Relationship between entomological inoculation rate, Plasmodium falciparum prevalence rate, and incidence of malaria attack in rural Gabon.

To assess the relationships between variations of Plasmodium falciparum transmission and those of peripheral parasitaemia prevalence or malaria attack incidence rates in regions with limited fluctuations of transmission, we conducted a follow-up in two Gabonese populations. Entomological surveys were carried out from May 1995 to April 1996 in Dienga, and from May 1998 to April 1999 in Benguia. In Dienga, malaria transmission was seasonal, being not detected during two 3-month periods. Mean entomological inoculation rate (EIR) was 0.28 infective bite/person/night. In Benguia, malaria transmission was perennial with seasonal fluctuations, mean EIR being 0.76 infective bite/person/night. In Dienga, 301 schoolchildren were followed from October 1995 to March 1996. Clinical malaria attack was defined as fever associated with >5000 parasites/microl of blood. P. falciparum prevalence varied from 28 to 42%, and monthly malaria attack incidence from 30 to 169 per thousand. In Benguia, the entire population (122 persons) was followed from November 1998 to April 1999. Prevalence varied from 22 to 50%, and monthly malaria attack incidence from 52 to 179 per thousand. In each area, entomological variations were not related to parasite prevalence, but preceded malaria attack incidence with 1- or 2-month time lag, corresponding to the pre-patency period that differs in the two populations, possibly according to differences in immunity related to parasite transmission.

Allelic family-specific humoral responses to merozoite surface protein 2 (MSP2) in Gabonese residents with Plasmodium falciparum infections.

Merozoite surface protein 2 (MSP2) expressed by Plasmodium falciparum asexual blood stages has been identified as a promising vaccine candidate. In order to explore allelic family-specific humoral responses which may be responsible for parasite neutralization during natural infections, isolates from individuals with either asymptomatic infections or uncomplicated malaria and residing in a Central African area where Plasmodium transmission is high and perennial, were analysed using MSP2 as polymorphic marker. The family-specific antibody responses were assessed by ELISA using MSP2 synthetic peptides. We observed an age-dependence of P. falciparum infection complexity. The decrease of infection complexity around 15 years of age was observed simultaneously with an increase in the mean number of MSP2 variants recognized. No significant difference in the P. falciparum genetic diversity and infection complexity was found in isolates from asymptomatic subjects and patients with uncomplicated malaria. The longitudinal follow-up showed a rapid development of immune responses to various regions of MSP2 variants within one week. Comparing humoral responses obtained with the other major antigen on the merozoite surface, MSP1, our findings suggest that different pathways of responsiveness are involved in antibody production to merozoite surface antigens.

Molecular analysis of DHFR and DHPS genes in P. falciparum clinical isolates from the Haut--Ogooué region in Gabon.

The main objective of this work was to determine the prevalence of mutations in genes coding for the dihydropteroate synthase (DHPS) and the dihydrofolate reductase (DHFR) enzymes which are implicated in resistance of P. falciparum to antifolate (pyrimethamine-sulfadoxine (P/S)). In this study, 117 human blood samples were collected at Franceville located in the region of Haut-Ogooué (South-eastern Gabon). In this area, a relatively low level of sensitivity of Plasmodium falciparum to P/S has been reported with 18.2% of RII and 12.1% of RI resistance. A nested polymerase chain reaction was used to amplify a fragment of the DHFR gene containing codon 108, where a point mutation causing a Serine (wild type) to Asparagine or to a Threonine (resistant types) change occurs in pyrimethamine resistant parasites. Eleven DHFR fragments were sequenced and mutations occurring at codons 51, 59 and 108 were analysed. The DHPS gene was amplified by polymerase chain reaction (PCR) and sequenced directly or after cloning. Variant amino acid residues 436, 437, 540, 581, 613 associated with sulfadoxine resistance were analysed. The analysis of codon 108 of the DHFR gene was undertaken for 81 isolates. More than one DHFR P. falciparum genotype was present in 64% of the samples. We showed that 47% of 141 DHFR gene PCR products had Serine (wild phenotype), and 52% had Asparagine. We found one isolate with the Thr-108 confirmed by sequencing of the PCR product. Triple, double and single DHFR mutant at positions 51, 59 and 108 were found. Only codons 436 and 437 of the 38 analysed sequences of the DHPS gene revealed point mutations. These results have been compared with those reported from different sites in Africa, Asia or South-America.

[No influence of season of transmission nor age of patients on the complexity and genetic diversity of Plasmodium falciparum infection in Cotonou, Benin]. / Pas d'influence de la saison de transmission ni de l'âge des patients sur la complexité et la diversité génétique des infections dues a Plasmodium falciparum à Cotonou (Bénin).

The aim of the present study was to determine the genetic diversity and allelic frequencies of the genes encoding for the merozoite surface protein-1 (MSP-1) and protein-2 (MSP-2) of P. falciparum collected from Beninese patients during the high and low transmission seasons in Cotonou, in South Benin. Sixty and twenty-four patients were sampled during the dry and wet seasons, respectively Parasite DNA was analysed using allele-specific primers to amplify block2 of MSP-1 and central variable region of MSP-2. A total of 12 (K1, Mad20, Ro33) MSP-1 and 23 (3D7, FC27 and hybrids) MSP-2 alleles were detected. Neither age nor transmission season modified the genetic diversity of P. falciparum nor the distribution of MSP-1 and MSP-2 alleles. Combining the results of MSP-1 and MSP-2 genotyping, multiple P. falciparum infections were observed in 57% and 70% of isolates during the wet and dry seasons, respectively. The complexity of infections defined as the number of parasite genotype per isolate was 2.4 and it was not affected either by the season or by the age of the host. We conclude that change of season did not influence the permanent turn-over of parasites and the complexity of infections. Data obtained here will serve as a baseline for future studies, such as the impact of malaria control measures on parasite populations, to be conducted in Cotonou.

No influence of the transmission season on genetic diversity and complexity of infections in Plasmodium falciparum isolates from Benin.

The principal goals of the present study were to determine the genetic diversity of the merozoite surface protein-1 (MSP-1) and protein-2 (MSP-2) genes and the complexity of infections in P. falciparum isolates collected from Beninese patients during high and low transmission season at Cotonou, in South Benin. Sixty and twenty-four patients were sampled during dry and wet season respectively. Parasite DNA was analysed using allele-specific primers to amplify block 2 of MSP-1 and central variable region of MSP-2 genes. A total of 12 (K1, Mad20, Ro33) MSP-1 and 13 (3D7 and FC27) MSP-2 alleles were detected in overall samples. Neither influence of age nor transmission season was observed in the genetic diversity of parasites and in the distribution ofMSP-1 and MSP-2 alleles. Combining the results of MSP-1 and MSP-2 genotyping, we observed 57% and 70% of multiple infections during dry and wet season respectively. The complexity of infections 2.4 fragments/individual was not affected either by the season or by the age of the host. We speculate that in an area with perennial transmission, change of season did not influence the permanent turn-over of parasites and the number of parasite genotype per person. Data obtained here will be serve as a baseline for future studies which will carried out at Cotonou to analyse the impact of any malaria control measures on parasite populations.

Sulfadoxine-pyrimethamine for the treatment of Plasmodium falciparum malaria in Gabonese children.

Chloroquine can no longer be recommended as the first-line treatment for falciparum malaria in several parts of Africa, given the increasing resistance of Plasmodium falciparum to this drug. The sulfadoxine-pyrimethamine combination (SP) is obviously an alternative candidate, that has already been selected as first-line antimalarial treatment by a few African countries. However, the extent of resistance to SP appears to be highly variable within Africa. Therefore, we investigated the efficacy of SP to treat uncomplicated malaria attacks in children from south-east Gabon. Sixty-six children presenting with a P. falciparum malaria attack were given a standard regimen of SP, and were followed at Days 3, 7, 14, and 21. No RIII response was observed, but relatively high prevalences of RII (18.2%) and RI (12.1%) were present. Moreover, analysis of the clinical outcome according to CDC criteria showed that initial clinical response was lacking in 8.5% of children, and that clinical failure occurred in 9.1%.

[Evaluation of a simple and rapid method of Plasmodium falciparum DNA extraction using thick blood smears from Gabonese patients]. / Evaluation d'une méthode simple et rapide d'extraction de l'ADN de Plasmodium falciparum à partir de gouttes épaisses de patients gabonais.

In field-based studies, sometimes it is difficult to collect and store samples. We have evaluated a method of malaria parasite deoxyribonucleic (DNA) extraction from non-stained thick dried blood smears collected from 108 Gabonese patients. This method of DNA isolation was compared to those using phenol/chloroform. Patients parasitemia ranged from 0 to 240,000 parasites/microliter of blood. Both methods of DNA preparation gave similar results. Of the 108 slides, 57% were Plasmodium falciparum positive after PCR analysis of the MSA-2 gene and 34% were positive by microscopical examination. Thirty-six and seventy-two blood smears from patients were also tested after one and four weeks' storage respectively, at room temperature, and the parasite DNA was successfully extracted. We conclude that this simple method of collection and rapid procedure of parasite DNA isolation are adequate and convenient in the field when a large number of samples are required and in the case of repetitive samplings of patients.

Site-based study on polymorphism of Plasmodium falciparum MSP-1 and MSP-2 genes in isolates from two villages in Central Africa.

We investigated Plasmodium falciparum genetic diversity in isolates collected from school-going residents aged from 5 to 15 years in the village of Pouma (Cameroon, Central Africa). Seventy-six children were grouped according to the clinical status. Asymptomatic status was defined as parasite carriage in the absence of any clinical symptom and malaria symptomatic status with patent parasitemia over 5000 parasites/microliter of blood and an axillary temperature > 37.5 degrees C. Parasite DNA was analysed prior to malaria treatment. Genotyping of the P. falciparum merozoite surface proteins (MSP) 1 and 2 was performed by polymerase chain reaction using allele-specific primers. K1, MAD20, Ro33 and 3D7/CAMP, FC27 allelic families were attributed to MSP-1 and MSP-2 genes, respectively. No association was found between P. falciparum MSP-1 and MSP-2 genotypes and the clinical status of children. Mixed P. falciparum infections were detected in 78% of overall samples and all isolates from symptomatic children contained more than 1 clone. The results obtained in the village of Pouma were compared to those of the village of Dienga in Gabon where a similar study, using the same genotyping methods, had been carried out in the same age group of schoolchildren. Data are interpreted in the context of malaria epidemiology in both settings.

Therapeutic efficacy of clindamycin in combination with quinine for treating uncomplicated malaria in a village dispensary in Gabon.

The efficacy of a 3-day clindamycin-quinine regimen to treat clinical malaria attacks was investigated in 256 children from western Gabon. Treatment was well tolerated by all of the children and its efficacy was higher than 97% by day 20. Thus this 3-day clindamycin-quinine regimen might constitute a potential alternative to chloroquine for treating clinical malarial attacks in children from Gabon.

Immunologic responses to soluble exoantigens of Plasmodium falciparum in Gabonese children exposed to continuous intense infection.

The development of antidisease immunity in children infected with Plasmodium falciparum is thought to be related to their immunologic responses to certain soluble parasite-derived exoantigens. We have assessed both cellular and humoral responses to these antigens in a cross-sectional study of a cohort of Gabonese schoolchildren who live in an area where malaria is holoendemic and perenially transmitted, in an attempt to identify immunologic markers of this early developing protective immunity. Concurrent parasitemia was found to have a significant influence on lymphoproliferative and antibody responses to the exoantigens. Individuals with higher levels of parasitemia had significantly lower proliferative and IgG isotype responses. Higher concentrations of specific IgG1 and IgG3, in particular, were associated with lower or no parasitemia, suggesting a possible protective role for these isotypes, whereas the level of IgM antibodies showed a trend towards higher concentrations in those with parasitemia, perhaps indicative of an exoantigen-induced T cell-independent response. Cytokine responses were unaffected by either the presence or the intensity of parasitemia and were dissociated from both proliferative and antibody response to the exoantigens. However, the mitogen-stimulated production of tumor-necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL)-6 was positively correlated with the corresponding lymphoproliferative responses. At the individual level, mitogen-stimulated TNF-alpha, interferon-gamma, IL-2, and IL-6 responses were positively correlated, as were mitogen- and exoantigen-induced TNF-alpha. The results are discussed in the light of current knowledge of immune responses to the exoantigens and the development of protective immunity to P. falciparum.