The Albert Schweitzer Hospital was founded in 1913 by Albert Schweitzer himself in Lambaréné. Today the hospital is administered by the International Foundation for the Albert Schweitzer Hospital. It consists of the classical departments: Internal Medicine, Surgery, Pediatrics, Obstetrics, Dentistry and more recently a Research Unit.
Since Prof. Peter G. Kremsner (Head of Department of Parasitology at the Medical Faculty, University of Tübingen) was nominated Head of the Research Unit in March 1992, work has been focused on malaria.
Lambaréné is situated on the equator in a typical Central African rain forest area on the river Ogooué in Gabon. Temperature fluctuates around 27°C on average and rain falls throughout the year with considerably less rain in July and August.
The prevalence of plasmodial infection shows a hyperendemic pattern in and around Lambaréné. The predominant species is Plasmodium falciparum, responsible for more than 90% of all infections, together with some P. malariae and P. ovale infections (Wildling et al. Trop. Med. Parasitol. 46: 77, 1995).
In the Research Unit every patient coming to the hospital with a clinical diagnosis of malaria (mostly fever) is seen, which makes a total of about 12,000 patients a year. Of these around 5000 have malaria, the vast majority being children. Out of these, about 150 have severe malaria, mostly severe malarial anemia and hyperparasitemia. These patients are between 5 and 6 years old. The chemotherapy of choice for severe malaria is intravenous quinine plus clindamycin four days, which was found to be superior to quinine for seven days (Kremsner et alt Antimicrob. Agents Chemother. 39: 1603, 1995).
There are two main lines of malaria research in Lambaréné: Chemotherapy and pathophysiology. In chemotherapy the idea of combination chemotherapy was investigated in a series of clinical trials in different patient groups from adults and school children having uncomplicated malaria to young children having severe malaria (briefly summarized in an article in the May 1997 issue of Parasitol Today by Kremsner, Luty and Graninger).
In this way combinations of classical antimalarials with antibiotics, especially clindamycin were investigated (Kremsner et al. J. Infect. Dis. 169: 467, 1994 and Am. J. Trop. Med. Hyg. 50: 790, 1994). Currently, the combination of atovaquone and proguanil is investigated in chemotherapy (Radloff et al. Lancet 347: 1511, 1996) and chemoprophylaxis of malaria (Lell et al. Lancet 351: 709, 1998).
In pathophysiology the impact of cytokine regulation on the development of the disease was investigated, drawing special attention to the dual role of tumor necrosis factor (Kremsner et al. Am. J. Trop. Med. Hyg. 53: 532, 1995 and Mordmüller et al. Eur. Cytokine Netw. 8: 29, 1997) and nitric oxide (Prada and Kremsner Parasitol Today 11: 409, 1995 and Kremsner et al. Trans. Roy. Soc. Trop. Med. Hyg. 90: 44, 1996), both molecules seem to play pivotal roles in the initial antiparasitic response and possibly also later in severe malaria. In an ongoing large prospective longitudinal trial factors influencing the development of severe disease and the reinfection rate are studied in 100 children with severe malaria and 100 matched mild controls. In this study a mutation in the promoter of the nitric oxide synthase 2 was first described and associated with protection against malaria (Kun et alt Lancet 351: 265, 1998).
Prof. Peter G. Kremser, University of Tübingen
© Association Internationale de l'Oeuvre du Docteur Albert Schweitzer de Lambaréné (AISL)
9. July 2001