Biomedical subjects

Kevin Marsh

Publications and source records attributed to Kevin Marsh.

77 records · Page 5Linked to original sources

PubMed2002

Short report: Positive correlation between rosetting and parasitemia in Plasmodium falciparum clinical isolates.

Plasmodium falciparum isolates that form rosettes with uninfected red cells are associated with severe malaria in African children, although the mechanism by which rosetting contributes to severe disease is unknown. Here we have analyzed the relationship between rosetting and parasitemia in two samples of clinical isolates from children with malaria in Kilifi, Kenya. A consistent positive correlation was found between rosetting and parasitemia (Spearman's rank correlation coefficent p = 0.467, P < .001, n = 154, for 1993 study; p = .407, P < .001, n = 74, for 2000 study). Rosetting may enhance parasite growth and survival by facilitating invasion or promoting immune evasion, thus allowing higher parasitemia to develop and increasing the likelihood of severe malaria.

Animals↗

PubMed2002

Nonimmune IgM, but not IgG binds to the surface of Plasmodium falciparum-infected erythrocytes and correlates with rosetting and severe malaria.

Recent work suggests that IgG and IgM from nonimmune human serum (natural antibodies) bind to the surface of Plasmodium falciparum-infected erythrocytes and contribute to rosette formation by stabilizing the interaction between infected and uninfected erythrocytes. Here we show, in both laboratory clones and field isolates, that only IgM but not IgG is detected on the surface of infected cells. In field isolates, there was a strong positive correlation between IgM binding and rosette formation (Spearman's rank correlation coefficient p = 0.804, P < 0.001). Both rosette formation and IgM binding were associated with severe malaria, although statistical analysis indicates that rosette formation is the more strongly associated variable. Rosette formation, but not IgM binding, was also associated with malarial anemia. We conclude that IgM is the predominant class of natural antibodies binding to the surface of infected erythrocytes. However, we could not confirm previous suggestions that infected erythrocytes are coated with nonimmune IgG, which could lead to their interaction with host Fcgamma receptors.

Animals↗

PubMed1994

Pharmacology of absorption and distribution: optimal use of antimalarial drugs in the treatment of severe falciparum malaria in Kenya.

Since 1989, a project at the KEMRI CRC Unit at Kilifi has focused on the design of appropriate and practicable regimens for the treatment of severe falciparum malaria. Initially, there was no data describing the absorption, distribution and elimination of quinine in Kenyan children, who constitute the great majority of patients. Pharmacokinetic studies were conducted to define these variables, which formed the basis for the design of appropriate and practicable treatment regimens. Even with optimal clinical management, the majority is high in cases of severe malaria treated with quinine at Kilifi. Alternative drugs have been studied in a search for a therapeutic regimen that will further reduce mortality.

Journal Article↗

PubMed1994

The role of the district hospital in child survival at the Kenyan Coast.

Strategies for improving child survivorship in sub-Saharan Africa by the year 2000 have focused on low-cost, peripheral preventative and curative activities often with little reference to essential clinical services offered by hospitals at the district level. However, the recent World Bank World Development Report has re-emphasised the potential of district hospitals within selective PHC activities. We have estimated the likely impact of in-patient care offered by a rural district hospital on the Kenyan coast on under 5's mortality through comprehensive demographic and hospital surveillance. Within this population, childhood mortality may have been reduced by 44% as a result of hospital in-patient care. Strengthened referral systems, improvements in hospital accessibility, and better hospital care should be an integral part of PHC and other health promotion activities in sub-Saharan Africa.

Journal Article↗

PubMedDate not supplied

The effects of untreated bednets on malaria infection and morbidity on the Kenyan coast.

A study was conducted in order to determine whether children that slept under untreated bednets were protected against both malaria infection and clinical disease compared with children not sleeping under bednets. The study was conducted in Kilifi District, Kenya, during the malaria season (June-August, 2000) and involved 416 children aged < or = 10 years. Data collected from a cross-sectional survey showed evidence of protection against malaria infection among children sleeping under untreated bednets in good condition compared with those not using nets (adjusted odds ratio [AOR] = 0.4, 95% CI 0.22-0.72, P = 0.002). There was no evidence of a protective effect against infection when comparing those that used untreated bednets that were worn and those not using nets (AOR = 0.75, 95% CI 0.34-1.63, P = 0.47). When these same children were followed-up during the malaria season, there was evidence of a lower rate of clinical malaria among those that used untreated nets in good condition (adjusted incidence rate ratio = 0.65, 95% CI 0.45-0.94, P = 0.022), while the rate of clinical malaria among those that used untreated bednets that were worn was similar to that of those that did not use bednets. In the face of persistent failure of communities to take up net retreatment, there is hope that untreated nets will offer some protection against malaria infection and disease compared with not using nets at all.

Bedding and Linens↗