Bāndarban, Bangladesh
Bāndarban, Bangladesh

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Fuehrer H.-P.,Medical University of Vienna | Fuehrer H.-P.,Malaria Research Initiative Bandarban | Stadler M.-T.,Biomedical Science | Buczolich K.,Medical University of Vienna | And 3 more authors.
Journal of Clinical Microbiology | Year: 2012

The primers traditionally used to detect Plasmodium ovale infections are known for not binding all P. ovale parasites within the small-subunit rRNA gene when used alone. We describe a simple, cost- and time-efficient multiplex nested PCR and a nested PCR using a novel set of primers for the simultaneous detection of P. ovale curtisi and P. ovale wallikeri. Copyright © 2012, American Society for Microbiology. All Rights Reserved.


Starzengruber P.,Medical University of Vienna | Starzengruber P.,Malaria Research Initiative Bandarban | Swoboda P.,Medical University of Vienna | Swoboda P.,Malaria Research Initiative Bandarban | And 16 more authors.
PLoS ONE | Year: 2012

Objective: Recent reports indicate that first cases of genuine artemisinin resistance have already emerged along the Thai-Cambodian border. The main objective of this trial was to track the potential emergence of artemisinin resistance in Bangladesh, which in terms of drug resistance forms a gateway to the Indian subcontinent. Methods: We conducted an open-label, randomized, controlled 42-day clinical trial in Southeastern Bangladesh to investigate the potential spread of clinical artemisinin resistance from Southeast Asia. A total of 126 uncomplicated falciparum malaria patients were randomized to one of 3 treatment arms (artesunate monotherapy with 2 or 4 mg/kg/day once daily or quinine plus doxycycline TID for 7 days). Only cases fulfilling a stringent set of criteria were considered as being artemisinin-resistant. Findings: The 28-day and 42-day cure rates in the artesunate monotherapy (2 and 4 mg/kg) and quinine/doxycyline arms were 97.8% (95% confidence interval, CI: 87.8-99.8%), 100% (95% CI: 91.1-100%), and 100% (95% CI: 83.4-100%), respectively. One case of re-infection was seen in the artesunate high dose arm, and a single case of recrudescence was observed in the low dose group on day 26. No differences in median parasite and fever clearance times were found between the 2 artesunate arms (29.8 h and 17.9 h vs. 29.5 h and 19.1 h). Not a single case fulfilled our criteria of artemisinin resistance. Parasite clearance times were considerably shorter and ex vivo results indicate significantly higher susceptibility (50% inhibitory concentration for dihydroartemisinin was 1.10 nM; 95% CI: 0.95-1.28 nM) to artemisinins as compared to SE-Asia. Conclusion: There is currently no indication that artemisinin resistance has reached Bangladesh. However, the fact that resistance has recently been reported from nearby Myanmar indicates an urgent need for close monitoring of artemisinin resistance in the region. Trial Registration: ClinicalTrials.gov NCT00639873. © 2012 Starzengruber et al.


Fuehrer H.-P.,Medical University of Vienna | Fuehrer H.-P.,Malaria Research Initiative Bandarban | Habler V.E.,Medical University of Vienna | Habler V.E.,Malaria Research Initiative Bandarban | And 11 more authors.
International Journal for Parasitology | Year: 2012

In spite of the high prevalence of malaria in Bangladesh and other southern Asian countries, there remains a substantial shortage of knowledge about the less common human malaria parasites. Recent studies indicate that Plasmodium ovale is made up of two species, namely Plasmodium ovale wallikeri and Plasmodium ovale curtisi. Genus- and species-specific nested PCR analyses of the ssrRNA gene was used to detect P. ovale infections among 2,246 diagnostic samples. Plasmodium ovale infections were further differentiated by nested PCR of the potra gene and multilocus sequence analysis of the cox1, porbp2 and the ssrRNA genes. Both P. ovale curtisi and P. ovale wallikeri occur sympatrically in the Chittagong Hill Tracts, Bangladesh and all patients presented with a mild or asymptomatic symptom complex at the time of diagnosis. The pathogens can be differentiated by nested PCRs targeting the ssrRNA and potra genes, and display dimorphism in multilocus sequence analyses. We believe that we report the first evidence of sympatric P. ovale curtisi and P. ovale wallikeri in southern Asia within a relatively confined study area of less than 5,000km 2. High rates of mixed infections, the emergence of "new" human malaria parasite species and the evidence of zoonotic capability call for optimised diagnostic strategies for a new era of eradication. © 2012 Australian Society for Parasitology Inc.


Starzengruber P.,Medical University of Vienna | Starzengruber P.,Malaria Research Initiative Bandarban | Fuehrer H.-P.,Medical University of Vienna | Fuehrer H.-P.,Malaria Research Initiative Bandarban | And 16 more authors.
Malaria Journal | Year: 2014

Background: The WHO has reported that RDT and microscopy-confirmed malaria cases have declined in recent years. However, it is still unclear if this reflects a real decrease in incidence in Bangladesh, as particularly the hilly and forested areas of the Chittagong Hill Tract (CHT) Districts report more than 80% of all cases and deaths. surveillance and epidemiological data on malaria from the CHT are limited; existing data report Plasmodium falciparum and Plasmodium vivax as the dominant species. Methods. A cross-sectional survey was conducted in the District of Bandarban, the southernmost of the three Hill Tracts Districts, to collect district-wide malaria prevalence data from one of the regions with the highest malaria endemicity in Bangladesh. A multistage cluster sampling technique was used to collect blood samples from febrile and afebrile participants and malaria microscopy and standardized nested PCR for diagnosis were performed. Demographic data, vital signs and splenomegaly were recorded. Results: Malaria prevalence across all subdistricts in the monsoon season was 30.7% (95% CI: 28.3-33.2) and 14.2% (95% CI: 12.5-16.2) by PCR and microscopy, respectively. Plasmodium falciparum mono-infections accounted for 58.9%, P. vivax mono-infections for 13.6%, Plasmodium malariae for 1.8%, and Plasmodium ovale for 1.4% of all positive cases. In 24.4% of all cases mixed infections were identified by PCR. The proportion of asymptomatic infections among PCR-confirmed cases was 77.0%, oligosymptomatic and symptomatic cases accounted for only 19.8 and 3.2%, respectively. Significantly (p < 0.01) more asymptomatic cases were recorded among participants older than 15 years as compared to younger participants, whereas prevalence and parasite density were significantly (p < 0.01) higher in patients younger than 15 years. Spleen rate and malaria prevalence in two to nine year olds were 18.6 and 34.6%, respectively. No significant difference in malaria prevalence and parasite density was observed between dry and rainy season. Conclusions: A large proportion of asymptomatic plasmodial infections was found which likely act as a reservoir of transmission. This has major implications for ongoing malaria control programmes that are based on the treatment of symptomatic patients. These findings highlight the need for new intervention strategies targeting asymptomatic carriers. © 2014 Starzengruber et al.; licensee BioMed Central Ltd.


Starzengruber P.,Medical University of Vienna | Starzengruber P.,Malaria Research Initiative Bandarban | Fuehrer H.-P.,Medical University of Vienna | Fuehrer H.-P.,Malaria Research Initiative Bandarban | And 9 more authors.
Malaria Journal | Year: 2014

Background: Spreading resistance of Plasmodium falciparum to existing drugs calls for the search for novel anti-malarial drugs and combinations for the treatment of falciparum malaria. Methods. In vitro and ex vivo investigations were conducted with fresh P. falciparum field isolates and culture-adapted P. falciparum clones to evaluate the anti-malarial potential of mirincamycin, a lincosamide, alone and in combination with tafenoquine (TQ), dihydroartemisinin (DHA), and chloroquine (CQ). All samples were tested in a histidine-rich protein 2 (HRP2) drug susceptibility assay. Results: Interaction analysis showed additive to synergistic interaction profiles with these potential partner drugs, with an overall geometric mean fractional inhibitory concentration at 50% inhibition (FIC50) of 0.78, 0.80 and 0.80 for mirincamycin with TQ, DHA, and CQ, respectively. Antagonism was not found in any of the tested field isolates or clones. The strongest tendency toward synergy (i.e. the lowest FIC) was seen with a combination ratio of 1:0.27 to 1:7.2 (mean 1:2.7) for the combination with tafenoquine. The optimal combination ratios for DHA and CQ were 1:444.4 to 1:36,000 (mean 1:10,755.5) and 1:2.7 to 1:216 (mean 1:64.5), respectively. No evidence of an activity correlation (i.e. potential cross-resistance) with DHA, mefloquine, quinine or chloroquine was seen whereas a significant correlation with the activity of clindamycin and azithromycin was detected. Conclusions: Mirincamycin combinations may be promising candidates for further clinical investigations in the therapy and prophylaxis of multidrug-resistant falciparum malaria or in combination with 4 or 8-aminoquinolines for the treatment and relapse prevention of vivax malaria. © 2014 Starzengruber et al.; licensee BioMed Central Ltd.


Swoboda P.,Medical University of Vienna | Swoboda P.,Malaria Research Initiative Bandarban | Ley B.,Medical University of Vienna | Ley B.,Malaria Research Initiative Bandarban | And 22 more authors.
American Journal of Tropical Medicine and Hygiene | Year: 2014

In malaria-endemic regions any febrile case is likely to be classified as malaria based on presumptive diagnosis largely caused by a lack of diagnostic resources. A district-wide prevalence study assessing etiologies of fever in 659 patients recruited in rural and semi-urban areas of Bandarban district in southeastern Bangladesh revealed high proportions of seropositivity for selected infectious diseases (leptospirosis, typhoid fever) potentially being misdiagnosed as malaria because of similarities in the clinical presentation. In an area with point prevalences of more than 40% for malaria among fever cases, even higher seroprevalence rates of leptospirosis and typhoid fever provide evidence of a major persistent reservoir of these pathogens. Copyright © 2014 by The American Society of Tropical Medicine and Hygiene.


Ganesh D.,Medical University of Vienna | Fuehrer H.-P.,Medical University of Vienna | Fuehrer H.-P.,Malaria Research Initiative Bandarban | Starzengruber P.,Medical University of Vienna | And 9 more authors.
Parasitology Research | Year: 2012

Malaria is still a major threat in many parts of the world with resistance spreading to almost all classes of antimalarials. The limited arsenal of available antimalarial drugs emphasizes the urgent need for novel antimalarial compounds. Owing to the fact that novel leads from nature have traditionally played a pivotal role in the development of various classes of antimalarials, we investigated a set of eight naturally occurring dietary flavonoids and their analogues for their antiplasmodial activity on clinical field isolates in southeastern Bangladesh and culture-adapted chloroquine-sensitive and chloroquine-resistant parasite clones. Except for taxifolin, all the other flavonoids had 50% inhibitory concentrations below 14 μM, both in the field and laboratory-adapted parasites. Neither of the flavonoids showed any activity correlation with chloroquine. The quercetin analogue rutin (7.10±10.32 μM) was the most active substance in field isolates as well as laboratory-adapted cultures (3.53±13.34 μM in 3D7 and 10.38± 15.08 μM in K1), providing the first evidence of its activity against Plasmodium falciparum parasites. Thus, our results provide important evidence of the antimalarial activity of flavonoids in traditional use and thus warrant further investigation of these compounds as potential antiplasmodial agents. © Springer-Verlag 2011.


Fuehrer H.-P.,Medical University of Vienna | Fuehrer H.-P.,Malaria Research Initiative Bandarban | Igel P.,Malaria Research Initiative Bandarban | Igel P.,University of Veterinary Medicine Vienna | And 11 more authors.
Parasitology Research | Year: 2012

A large variety of ectoparasites parasitizing on livestock, dogs, and rodents are documented throughout the world, of which several are proven vectors for major (including zoonotic) diseases affecting humans and/or livestock. However, there remains a significant lack of knowledge in regard to the ectoparasite fauna in remote regions of the developing world, such as southeastern Bangladesh, and an urgent need to investigate this fauna to improve diagnostic options. In the course of the present study, more than 5,300 ectoparasites were collected by flag dragging and handpicking of livestock, dogs, and rodents in the District of Bandarban (Chittagong Hill Tracts) in southeastern Bangladesh. Three tick species were identified: Haemaphysalis bispinosa (flagging, cattle, goats, and dogs), Rhipicephalus microplus (cattle, goats), and Rhipicephalus sanguineus (dogs, goats, and flagging). H. bispinosa was the dominant tick species on mammalian hosts as well as on vegetation. Furthermore, Ctenocephalides canis (dogs, goats) and Linognatus sp. (goat) were found. Overall, 73 rodents of eight different species (e.g., Mus musculus, Rattus sikkimensis, Bandicota bengalensis, and Niviventer sp.) hosted a variety of ectoparasites such as mites (Laelaps nuttali, Laelaps echidninus, Lyponissoides sp. and Ornithonyssus bacoti), fleas (Xenopsylla cheopis), and one myiasis-causing dipteran species. Monitoring the ectoparasite burden of livestock and other mammals is urgently needed in order to control ectoparasites associated with social and economic burden (e.g., reduced milk production, weight loss). Several zoonotic diseases can be transmitted by ectoparasites in this area, where the majority of the population live in basic housing conditions and in direct contact with livestock, dogs, and rodents. ©Springer-Verlag 2012.


Fuehrer H.-P.,Medical University of Vienna | Fuehrer H.-P.,Malaria Research Initiative Bandarban | Igel P.,Malaria Research Initiative Bandarban | Igel P.,University of Veterinary Medicine Vienna | Auer H.,Medical University of Vienna
Parasitology Research | Year: 2011

Capillaria hepatica (syn. for Calodium hepaticum) is a zoonotic nematode parasitizing in the livers of rodents as main hosts and in numerous other mammals including humans. It is the causative agent of the rare conditions of hepatic capillariosis and spurious C. hepatica infections in humans. In this review, 163 reported cases of infestations with this parasite (72 reports of hepatic capillariosis, 13 serologically confirmed infestations and 78 observations of spurious infections) are summarized with an overview on the distribution, symptoms, pathology, diagnosis, serology and therapy of this rare human pathogen. © 2011 Springer-Verlag.


Fuehrer H.-P.,University of Veterinary Medicine Vienna | Fuehrer H.-P.,Malaria Research Initiative Bandarban | Fuehrer H.-P.,Medical University of Vienna | Treiber M.,Malaria Research Initiative Bandarban | And 9 more authors.
Parasitology Research | Year: 2013

Dirofilaria immitis is a parasite of domestic and wild canids and felids in tropical, subtropical and temperate regions throughout the world. The canine heartworm (D. immitis) is the causative agent of canine and feline cardiopulmonary dirofilariasis. This parasite is known to cause a zoonotic disease, namely human pulmonary dirofilariasis. D. immitis is known to be endemic in several South and Southeast Asian countries (e.g. India and Malaysia), but there has previously been no information about the presence of this pathogen in Bangladesh. We present a case of canine dirofilariasis caused by D. immitis in rural southeastern Bangladesh. A male filaroid nematode (95 mm in length and 1.94 mm in width) was identified in the heart of a dog. Species classification was performed by microscopy and molecular tools. Sequence analysis revealed a 100 % identity within the mitochondrial cytochrome c oxidase I (CO1) gene to two Chinese and one Australian D. immitis samples. Usually, dogs stay outside overnight with a high risk to get infected with D. immitis via nocturnal mosquito vectors, which may lead to high prevalences of this pathogen in the canine population and thus increase the risk of human infections with this neglected parasitic disease. © 2013 Springer-Verlag Berlin Heidelberg.

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