P A Kager

Publications (126)362.86 Total impact

• Article: Cutaneous leishmaniasis in three Dutch military cohorts following jungle training in Belize.

  P P A M van Thiel, J E Zeegelaar, T van Gool, W R Faber, P A Kager
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  ABSTRACT: Skin lesions occur frequently in travelers to tropical countries. Military personnel acquire skin lesions regularly during jungle training as did Dutch troops who trained in the jungle of Belize in 1998, 2004 and 2009, in an area endemic for cutaneous leishmaniasis. Demographic and clinical data were collected retrospectively. Diagnostic investigations for cutaneous leishmaniasis included Giemsa stain, culture, PCR and NASBA and histopathology of biopsies. Treatment of leishmaniasis was with sodium stibogluconate, given intravenously or intralesionally, the latter with cryotherapy. In 1998 and 2004 cutaneous leishmaniasis due to Leishmania braziliensis and Leishmania mexicana infection was diagnosed in 25 persons out of 99 (attack rate 25.2%) and 14 persons out of 80 (attack rate 17.5%) respectively. In 2009 cutaneous leishmaniasis was not acquired. Skin problems were common during and after jungle training. Cutaneous leishmaniasis was important in the first two cohorts but not observed in the third cohort. Factors that could have played a role in the absence of cutaneous leishmaniasis in the third cohort include variability in transmission and availability of better preventive measures and adherence to these. Sodium stibogluconate treatment, intralesional or intravenous, was effective.
  Travel Medicine and Infectious Disease 03/2011; 9(3):153-60. · 1.50 Impact Factor
• Source

  Available from: mahidol.ac.th

  Article: Viral respiratory tract infections among patients with acute undifferentiated fever in Vietnam.

  Hoang Lan Phuong, Tran T T Nga, Gerard J van Doornum, Jan Groen, Tran Q Binh, Phan T Giao, Le Q Hung, Nguyen V Nams, P A Kager, Peter J de Vries
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  ABSTRACT: To investigate the proportion of viral respiratory tract infections among acute undifferentiated fevers (AUFs) at primary health facilities in southern Vietnam during 2001-2005, patients with AUF not caused by malaria were enrolled at twelve primary health facilities and a clinic for malaria control program. Serum was collected on first presentation (t0) and after 3 weeks (t3) for serology. After exclusion of acute dengue infection, acute and convalescent serum samples from 606 patients were using enzyme-linked immunoassays to detect IgA, as well as IgM and IgG antibodies against common respiratory viruses. Paired sera showed the following infections: human parainfluenza virus (HPIV, 4.7%), influenza B virus (FLUBV, 2.2%), influenza A virus (FLUAV, 1.9%) and human respiratory syncytial virus (HRSV, 0.6%). There was no association between type of infection and age, sex or seasonality; some inter-annual differences were observed for influenza. Antibody prevalence, indicative of previous infections, was relatively low: HPV, 56.8%, FLUBV, 12.1%; FLUAV, 5.9% and HRSV, 6.8%.
  The Southeast Asian journal of tropical medicine and public health 09/2010; 41(5):1116-26. · 0.60 Impact Factor
• Article: Visceral leishmaniasis in Aba-Roba, south-western Ethiopia: prevalence and incidence of active and subclinical infections.

  A Hailu, M Gramiccia, P A Kager
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  ABSTRACT: Between August 1997 and February 2005, a prospective study of human visceral leishmaniasis (VL) was undertaken in two villages in the Konso district of south-western Ethiopia, to provide epidemiological indices of subclinical infection and active VL. Six cross-sectional surveys at 6-month intervals (ending in August 2000) were complemented by a single survey in February 2005. The prevalences and incidences of leishmanial infection and active VL, which were determined using leishmanin skin tests (LST), direct agglutination tests (DAT) and parasitological diagnosis, varied spatio-temporally and by age and gender. At baseline, when 1339 individuals were investigated, the overall prevalences of LST positivity, DAT positivity and active VL among the 1232 subjects who had not been treated previously were 30.0%, 5.4% and 0.49%, respectively. During the study, <10% of the subjects found DAT-positive at baseline progressed to active VL (with a mean of about nine cases of subclinical infection for every one of active VL). The median age of an incident VL case was 10.5 years. The highest rates of LST conversion occurred among the subjects aged 5-25 years. A subject who became LST-positive during the study was much less likely to develop active VL than the other subjects.
  Annals of Tropical Medicine and Parasitology 12/2009; 103(8):659-70. · 1.43 Impact Factor
• Source

  Available from: Aldert Bart

  Article: Miltefosine treatment of Leishmania major infection: an observational study involving Dutch military personnel returning from northern Afghanistan.

  P P A M van Thiel, T Leenstra, P A Kager, H J de Vries, M van Vugt, W F van der Meide, A Bart, J E Zeegelaar, A van der Sluis, H D F H Schallig, T van Gool, W R Faber, P J de Vries
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  ABSTRACT: In a retrospective, observational study involving 34 patients with Leishmania major infection, 31 of whom had experienced unsuccessful treatment with intralesional antimony (ilSb(v)), miltefosine proved effective. Thirty patients experienced cure after receipt of miltefosine, 3 after receipt of additional ilSb(v), and 1 after 28 daily intravenous injections of antimony. Temporary diminution of ejaculate volume was reported by 21 patients.
  Clinical Infectious Diseases 12/2009; 50(1):80-3. · 9.15 Impact Factor
• Article: Cutaneous leishmaniasis with lymphadenopathy due to Leishmania donovani.

  W R Faber, J Wonders, A J Jensema, E Chocholova, P A Kager
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  ABSTRACT: We describe a case of cutaneous leishmaniasis with lymphadenopathy due to Leishmania donovani, which was successfully treated with oral miltefosine. Given the increased prevalence of travelling, patients presenting with lymph-node enlargement should have leishmaniasis included in the differential diagnosis even in the absence of typical ulceration.
  Clinical and Experimental Dermatology 01/2009; 34(5):e196-8. · 1.20 Impact Factor
• Article: Fatal case of human rabies (Duvenhage virus) from a bat in Kenya: The Netherlands, December 2007.

  P P A M van Thiel, J A R van den Hoek, F Eftimov, R Tepaske, H J Zaaijer, L Spanjaard, H E L de Boer, G J J van Doornum, M Schutten, A Osterhaus, P A Kager
  Euro surveillance: bulletin europeen sur les maladies transmissibles = European communicable disease bulletin 02/2008; 13(2). · 6.15 Impact Factor
• Article: [The treatment of falciparum malaria].

  P A Kager
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  ABSTRACT: Only a few drugs are available for the treatment of malaria. Artemisinin combination treatment is advocated because of its efficacy and to prevent the development of resistance. In the Netherlands, falciparum malaria is treated with atovaquone-proguanil or artemether-lumefantrine, both registered as 3-day treatments. In a recent study, 21 patients were treated with artemether-lumefantrine for 5 days. There are arguments in favour of a 5-day course: absorption of lumefantrine is dependent on food intake and the serum levels of lumefantrine are higher on day 7 after a 5-day course than after a 3-day course. As shown by studies in Thailand, the serum level is related to the relapse rate, although these studies revealed no difference in relapse rate between the 3- and 5-day courses. In endemic countries, short courses of treatment are favoured to further patient compliance. Artesunate for i.v. administration is urgently needed.
  Nederlands tijdschrift voor geneeskunde 11/2007; 151(40):2192-4.
• Article: The effect of weekly iron and vitamin A supplementation on hemoglobin levels and iron status in adolescent schoolgirls in western Kenya.

  T Leenstra, S K Kariuki, J D Kurtis, A J Oloo, P A Kager, F O ter Kuile
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  ABSTRACT: Iron deficiency anemia is a major public health problem in developing countries and may affect school performance and physical work capacity in nonpregnant adolescents, and may increase the risk of anemia during subsequent teenage pregnancies. We assessed the effect of weekly iron (120 mg elemental iron) and vitamin A (25 000 IU) supplementation on hemoglobin, iron status and malaria and nonmalaria morbidity in adolescent schoolgirls. A total of 279 schoolgirls aged 12-18 years from public primary schools in Kisumu, western Kenya. Double-blind randomized placebo-controlled trial using a factorial design. Five months of iron supplementation was associated with a 0.52 g dl(-1) (0.21, 0.82) greater increase in hemoglobin relative to iron placebo. The effect was only observed in girls with iron deficiency on enrollment (1.34 g dl(-1) (0.79, 1.88)), but not in iron-replete girls (-0.20 g dl(-1) (-0.59, 0.18)). Similar differences in treatment effect were seen between menstruating and nonmenstruating girls. The effect of iron was independent of vitamin A. The baseline prevalence of vitamin A deficiency was low (6.7%) and no sustained increase in hemoglobin was seen with weekly vitamin A (-0.07 g dl(-1) (-0.38, 0.25)). Incidence of malaria parasitemia was higher in the iron than iron-placebo groups (Rate ratio 1.33 (0.94, 1.88)). Weekly iron supplementation results in substantial increases in hemoglobin concentration in adolescent schoolgirls in western Kenya, which may outweigh possible risks caused by malaria, but only in iron-deficient or menstruating girls and not in iron-replete and nonmenstruating girls.
  European journal of clinical nutrition 11/2007; 63(2):173-82. · 3.07 Impact Factor
• Source

  Available from: kit.nl

  Article: The effect of health care worker training on the use of intermittent preventive treatment for malaria in pregnancy in rural western Kenya.

  P O Ouma, A M Van Eijk, M J Hamel, E Sikuku, F Odhiambo, K Munguti, J G Ayisi, P A Kager, L Slutsker
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  ABSTRACT: In 1998, Kenya adopted intermittent preventive treatment (IPTp) with sulphadoxine-pyrimethamine (SP) for malaria prevention during pregnancy. We conducted a survey in 2002 among women who had recently delivered in the rural neighbouring areas Asembo and Gem and reported coverage of 19% of at least one dose and 7% of two or more doses of SP. Health care workers (HCW) in Asembo were retrained on IPTp in 2003. To evaluate if IPTp coverage increased and if the training in Asembo led to better coverage than in Gem, and to identify barriers to the effective implementation of IPTp. Community-based cross-sectional survey among a simple random sample of women who had recently delivered in April 2005, interviews with HCW of antenatal clinics (ANC) in Asembo and Gem. Of the 724 women interviewed, 626 (86.5%) attended the ANC once and 516 (71.3%) attended two or more times. Overall IPTp coverage was 41% for at least one dose, and 21% for at least two doses of SP. In Asembo, coverage increased from 19% in 2002 to 61% in 2005 for at least one dose and from 7% to 17% for two doses of SP. In Gem, coverage increased from 17% to 28% and 7% to 11%, respectively. Interviews of HCW in both Asembo and Gem revealed confusion about appropriate timing, and lack of direct observation of IPTp. Training of HCW and use of simplified IPTp messages may be a key strategy in achieving Roll Back Malaria targets for malaria prevention in pregnancy in Kenya.
  Tropical Medicine & International Health 09/2007; 12(8):953-61. · 2.80 Impact Factor
• Source

  Available from: Le Quoc Hung

  Article: Nutritional status following malaria control in a Vietnamese ethnic minority commune.

  L Q Hung, P J de Vries, P T Giao, T Q Binh, N V Nam, M T Chong, P A Kager
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  ABSTRACT: To study whether control of malaria leads to catch-up growth or an increase of obesity in a marginally nourished population. A Vietnamese ethnic minority commune in southern Vietnam. Repeated annual anthropometric surveys were performed from 1995 to 2000. Z-scores for height, weight and BMI for age and weight-for-height were determined by using NCHS 1978 and CDC 2000 reference tables and by the LMS method. Active malaria control that reduced the parasite carrier rate from 50% in 1994 to practically nil in 1998. Inhabitants were generally of short stature and very thin. Using the US reference tables, the prevalence of moderate/severe stunting among children was 53/24% and of wasting 27/9% in the first survey in 1995. Physical condition and normal daily activities of most inhabitants were normal. The repeated LMS-Z-scores uncovered a significant recovery of stunting, extending into preadolescence, including the development of a pubertal growth spurt for girls and enhancement of pubertal growth in boys, after control of malaria. The mean (95% CI) annual increase of Z-height-for-age was 0.11 (0.09-0.12) for boys and 0.14 (0.13-0.15) for girls (P<0.001). As a consequence, weight-for-age and BMI Z-scores decreased without indication of developing obesity. Catch-up growth, extending into preadolescent age, was observed in a Vietnamese ethnic minority population with a chronic state of low food intake, without indication of developing obesity. The control of malaria was probably the most significant contribution to this catch-up growth.
  European Journal of Clinical Nutrition 08/2005; 59(8):891-9. · 2.46 Impact Factor
• Article: Prevalence and severity of malnutrition and age at menarche; cross-sectional studies in adolescent schoolgirls in western Kenya.

  T Leenstra, L T Petersen, S K Kariuki, A J Oloo, P A Kager, F O ter Kuile
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  ABSTRACT: Nutritional status is an important marker of overall health and linear growth retardation has serious long-term physiological and economic consequences. Approximately 35 and 29% of preschool children in sub-Saharan Africa are stunted and underweight, respectively. There is relatively little information available about the nutritional status in adolescents, the age group with the highest growth velocity after infancy. We conducted a series of cross-sectional surveys to determine the prevalence and main risk groups for malnutrition and to describe the associations between age, sexual maturation and nutritional status in adolescent schoolgirls in western Kenya. Three cross-sectional surveys; one in Mumias, using random sampling in all schools, and two surveys in Asembo, using a multi-stage random sample design. Public primary schools in two different rural malaria endemic areas in western Kenya with high levels of malnutrition in preschool children. In all, 928 randomly selected adolescent schoolgirls aged 12-18 y. Overall prevalence of stunting and thinness was 12.1 and 15.6%, respectively. Of the total, 2% were severely stunted. Menarche and start of puberty were delayed by approximately 1.5-2 y compared to a US reference population. The prevalence of stunting and thinness decreased with age and mean height for age z-scores converged towards the median of the US reference curve. Girls who had not yet started menstruating were more likely to be stunted than the girls of the same age who were post-menarche. Stunting and thinness are common in young adolescent schoolgirls in these poor rural settings in western Kenya, but the prevalence decreases with age, providing observational support that children catch up on incomplete growth attained earlier in life due to a maturational delay of 1.5-2 y allowing prolonged growth.
  European Journal of Clinical Nutrition 02/2005; 59(1):41-8. · 2.46 Impact Factor
• Article: Changing pattern of imported cutaneous leishmaniasis in the Netherlands.

  J E Zeegelaar, W H Steketee, P P A M van Thiel, J C F M Wetsteyn, P A Kager, W R Faber
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  ABSTRACT: Cutaneous leishmaniasis (CL) in western countries seems to be appearing more frequently. Our aim was to determine if there has been a shift in countries where CL is acquired and whether the incidence has changed, and to assess current diagnostic procedures and treatment modalities. In a retrospective study medical records of patients with the diagnosis of CL at the Departments of Tropical Dermatology and Tropical Medicine, Academic Medical Center, Amsterdam, the Netherlands, from 1990 to 2000 were analysed. CL was diagnosed in 78 patients. The majority was acquired in Belize, Surinam, French Guyana and Bolivia. Giemsa stains were positive for the parasite in impression smears from 43% and in biopsies from 71%. Seventy-eight per cent of cases were culture-positive and 89% were PCR-positive. Sixty-two patients were treated systemically: pentavalent antimony (32), pentamidine isetionate (11), itraconazole (19), and 13 locally, the majority with a combination of cryosurgery and intralesional pentavalent antimony. Imported CL is becoming more frequent, with South and Middle American countries being important sources of infection. Multiple tests, of which PCR is the most sensitive, are required to confirm the diagnosis. Systemic treatment was given to the majority of the patients.
  Clinical and Experimental Dermatology 02/2005; 30(1):1-5. · 1.20 Impact Factor
• Article: Comparison of the parasitologic efficacy of amodiaquine and sulfadoxine-pyrimethamine in the treatment of Plasmodium falciparum malaria in the Bungoma District of western Kenya.

  C J Vreugdenhil, F Y Scheper, S R Hoogstraatte, M Smolders, S Gikunda, F G Cobelens, P A Kager
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  ABSTRACT: The efficacy of amodiaquine (AQ) and sulfadoxine-pyrimethamine (SP) was assessed in 310 symptomatic children from western Kenya with uncomplicated Plasmodium falciparum malaria. A non-blinded, randomized, 14-day study was performed and parasitologic criteria were used. Of 310 patients included, 238 (77%) completed the study: 120 received AQ and 118 received SP. In those treated with AQ, there were sensitive (S) infections in 107 patients (89.2%, 95% confidence interval [CI] = 82.2, 94.1%), RI resistance in 10 (8.3%, 95% CI = 4.1, 14.8%), RII resistance in 1 (0.8%, 95% CI = 0, 4.6%), and RIII resistance in 2 (1.7%, 95% CI = 0.2, 5.9%). In those treated with SP, there were S infections in 74 patients (62.7%, 95% CI = 53.3, 71.4%), RI resistance in 21 (17.8%, 95% CI = 11.4, 25.9%), RII resistance in 11 (9.3%, 95% CI = 4.7, 16.1%), and RIII resistance in 12 (10.2%, 95% CI = 5.4, 17.1%). Resistance rates were consistently higher in the SP-treated patients (P < 0.001). Resistance to SP in this area has reached such levels that it should no longer be the first-line treatment. Alternative treatment, such as SP plus AQ combination treatment or artemisinin combination treatment, is urgently needed.
  The American journal of tropical medicine and hygiene 11/2004; 71(5):537-41. · 2.59 Impact Factor
• Article: FFAs are not involved in regulation of gluconeogenesis and glycogenolysis in adults with uncomplicated P. falciparum malaria.

  Huynh van Thien, G J Weverling, M T Ackermans, Nguyen canh Hung, E Endert, P A Kager, H P Sauerwein
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  ABSTRACT: In normal subjects, elevation of plasma free fatty acid (FFA) levels stimulates gluconeogenesis (GNG) and inhibits glycogenolysis (GLY). In adults with uncomplicated Plasmodium falciparum malaria, GNG is increased and GLY decreased. To test the hypothesis that FFAs are regulators of GNG and GLY in uncomplicated falciparum malaria, we investigated the effect of inhibition of lipolysis by acipimox in 12 patients with uncomplicated falciparum malaria. Six of them were given acipimox, and six served as controls. Also as controls, six matched healthy subjects were studied on two occasions with and without acipimox. After 16 h of fasting, glucose production and GNG were significantly higher in the malaria patients compared with the healthy controls (P = 0.003 and < 0.0001, respectively), whereas GLY was significantly lower (P < 0.001), together with elevated plasma concentrations of cortisol and glucagon. During the study, glucose production in patients declined over time (P < 0.0001), without a statistically significant difference between the acipimox-treated and untreated patients. In controls, however, with acipimox the decline was less outspoken compared with nontreated controls (P = 0.005). GNG was unchanged over time in patients as well as in healthy controls, and no influence of acipimox was found. In patients, GLY declined over time (P < 0.001), without a difference between acipimox-treated and untreated patients. In contrast, in controls treated with acipimox, no change over time was found, which was statistically different from the decline in untreated controls (P = 0.002). In conclusion, in falciparum malaria, FFAs are not involved in regulation of glucose production, nor of GNG or GLY.
  AJP Endocrinology and Metabolism 10/2004; 287(4):E609-15. · 4.75 Impact Factor
• Source

  Available from: Feiko O ter Kuile

  Article: Prevalence and severity of anemia and iron deficiency: cross-sectional studies in adolescent schoolgirls in western Kenya.

  T Leenstra, S K Kariuki, J D Kurtis, A J Oloo, P A Kager, F O ter Kuile
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  ABSTRACT: Anemia is a major public health concern in preschool children and pregnant women in the developing world. While many studies have examined these two at-risk groups, there is a paucity of data on anemia in adolescents living in developing countries in the complex ecologic context of poverty, parasitism, and malnutrition. We evaluated the prevalence, severity, and risk factors of anemia in adolescent schoolgirls in an area with intense malaria transmission in western Kenya. Two cross-sectional surveys were conducted, using a multistage random sample design. Public primary schools in an area with intense malaria transmission in western Kenya. A total of 648 randomly selected adolescent schoolgirls aged 12-18 y. The prevalence of anemia (Hb <120 g/l) was 21.1%; only one girl had an Hb less than 70 g/l. Ferritin levels were available from a subsample of 206 girls. The prevalence of iron deficiency (ferritin <12 microg/l) was 19.8, and 30.4% of anemic girls were iron deficient. Malaria and schistosomiasis were the main risk factors for anemia in younger girls (12-13 y), while menstruation was the principal risk factor in older girls (14-18 y). Iron deficiency and anemia in school-attending girls in western Kenya were more prevalent than in developed countries, but considerably less prevalent than in preschool children and pregnant women from the same study area. Our findings are consistent with other recent school-based surveys from western Kenya, but not with recent community- and school-based cross-sectional surveys from other parts of sub-Saharan Africa. It deserves further study to determine if adolescent girls not attending school are at higher risk of anemia.
  European Journal of Clinical Nutrition 05/2004; 58(4):681-91. · 2.46 Impact Factor
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  Available from: Erik Endert

  Article: Gluconeogenesis and fasting in cerebral malaria.

  H van Thien, M T Ackermans, G J Weverling, T Dang Vinh, E Endert, P A Kager, H P Sauerwein
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  ABSTRACT: In healthy subjects after an overnight fast, glucose production is for approximately 50% derived from glycogenolysis. If the fast is prolonged, glucose production decreases due to a decline in glycogenolysis, while gluconeogenesis remains stable. In cerebral malaria, glucose production is completely derived from gluconeogenesis after an overnight fast. It is not known if glucose production also decreases during fasting when its only source is gluconeogenesis. Glucose production was measured by infusion of [6,6-2H2]glucose in seven patients with cerebral malaria after prolonging a fast from 20.30 to 00.30 hours. Glucose production decreased by approximately 10% (27.4 +/- 2.1 to 24.7 +/- 1.6 micromol/kg/min, p = 0.05), without changes in the plasma concentrations of glucoregulatory hormones, FFA or precursors. In the patients with cerebral malaria, glucose production decreases during fasting due to a decrease in the rate of gluconeogenesis. These data suggest that the decrease in the rate of glucose production during short-term fasting is actively regulated and not simply due to shrinkage of glycogen content, as in the absence of glycogenolysis, glucose production decreases at the same rate as normally seen in healthy subjects whose glucose production is for approximately 50% derived from glycogen and in whom gluconeogenesis is stable.
  The Netherlands Journal of Medicine 05/2004; 62(4):129-33. · 2.07 Impact Factor
• Article: [Clinical reasoning and decision making in practice. A depressive foreign woman with symptoms of malaise].

  W Hart, P H Slee, H G Schipper, R P Koopmans, P A Kager
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  ABSTRACT: A 27-year-old woman was admitted to the hospital with a depression, anaemia and fatigue. She had come from Angola to the Netherlands as a refugee 2 years before this evaluation. As an explanation for her symptoms tropical infectious diseases of parasitic origin were considered, but no clues were found in this direction. The test for trypanosomiasis was considered to be suggestive for an infection in the past (persistent titre 1:200). She was discharged but readmitted 6 months later because of a deterioration of her clinical condition. Magnetic resonance imaging showed bilateral signal abnormalities within the white matter of the brain. On examination no neurological signs or abnormalities were found. Again, no definite diagnosis could be made and the patient was discharged. Because of a further deterioration of her clinical condition she was readmitted a short time later for the third time. On the MRI the white matter lesions had increased. The serum protein electrophoresis was markedly abnormal with an elevated IgM Level. Finally, at a repeated lumbar puncture mobile trypanosomes were found. The diagnosis of 'West African sleeping sickness' was made and the patient was treated with eflornithine. She recovered completely during the next 18 months.
  Nederlands tijdschrift voor geneeskunde 05/2004; 148(16):771-6.
• Article: Effectiveness of intermittent preventive treatment with sulphadoxine-pyrimethamine for control of malaria in pregnancy in western Kenya: a hospital-based study.

  A M van Eijk, J G Ayisi, F O ter Kuile, J A Otieno, A O Misore, J O Odondi, D H Rosen, P A Kager, R W Steketee, B L Nahlen
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  ABSTRACT: To monitor the effectiveness of intermittent preventive treatment (IPT) with sulphadoxine-pyrimethamine (SP) for the control of malaria in pregnancy at delivery in the Provincial Hospital in Kisumu, Kenya, and to assess the effect of IPT in participants in a cohort study. Between June 1999 and June 2000, information on IPT and birth outcome was collected in 2302 consecutive deliveries. A group of 889 women, who were enrolled in a cohort to assess the interaction between malaria and HIV, were analysed separately because of the enrollment criteria and different access to health care. The prevalence of placental malaria was 13.8% and of low birthweight (LBW) was 12.2%. In multivariable analysis, IPT (> or =1 dose of SP) was associated with a reduction in placental malaria and LBW [adjusted odds ratio (OR) 0.56, 95% confidence interval (CI) 0.39-0.83 and OR 0.65, 95% CI 0.45-0.95, respectively]. An adjusted mean increase in birthweight of 61 g was seen (95% CI 22-101 g) for each increment in number of SP doses (> or =2 doses grouped together). IPT was associated with a reduction in placental malaria in HIV-seronegative women (OR 0.49, 95% CI 0.28-0.86) but this was not significant among HIV-seropositive women (OR 0.45, 95% CI 0.20-1.05). A significant effect on birthweight could not be detected among participants in the HIV-cohort. This evaluation confirms that IPT with SP is effective in reducing placental malaria and LBW. It will be important to increase coverage of IPT and to extend IPT to antenatal clinics in peri-urban and rural areas.
  Tropical Medicine & International Health 04/2004; 9(3):351-60. · 2.80 Impact Factor
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  Available from: ncbi.nlm.nih.gov

  Article: Relative bioavailability of three newly developed albendazole formulations: a randomized crossover study with healthy volunteers.

  I M Rigter, H G Schipper, R P Koopmans, H J M van Kan, H W Frijlink, P A Kager, H-J Guchelaar
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  ABSTRACT: This study of healthy volunteers shows that the relative bioavailability of albendazole formulations that use arachis oil-polysorbate 80 or hydroxypropyl-beta-cyclodextrin as an excipient was enhanced 4.3- and 9.7-fold compared to the results seen with commercial tablets. Administration of macrogol suppositories did not result in measurable plasma concentrations of albendazole sulfoxide.
  Antimicrobial Agents and Chemotherapy 04/2004; 48(3):1051-4. · 4.84 Impact Factor
• Article: Influence of prolonged starvation on glucose kinetics in pregnant patients infected with Plasmodium falciparum.

  Huynh van Thien, M T Ackermans, G J Weverling, V O Thanh Chien, E Endert, P A Kager, H P Sauerwein
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  ABSTRACT: Hypoglycaemia is a recognised complication of malaria in pregnancy, but its pathophysiology is not well understood. We studied the influence of fasting on glucose production and gluconeogenesis by infusion of [6,6-(2)H(2)]glucose and ingestion of (2)H(2)O in 20 female subjects, eight pregnant patients with uncomplicated falciparum malaria, six pregnant controls matched for age and trimester and six non-pregnant controls matched for age. Infection with Plasmodium falciparum induced a significant increase in glucose production (16.7+/-0.3 vs. 12.4+/-0.8 micromol/kg/min; P=0.002) and gluconeogenesis (12.5+/-0.6 vs. 8.2+/-0.7 micromol/kg/min; P=0.001) without a change in the glucoregulatory hormone milieu, compared to the healthy pregnant controls. Extension of the fast from 20.30 to 24.30 h resulted in a rate of decline of glucose production that was similar in patients with malaria and healthy pregnant subjects, a decline that was steeper compared to the non-pregnant subjects (-0.283 and -0.426 vs. -0.065 micromol/kg/min/h; P=0.037). The plasma glucose concentration measured at 20.30 h of fasting in the malaria patients was intermediate between the value found in the pregnant and the non-pregnant controls (4.01+/-0.2 mmol/l) while it was significantly lower in the non-infected pregnant women compared to non-pregnant controls (3.59+/-0.14 vs. 4.70+/-0.29 mmol/l; P=0.009). Plasma glucose concentration declined at a similar rate in patients with malaria and pregnant controls but faster compared to the non-pregnant controls (-0.078 and -0.093 vs. -0.044 mmol/l/h; P < 0.05). We conclude that fasting is a major risk factor for hypoglycaemia in pregnancy. Non-severe Plasmodium falciparum infection in pregnant women results in higher glucose production and higher glucose levels, thereby, compared to healthy pregnant patients, delaying of the occurrence of hypoglycaemia due to fasting. The exact mechanism of hypoglycaemia in fasting pregnant women remains to be elucidated.
  Clinical Nutrition 02/2004; 23(1):59-67. · 3.73 Impact Factor