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Subject: search.filters.subject.antimalarial agent

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    Atovaquone/Proguanil Resistance in an Imported Malaria Case in Chile
    (2021)
    Stella M. Chenet
    ;
    Alan Oyarce
    ;
    Jorge Fernandez
    ;
    Rafael Tapia-Limonchi
    ;
    WEITZEL, THOMAS  
    <jats:title>ABSTRACT</jats:title><jats:p>In November 2018, we diagnosed a cluster of falciparum malaria cases in three Chilean travelers returning from Nigeria. Two patients were treated with sequential intravenous artesunate plus oral atovaquone/proguanil (AP) and one with oral AP. The third patient, a 23-year-old man, presented with fever on day 29 after oral AP treatment and was diagnosed with recrudescent falciparum malaria. The patient was then treated with oral mefloquine, followed by clinical recovery and resolution of parasitemia. Analysis of day 0 and follow-up blood samples, collected on days 9, 29, 34, 64, and 83, revealed that parasitemia had initially decreased but then increased on day 29. Sequencing confirmed Tyr268Cys mutation in the <jats:italic>cytochrome b</jats:italic> gene, associated with atovaquone resistance, in isolates collected on days 29 and 34 and <jats:italic>P. falciparum dihydrofolate reductase</jats:italic> mutation Asn51Ile, associated with proguanil resistance in all successfully sequenced samples. Molecular characterization of imported malaria contributes to clinical management in non-endemic countries, helps ascertain the appropriateness of antimalarial treatment policies, and contributes to the reporting of drug resistance patterns from endemic regions.</jats:p>
      4Scopus© Citations 5
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      20Scopus© Citations 1
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    Factors associated with neuropsychiatric involvement in Latin American patients with systemic lupus erythematosus
    (2021)
    Leonor A Barile-Fabris
    ;
    Hilda Fragoso-Loyo
    ;
    Daniel Wojdyla
    ;
    Rosana Quintana
    ;
    Guillermo J Pons-Estel
    <jats:sec><jats:title>Introduction</jats:title><jats:p> Factors related to presentation of neuropsychiatric (NP) SLE manifestations, early in the course of the disease, and during follow up have not been clearly established. </jats:p></jats:sec><jats:sec><jats:title>Purpose</jats:title><jats:p> To identify disease and non-disease related factors associated with NP manifestations in early SLE. </jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p> We included 1193 patients from the GLADEL inception cohort free of NP involvement at cohort entry. We evaluated the association of demographic, clinical and laboratory data with NP involvement during follow-up. </jats:p></jats:sec><jats:sec><jats:title>Statistical methods</jats:title><jats:p> Independent factors associated with NP involvement were identified using a multivariable Cox regression model. </jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p> Factors independently associated with NP manifestations were: mestizo ethnicity (HR 1.701, 95% CI 1.282–2.258, p = 0.0002), myalgias/myositis (HR 1.832, 95% CI 1.335–2.515, p = 0.0002), pneumonitis (HR 2.476, 95% CI 1.085–5.648, p = 0.0312), shrinking lung (HR 2.428, 95% CI 1.074–5.493, p = 0.0331) and hemolytic anemia (HR 1.629, 95% CI 1.130–2.347, p = 0.0089). Longer disease duration at cohort entry (13 to 24 months) was associated with a lower risk of developing NP manifestations (HR 0.642, 95% CI 0.441–0.934, p = 0.0206). </jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p> Patients with myalgias/myositis, pneumonitis, shrinking lung and hemolytic anemia are at higher risk of NP involvement, whereas longer disease duration at cohort entry is associated with a lower risk of developing NP involvement. </jats:p></jats:sec>
      15Scopus© Citations 3
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    Factors predictive of serious infections over time in systemic lupus erythematosus patients: data from a multi-ethnic, multi-national, Latin American lupus cohort
    (2019)
    V R Pimentel-Quiroz
    ;
    M F Ugarte-Gil
    ;
    GB Harvey
    ;
    D Wojdyla
    ;
    G J Pons-Estel
    <jats:sec><jats:title>Aim</jats:title><jats:p> The aim of this study was to identify factors predictive of serious infections over time in patients with systemic lupus erythematosus (SLE). </jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p> A multi-ethnic, multi-national Latin American SLE cohort was studied. Serious infection was defined as one that required hospitalization, occurred during a hospitalization or led to death. Potential predictors included were sociodemographic factors, clinical manifestations (per organ involved, lymphopenia and leukopenia, independently) and previous infections at baseline. Disease activity (SLEDAI), damage (SLICC/ACR Damage Index), non-serious infections, glucocorticoids, antimalarials (users and non-users), and immunosuppressive drugs use; the last six variables were examined as time-dependent covariates. Cox regression models were used to evaluate the predictors of serious infections using a backward elimination procedure. Univariable and multivariable analyses were performed. </jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p> Of the 1243 patients included, 1116 (89.8%) were female. The median (interquartile range) age at diagnosis and follow-up time were 27 (20–37) years and 47.8 (17.9–68.6) months, respectively. The incidence rate of serious infections was 3.8 cases per 100 person-years. Antimalarial use (hazard ratio: 0.69; 95% confidence interval (CI): 0.48–0.99; p = 0.0440) was protective, while doses of prednisone &gt;15 and ≤60 mg/day (hazard ratio: 4.18; 95 %CI: 1.69–10.31; p = 0.0019) and &gt;60 mg/day (hazard ratio: 4.71; 95% CI: 1.35–16.49; p = 0.0153), use of methylprednisolone pulses (hazard ratio: 1.53; 95% CI: 1.10–2.13; p = 0.0124), increase in disease activity (hazard ratio: 1.03; 95% CI: 1.01–1.04; p = 0.0016) and damage accrual (hazard ratio: 1.22; 95% CI: 1.11–1.34; p &lt; 0.0001) were predictive factors of serious infections. </jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p> Over time, prednisone doses higher than 15 mg/day, use of methylprednisolone pulses, increase in disease activity and damage accrual were predictive of infections, whereas antimalarial use was protective against them in SLE patients. </jats:p></jats:sec>
      6Scopus© Citations 75