation’s IRSS (Institute of Research in Health Sciences in English) research institute.

Malaria is a life-threatening disease spread by the female Anopheles mosquito. In 2017, there were an estimated 219 million cases worldwide, claiming 435,000 lives, according to the World Health Organization. The vast majority of cases are in Africa.“No transgenic malaria control has come this far down the road toward actual field testing. This paper marks a big step and sets a precedent for this and other transgenic methods to move forward.” - Brian Lovett, lead author of the paper, University of Maryland’s entomology department. Researchers took a strain of the fungus Metarhizium pingshaense, which infects mosquitoes in the wild, and genetically modified it to produce a toxin found in the venom of the Australian Blue Mountains funnel-web spider. Laboratory trials showed the genetically modified fungus killed mosquitoes more rapidly than they can breed, according to the study.

The insecticide was then unleashed in a purpose-built 6,550-square-foot ‘village’ in Burkina Faso, containing huts, plants, and breeding pools, and covered in netting to stop the insects escaping. Colin Sutherland, co-director of the Malaria Centre at the UK-based London School of Hygiene and Tropical Medicine, said the results were “very promising”.

“Current mainstay methods for Anopheles control target mosquitoes resting or biting indoors and rely on synthetic chemical insecticides. This new biocidal approach targets mosquitoes biting and resting outdoors as well as indoors, and may be less vulnerable to the problem of insecticide resistance,” he said in a press statement.

June 4, 2019

An increase in mumps reported

The BBC reports a sharp increase in cases of mumps this year in England. Mumps is more serious and more painful the older you are. Headaches, fever and ear pain often accompany the swelling.

Before the MMR vaccine - the second M stands for mumps - was introduced in the UK in 1988, eight out of 10 people developed mumps and most of them were children of school age.

At that time there were five deaths a year from mumps, mainly due to encephalitis or swelling of the brain.

"The mumps vaccine is not as effective as other bits of MMR, which is why it's important to have two doses," says Prof. Helen Bedford, from the Royal College of Pediatrics and Child Health.

The WHO has identified “vaccine hesitancy” as a major public health threat. Non-vaccination affects the individual who is not vaccinated, all those in contact with the individual, and pretty quickly has global impacts. Mumps is easily spread, through saliva or droplets in a cough or sneeze – another reminder about the importance of vaccination.

"Mumps can make children feel very unwell and stay in bed for days. It's not nothing. Perhaps we've lost sight of what these illnesses are really like," she says.

may 28, 2019

Tuberculosis Makes A Dangerous Return to Paris

RFI reports on a study released by the French public health authorities, which shows an overall increase in the number of cases of tuberculosis since 2016, particularly in the north Parisian region of Seine-Saint-Denis. Does this mean the disease, often associated with the first half of the 20th century and earlier, is making a comeback?

“I wouldn’t say we should be worried,” smiles Giulia Manina, who heads a research group studying microbial individuality and infection with a focus on tuberculosis at the Pasteur Institute in Paris. But she adds that awareness is key and while Paris has a higher incidence due to “globalisation, migration fluxes . . . it is not the only reason for the re-emergence of tuberculosis”. Although considered a disease of the past, tuberculosis has never left us. The mainly pulmonary (or lung) disease can spread to other organs such as the brain or the bones. And because it is typically in the lungs, “it can spread easily” explains Manina. If a person has an active infection, as opposed to one that is still dormant, he or she can infect a lot of other people. “For instance, it is estimated that one person can infect up to ten others with a cough” adds the scientist, explaining the infectiousness of the disease, especially in high-density areas.

May 15, 2019