Homeopathic Resistant Malaria

  • University of Gothenbourg
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Multiresistant Plasmodium falciparum malaria is a major threat to travelers to subSaharan Africa. However, even if chemoprophylaxis does not prevent clinical malaria in some individuals, it does lead to a reduction in the severity of the disease.1 In Sweden, we have recently seen five patients with malaria (three due to P. ovale and two due to P. falciparum) who have used homeopathic drugs for prophylaxis during visits to West Africa. We are concerned about this incidence and afraid that reduced confidence in modern medical malaria prophylaxis will encourage some individuals to try totally ineffective alternatives. Three women (57, 40, and 39 years old) visited Guinea Conacry in January 1995 as members of a group of 24 persons learning about African dances. The 57-year-old woman took mefloquine irregularly but vomited each time after intake. She also used Spenglersan M, which is a homeopathic drug that is administered (one drop daily in the bend of the arm) as malaria prophylaxis. The two other women used Spenglersan M only. They all fell ill with P. ovale malaria despite ongoing intake. Spenglersan M is said to contain both antigen from P. falciparum and antibodies against the parasite diluted to 1:1,000,000,000 concentration. The fourth case was a 26-year-old man who visited Ghana and Burkina Faso in October and November 1994. He used China D-6 for prophylaxis. This is a homeopathic preparation of the bark from the cinchona tree. Not even trace amounts of quinine were found in the tablets with a very sensitive high-performance liquid chromatographic method.2 Four days after returning from Africa he fell ill with P. falciparum malaria and received sulphadoxine-pyrimethamine treatment. After clinical relapse (RI), mefloquine was given and the patient was eventually cured. The fifth case was a 34-year-old woman admitted to hospital because of P. falciparum malaria after a visit to Guinea Conacry in January 1995. She had taken a homeopathic drug, Charaka comp 118, as prophylaxis. The drug is said to contain different extracts from herbs diluted 30 times. At first she refused to stay in hospital, but 2 days later she was readmitted and treated in the intensive care unit because of severe malaria with hypotonia and anemia. She had hyperparasitemia with 23% infected erythrocytes. Exchange transfusion was done, quinine was given, and the patient recovered without sequelae. The mortality is about 1% in people with P. falciparum infection.3 We therefore urge the readers to stand up against the dangerous use of homeopathic drugs and instead motivate travelers to use protective malaria prophylaxis.

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... Non-falciparum malaria is rare with sporadic descriptions in published literature [5,6]. Cases of Plasmodium vivax, Plasmodium ovale, and mixed P. falciparum and P. vivax infections have been reported among travellers [5,[7][8][9]. ...
... Parenteral quinine was the first-line regimen for the treatment of severe malaria prior to its replacement by artesunate therapy [3,30]. A case of severe malaria was described in a traveller who was successfully treated with quinine [8]. ...
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Malaria is one of the leading causes of mortality and morbidity in Guinea. The entire country is considered at risk of the disease. Transmission occurs all year round with peaks occurring from July through October with Plasmodium falciparum as the primary parasite species. Chloroquine (CQ) was the first-line drug against uncomplicated P . falciparum in Guinea until 2005, prior to the adoption of artemisinin-based combination therapy (ACT). In this review, data on therapeutic efficacy of CQ and artemisinin-based combinations reported in published literature is summarized. Against CQ, a failure rate of 27% (12/44) was reported in a study in 1992; a median failure rate of 15.6% [range: 7.7–28.3; 8 studies] was observed during 1996–2001, and 81% (17/21) of the patients failed to clear parasitaemia in a study conducted in 2007. For artemisinin-based combinations, three published studies were identified (1495 patients; 2004–2016); all three studies demonstrated day 28 polymerase chain reaction corrected efficacy > 95%. One study characterized kelch - 13 mutations (389 tested; samples collected in 2016) with no evidence of mutations currently known to be associated with artemisinin resistance. The impact of the ongoing COVID-19 pandemic and widespread usage of counterfeit medicines are immediate challenges to malaria control activities in Guinea.
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Professional psychology is in apparent conflict about its relationship to “complementary” and “alternative” medicine (CAM)—some scholars envision a harmonious partnership, whereas others perceive irreconcilable differences. We propose that the field’s ambivalence stems at least partly from the fact that inquiring psychologists can readily point to peer-reviewed empirical evidence (e.g., published reports of randomized controlled trials) to either substantiate or refute claims for the efficacy of most CAM modalities. Thankfully, recent intellectual developments in the fields of medicine and scientific psychology—developments which we refer to collectively as the science-based perspective—have led to the identification of several principles that may be used to judge the relative validity of conflicting health intervention research findings, including the need to consider (a) the prior scientific plausibility of a treatment’s putative mechanism-of-action; and, commensurately, (b) the degree of equivalence between treatment and control groups—except for the single active element of the treatment believed to cause a specific change, all else between the two groups should be identical. To illustrate the potential of this approach to resolve psychology’s CAM controversy, we conducted a re-review of the research cited by Barnett and Shale [2012; Professional Psychology: Research and Practice, 43(6), 576-585] regarding the efficacy of 11 types of CAM that psychologists might endorse. Less than 15% of the studies we reviewed (N = 239) employed research designs capable of ruling out non-specific effects, and those that did tended to produce negative results. From a science-based perspective, psychologists should reject CAM in principle and practice.
Quinine, a quinoline derivative, is an ancient antipyretic drug with antimalarial properties that has been phased out by more effective synthetic candidates. In previous studies we discovered that hydroxychloroquine (HCQ), a synthetic antimalarial with structural similarities to quinine, reduced the binding of antiphospholipid (aPL) immune complexes to phospholipid bilayers. We performed ellipsometry and atomic force microscopy (AFM) studies to measure the effect of quinine on dissociation of anti-β2-glycoprotein I (anti-β2GPI) immune complexes. We found that quinine desorbed pre-formed β2GPI-aPL immunoglobulin (Ig)G complexes from phospholipid bilayers at significantly lower molar concentrations than HCQ. Quinine also inhibited the formation of immune complexes with a higher efficacy than HCQ at equivalent drug concentrations of 0.2 mg/ml (0.192 ± 0.025 µg/cm(2) for quinine vs. 0.352 ± 0.014 µg/cm(2) for HCQ, p < 0.001). Furthermore, AFM imaging experiments revealed that addition of quinine disintegrated immune complexes bound to planar phospholipid layers. The desorptive and inhibitory effects of the old drug, quinine, toward β2GPI-aPL IgG complexes and β2GPI were significantly more pronounced compared to the synthetic antimalarial, HCQ. The results suggest that the quinoline core of the molecule is a critical domain for this activity and that side chains may further modulate this effect. The results also indicate that there may yet be room for considering new activities of very old drugs in devising clinical trials on potential non-anticoagulant treatments for antiphospholipid syndrome (APS).
Conference Paper
The objective of this work was to identify the existence of biases on the reporting of Homeopathy efficacy in Brazilian newspapers. To this end, the online archives of two large newspapers - one in Rio de Janeiro city and one in São Paulo city - were searched for all news or reports concerning Homeopathy in the period January 2009-December 2010. The identified items were then classified as “favorable”, “unfavorable” or “neutral” in what concerns the efficacy of Homeopathic therapy. Paid advertisements and “passing” references were excluded. Thirty-one items were identified, and the results indicated an overall preponderance of “favorable”, as compared to “unfavorable“, reports (14 favorable, 7 unfavorable). In conclusion, newspaper reporting of homeopathic efficacy is not compatible with the most update scientific evidence on the topic.
Every year, millions of people travel abroad, exposing themselves to various diseases. Advice on risk avoidance and on self-medication is not always successful; sometimes travellers return home ill or become unwell soon afterwards. There are many possible causes for such illnesses, and physicians should try to establish whether the disease is specifically associated with the recent journey. The approach to assessment of the ill traveller should make use not only of signs and symptoms, but also of geography and epidemiology. Travellers with fever need immediate attention to rule out serious and potentially life-threatening conditions. Faced with a difficult diagnosis, physicians should consult with experts in tropical and travel medicine.
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Controversies in malaria prevention arise from the absence of data, conflicting data between different studies, conflicting recommendations, deviation of local practice from scientific data, and varying risk thresholds. Misconceptions about the seriousness of malaria, the tolerability of chemoprophylaxis drugs, and the efficacy and safety of repellents contribute to the controversies. To compare several national guidelines on malaria chemoprophylaxis to identify variations in recommendations. We reviewed studies on tolerability of mefloquine with particular focus on its neuropsychiatric adverse effects and influence on performance. We also describe why most recommended chemoprophylactic regimens fail to prevent relapses of Plasmodium vivax malaria and review available options. We searched scientific publications in MEDLINE via PubMED for relevant articles with a cutoff date of December 2006 using the search terms malaria, chemoprophylaxis, travel, mefloquine, neuropsychiatric adverse events, tolerability, vivax malaria, and primaquine. Additional references were obtained from bibliographies of the selected articles. There were no language restrictions. Gaps and conflicts exist among current guidelines. Health authorities vary in the chemoprophylaxis drugs they recommend, the indications for continuous prophylaxis vs no prophylaxis, and the use of standby emergency treatment. Despite widespread reports on the adverse effects of mefloquine, controlled studies found that serious neuropsychiatric adverse events occur at rates comparable with or lower than other chemoprophylaxis drugs. Moreover, mefloquine does not appear to impair performance while driving, flying, or diving. Vivax malaria causes significant illness in travelers, but current first-line chemoprophylaxis agents do not prevent relapses of vivax malaria. Although not licensed in most countries as primary prophylaxis, primaquine effectively prevents relapses of vivax malaria. Prevention of malaria in travelers requires detailed knowledge of malaria epidemiology and host-vector-parasite interactions. Decisions are complicated by a lack of standardized recommendations, controversies, and misconceptions. Improved international consensus is indicated to minimize conflicting guidelines, clarify controversies, and promote adherence to preventive measures.
To investigate the effects of antimalarial chemoprophylaxis and other variables on the severity of falciparum malaria. Review of consecutive malaria cases between 1987 and 1991. The Hospital for Tropical Diseases, London. 250 consecutive cases of mild and 51 consecutive cases of severe falciparum malaria. Prophylaxis was taken in 52.4% (131/250) of the cases of mild malaria and 21.6% (11/51) of cases of severe malaria. Severe malaria was more common in white patients than in those of African origin and was also seen more commonly in people returning from central, southern, and east Africa than in those returning from west Africa. Patients with severe malaria presented sooner than patients with mild malaria. Prior chemoprophylaxis led to a reduction in the severity of falciparum malaria. Ethnic origin, time to presentation, and sex were also associated with the severity of malaria.
The analysis of quinine in whole blood, plasma, urine, and samples dried on filter paper is described. Extraction was made with toluene followed by back-extraction into phosphate buffer. A reversed-phase liquid chromatography system with fluorescence detection was used. The within-day coefficient of variation of the method was 4-10% at the lower limit of determination (2 nM in plasma and 50 nM in whole blood, dried samples, and urine) and 2-4% at 10 microM. The quinine concentration was found to be lower in whole blood than in plasma (mean ratio, plasma-whole blood, 1.17). The concentration in capillary blood was lower than that in venous blood (mean ratio, capillary blood-venous blood, 0.93).
MD: Department of Infectious Diseases, Danderyd Hospital. Karolinska Institute
  • Tony Carlsson
Tony Carlsson, MD: Department of Infectious Diseases, Danderyd Hospital. Karolinska Institute. Danderyd, Sweden;
Department of Infectious Diseases, Central Hospital, Kristianstad, Sweden; and Urban Hellgren, MD, PhD: Department of Infectious Diseases
  • Liv Bergqvist
  • Md
Liv Bergqvist, MD: Department of Infectious Diseases, Central Hospital, Kristianstad, Sweden; and Urban Hellgren, MD, PhD: Department of Infectious Diseases, Huddinge Hospital, Travel lgg6; 3:62. Karolinska Institute, Huddinge, Sweden. Reprint requests: Dr, Tony Carlsson, Department of Diseases, Hospital, s-182 88
Hall AP Severity of imported falciparum malaria: effect of taking antimalarial prophylaxis Reversed-phase high-performance liquid chromatography deterniina-tion of quinine in plasma, whole blood, urine and samples dried on filter paper
  • Lewis Jl Rn Davisson
  • Ross M Fridkn
  • U Hellgren
  • Gustahson
  • Ll
Lewis JL, Davisson RN, Ross EJ, Hall AP Severity of imported falciparum malaria: effect of taking antimalarial prophylaxis. Ericsson 0, Fridkn M, Hellgren U, Gustahson LL. Reversed-phase high-performance liquid chromatography deterniina-tion of quinine in plasma, whole blood, urine and samples dried on filter paper.Ther Drug Monit 1993;15:334-337.
Reversedphase high-performance liquid chromatography deterniination of quinine in plasma, whole blood, urine and samples dried on filter paper
  • M Fridkn
  • U Hellgren
  • L L Gustahson
Ericsson 0, Fridkn M, Hellgren U, Gustahson LL. Reversedphase high-performance liquid chromatography deterniination of quinine in plasma, whole blood, urine and samples dried on filter paper.Ther Drug Monit 1993;15:334-337. World Health Organization. International travel and health. Geneva:World Health Organization, 1995. BMJ 1992;305:741-743.