U.S. team to battle malaria in Peru

In the middle of the Peruvian Amazon, a battle against malaria – the second largest killer of people worldwide – will be undertaken by an international team of researchers led by tropical disease specialist Joseph Vinetz, M.D., from the University of California, San Diego (UCSD) School of Medicine. The team will also study a variety of other tropical infectious diseases endemic to the area.

With $750,000 from the Fogarty Training Grant for Global Infectious Diseases of the National Institutes of Health (NIH), Vinetz and the grant’s Peruvian co-director, Eduardo Gotuzzo, director of the Tropical Medicine Institute, Universidad Paruana Cayetano Heredia, will oversee a training program and research projects, both at the program headquarters in Iquitos, Peru, and at UCSD, where selected Peruvian researchers will receive advance medical-research training.

In spite of its virtual elimination in the United States, malaria is still the cause of approximately 1.5 million deaths a year and 300 million infections. Only tuberculosis cases outnumber malaria, and patients with HIV/AIDS rank third.

U.S. travelers to malaria-infested areas are susceptible to the disease and are warned by the Centers for Disease Control (CDC) to take anti-malarial medication. Also at risk are U.S. soldiers stationed around the world and the U.S. military is working on drugs and vaccines to try to prevent the disease in its overseas soldiers.

In recent years, there’s been an alarming increase in malaria cases in both the developed and developing world, partly due to an increasing resistance to chloroquine, the most common anti-malaria drug. The world areas most impacted by the disease are South America, Asia and Africa.

These are all reasons that Vinetz has chosen malaria and another infectious disease called leptospirosis as his areas of specialty. His colleagues are internationally recognized exper6ts who study intestinal parasitic and bacterial infections, bioterrorism diseases such as brucellosis, chronic disfiguring skin diseases such as leishmaniasis, and viruses transmitted by mosquitos. Beginning this summer, Vinetz will lead the international team of physicians from the U.S. and Peru in the NIH-funded training program titled “Endemic Infectious Diseases in the Peruvian Amazon.” Although focusing primarily on malaria, the program will also include other infectious diseases, such as leptospirosis, that impact disadvantaged populations in developing countries. The overall goals are to enhance research capacity in Peru, to establish research connections between UCSD and Peru to expand opportunities for biomedical research, and, overall, to create a model of multidisciplinary research in developing countries.

Epidemic malaria has rapidly emerged in the Peruvian Amazon region, increasing 50-fold between 1992-97. According to the CDC, Peru reports the second highest number of malaria cases in South America, after Brazil. The symptoms of malaria include fever and flu-like illness with chills, headache, muscle aches and fatigue. If not promptly treated, the disease may cause kidney failure, coma and death.

Leptospirosis is a bacterial disease transmitted from infected mammals (wild and domestic) to humans via infected urine that may be in water. It is primarily an occupational disease that affects farmers, veterinarians and sewer workers or others whose work involves animal contact. In humans, it causes a wide range of symptoms such as high fever, severe headache, muscle aches and abdominal distress. If the disease is not treated, the patient may develop kidney damage, meningitis, liver failure and respiratory distress.

“The overall goal of our UCSD program is to enhance Peruvian research capacity in all facets of biomedical research, including research in the lab, in the field and with human subjects. We’ll also cover research ethics and health economics,” Vinetz said. “Primarily, we’ll be in the Peruvian Amazon, training local researchers, physicians, biologists, nurses, and students wishing to pursue doctorates.”

Although the Peruvian people are motivated to research the infectious diseases in their region, there is a dearth of expertise and investment in people and physical infractructure, Vinetz noted. “We’ll be able to help them become self-sufficient.”

Peruvians who will serve as mentors for the NIH-funded program include Universidad Peruana Cayetano Heredia faculty Humberto Guerra, Jorge Arevalo, and Alejandro Llanos. Additional Peruvians are Graciela Meza, Universidad de Las Amazonas del Peru and Hermann Silva, Hospital Apoyo de Iquitos. UCSD faculty who will participate in the training project include C. Hoyt Bleakley, Joshua Fierer, Donald Guiney, Frances Gillin, Michael Kalichman, Lynette Corbeil, Sharon Reed, Victor Nizet and Monica Diaz.

Gary Klimpel, Robert Tesh and Scott Weaver from the University of Texas Medical Branch, and Margaret Kosek, Johns Hopkins University, will round out the project team. Peruvian physicians already at UCSD training include Universidad Peruana Cayetano Heredia medical graduates Jessica Ricaldi, who will be entering the Molecular Pathology doctoral program in the fall of 2004, and Christian Ganoza, both of whom will be returning to Peru to continue their scientific careers once they complete their training.

Prior to joining the UCSD faculty as an associate professor in 2002, Vinetz was an associate professor with the World Health Organization’s Collaborating Center for Tropical Diseases at the University of Texas Medical Branch in Galveston. His past experience also includes clinical training in internal medicine and infectious diseases at Johns Hopkins School of Medicine and as a Howard Hughes Physician Postdoctoral Fellow in the Laboratory of Parasitic Diseases at the National Institutes of Health.

Vinetz first visited Peru in 1998 and was a participant in the Gorgas Expert Course in Tropical Medicine in 2001, in which he now teaches. Now, he spends about two months a year in his state-of-the-art laboratory in Iquitos, Peru, where he has a group of 20 Peruvian researchers and collaborators. Vinetz’ malaria studies focuses on the molecular, cellular and biochemical mechanisms by which the malaria parasite (the ookinete) invades the mosquito mid-gut. His long-term goal is to develop strategies of blocking malaria transmission. In his research on leptospirosis, Vinetz and his team want to know why some patients develop only unapparent infection or mild disease, while others develop jaundice, renal failure, hemorrhage, meningitis and/or heart failure. Their studies range from epidemiology and ecology to immunology to molecular pathogenesis.