Metals and arsenic distribution in stray dogs' tissues around a lead-zinc mine in Kabwe, Zambia.

Metal contamination poses a threat to human, animal, and environmental health. The purpose of the current study was to assess the accumulation of toxic and trace metal concentrations in tissues of stray dogs in Kabwe, a town known for lead pollution due to a long history of lead and zinc mining. Brain, spleen, heart, stomach, stomach content, small intestine, kidney, liver, and bone samples were collected from 29 stray dogs (14 from locations within 3 km of the mine and 15 from sites 7 km away from the mine) after necropsy. Inductively coupled plasma mass spectrometry was used to analyze toxic metals, arsenic (As), cadmium (Cd), and lead (Pb), and trace elements, copper (Cu) and zinc (Zn). The lungs (0.117 ± 0.114 mg/kg dry weight), kidney (7.515 ± 8.830 mg/kg dry weight), and bone (41.68 ± 66.83 mg/kg dry weight) were found to have the highest concentrations of As, Cd, and Pb, respectively. In contrast, higher Cu and Zn concentrations were measured in the liver than in other tissues. In all tissues analyzed, tissues sampled from dogs near the mine had significantly higher mean concentrations of Cd and Pb than dogs far away. Neither sex nor age-related differences were observed in the distribution of metals in most tissues. There were significant associations among toxic (Pb and Cd) and trace metals (Cu and Zn). In the kidney, Cd positively correlated with Pb (ρ = 0.534) and Zn (ρ = 0.600), whereas in the liver, Cu correlated with Zn (ρ = 0.565). The current study's findings suggest that environmental pollution is still a problem in Kabwe, and environmental remediation is needed to address the pollution.

Bacteremia in Malawian children with severe malaria: prevalence, etiology, HIV coinfection, and outcome.

BACKGROUND: Previous prospective studies of bacteremia in African children with severe malaria have mainly included children with cerebral malaria, and no study has examined the impact of human immunodeficiency virus (HIV) infection. We examined the prevalence and etiology of bacteremia and the impact of HIV infection on bacteremia in Malawian children with severe malaria, as well as the impact of bacteremia and HIV infection on outcome. METHODS: From 1996 until 2005, blood for culture was obtained on admission from all children admitted with severe malaria during the rainy season to the Paediatric Research Ward at the Queen Elizabeth Central Hospital in Blantyre, Malawi. HIV testing was performed prospectively from 2001 to 2005 and retrospectively for those admitted from 1996 to 2000. Multivariate regression analysis examined independent risk factors for bacteremia and death. RESULTS: Sixty-four (4.6%) of 1388 children with severe malaria had bacteremia; nontyphoidal Salmonellae (NTS) accounted for 58% of all bacteremias. The prevalence of any bacteremia and of NTS bacteremia was highest in children with severe malarial anemia (11.7% and 7.6%), compared with the prevalence in children with cerebral malaria and severe anemia (4.7% and 3.8%) and in those with cerebral malaria alone (3.0% and 0.9%). HIV infection status was determined in 1119 patients. HIV prevalence was 16% (and was highest in those with severe malaria anemia, at 20.4%), but HIV infection was not significantly associated with bacteremia. Neither bacteremia nor HIV infection was associated with death. CONCLUSIONS: Antibiotics are not routinely indicated for children with severe malaria in this region, in which HIV is endemic. However, antibiotic therapy should be used to treat NTS infection if bacteremia is suspected in children with severe malarial anemia.

Population pharmacokinetics of artesunate and dihydroartemisinin following intra-rectal dosing of artesunate in malaria patients.

BACKGROUND: Intra-rectal artesunate has been developed as a potentially life-saving treatment of severe malaria in rural village settings where administration of parenteral antimalarial drugs is not possible. We studied the population pharmacokinetics of intra-rectal artesunate and the relationship with parasitological responses in patients with moderately severe falciparum malaria. METHODS AND FINDINGS: Adults and children in Africa and Southeast Asia with moderately severe malaria were recruited in two Phase II studies (12 adults from Southeast Asia and 11 children from Africa) with intensive sampling protocols, and three Phase III studies (44 children from Southeast Asia, and 86 children and 26 adults from Africa) with sparse sampling. All patients received 10 mg/kg artesunate as a single intra-rectal dose of suppositories. Venous blood samples were taken during a period of 24 h following dosing. Plasma artesunate and dihydroartemisinin (DHA, the main biologically active metabolite) concentrations were measured by high-performance liquid chromatography with electrochemical detection. The pharmacokinetic properties of DHA were determined using nonlinear mixed-effects modelling. Artesunate is rapidly hydrolysed in vivo to DHA, and this contributes the majority of antimalarial activity. For DHA, a one-compartment model assuming complete conversion from artesunate and first-order appearance and elimination kinetics gave the best fit to the data. The mean population estimate of apparent clearance (CL/F) was 2.64 (l/kg/h) with 66% inter-individual variability. The apparent volume of distribution (V/F) was 2.75 (l/kg) with 96% inter-individual variability. The estimated DHA population mean elimination half-life was 43 min. Gender was associated with increased mean CL/F by 1.14 (95% CI: 0.36-1.92) (l/kg/h) for a male compared with a female, and weight was positively associated with V/F. Larger V/Fs were observed for the patients requiring early rescue treatment compared with the remainder, independent of any confounders. No associations between the parasitological responses and the posterior individual estimates of V/F, CL/F, and AUC0-6h were observed. CONCLUSIONS: The pharmacokinetic properties of DHA were affected only by gender and body weight. Patients with the lowest area under the DHA concentration curve did not have slower parasite clearance, suggesting that rectal artesunate is well absorbed in most patients with moderately severe malaria. However, a number of modelling assumptions were required due to the large intra- and inter-individual variability of the DHA concentrations.

The pattern of bacteraemia in children with severe malaria.

Bacteraemia is a recognised complication of severe malaria and may increase mortality. We determined 1) the rate and pattern of bacteraemia in children with severe malaria; 2) the impact of bacteraemia on case-fatality rate; and 3) the rate and pattern of bacteraemia in following blood transfusion for severe malarial anaemia. For the first two objectives, a prospective study was undertaken involving children admitted consecutively to the Malaria Research Project ward between February 1996 and June 1999. Blood culture was performed on admission. Independent associations with bacteraemia and mortality were determined by logistic regression. Of 701 children with a final diagnosis of severe malaria, 36 (5.1%) had bacteraemia. A wide range of bacteria was isolated and the commonest was non-typhoidal Salmonella (NTS: n=18 or 50% of all isolates). The rate of bacteraemia was significantly higher in children with severe malarial anaemia without coma (11.2%) than in children with cerebral malaria without anaemia (3.2%) and this was due to the significant association of NTS bacteraemia with severe malarial anaemia (p<0.001). The overall case-fatality rate was 15% and was higher in children with bacteraemia (22%) but this difference was not significant. For the third objective, data were collected retrospectively of all children who received a blood transfusion in the paediatric department from March 1996 until May 1997 inclusive. A total of 1712 children received a blood transfusion. Of these, 243 (14.2%) had a blood culture taken for the investigation of fever following transfusion; a pathogen was grown from 60 (24.7%). NTS bacteraemia accounted for 76.3% of all bacteraemia cases. NTS bacteraemia is a common complication of severe malarial anaemia.