Evaluation of red blood cell count as an ancillary index to hemoglobin level in defining the severe falciparum malarial anemia among Ghanaian children in low-resource communities

Host-parasite interaction in severe and uncomplicated malaria infection in ghanaian children

PURPOSE

During malarial infection, both parasites and host red blood cells (RBCs) come under severe oxidative stress due to the production of free radicals. The host system responds in protecting the RBCs against the oxidative damage caused by these free radicals by producing antioxidants. In this study, we investigated the antioxidant enzyme; superoxide dismutase (SOD) activity and cytokine interactions with parasitaemia in Ghanaian children with severe and uncomplicated malaria.

METHODOLOGY

One hundred and fifty participants aged 0-12 years were administered with structured questionnaires. Active case finding approach was used in participating hospitals to identify and interview cases before treatment was applied. Blood samples were taken from each participant and used to quantify malaria parasitaemia, measure haematological parameters and SOD activity. Cytokine levels were measured by commercial ELISA kits. DNA comet assay was used to evaluate the extent of parasite DNA damage due to oxidative stress.

RESULTS

Seventy - Nine (79) and Twenty- Six (26) participants who were positive with malaria parasites were categorized as severe (56.75 × 103 ± 57.69 parasites/µl) and uncomplicated malaria (5.87 × 103 ± 2.87 parasites/µl) respectively, showing significant difference in parasitaemia (p < 0.0001). Significant negative correlation was found between parasitaemia and SOD activity levels among severe malaria study participants (p = 0.0428). Difference in cytokine levels (IL-10) amongst the control, uncomplicated and severe malaria groups was significant (p < 0.0001). The IFN-γ/IL-10 /TNF-α/IL-10 ratio differed significantly between the malaria infected and non- malaria infected study participants. DNA comet assay revealed damage to Plasmodium parasite DNA.

CONCLUSION

Critical roles played by SOD activity and cytokines as anti-parasitic defense during P. falciparum malaria infection in children were established.

Diagnostic utility of haematological parameters in predicting the severity of HIV infection in southwestern Ethiopia: a comparative cross-sectional study

OBJECTIVES

This study aimed to evaluate the diagnostic utility of haematological parameters as a predictive marker of the severity of HIV infection in southwestern Ethiopia.

DESIGN

Comparative cross-sectional study.

SETTING

This study was conducted in southwestern Ethiopia.

PARTICIPANTS

Venous blood samples were collected from 344 participants (172 HIV, 172 healthy controls (HC)) and haematological parameters were determined using the automated haematology analyser. The diagnostic utility of haematological parameters was determined by a receiver operating curve analysis. Data were analysed using SPSS V.21 and the p value was set at less than 0.05 for the statistical significance.

RESULTS

In this study, red cell count (RCC) distinguishes HIV-infected patients from HC at a threshold value of 4.05×109/L with sensitivity, specificity and an area under the curves (AUC) of 73.8%, 78.5% and 0.87, respectively. At a cut-off value of 4.25×109/L, RCC significantly distinguishes non-severe HIV-infected patients from HC with a sensitivity of 72.7%, specificity of 81.7% and an AUC of 0.86. Haemoglobin (Hgb) significantly differentiates severe HIV-infected patients from HC with sensitivity, specificity and an AUC of 95.9%, 86.7% and 0.96, respectively. Platelet count (PLT) significantly discriminates HC from non-severe and severe HIV-infected patients with an AUC of 0.74 and 0.963, respectively.

CONCLUSION

RCC, PLT and Hgb demonstrated better diagnostic performance in predicting the severity of HIV infection and have been identified as the best haematological markers in predicting the presence and severity of HIV infection. Thus, the haematological profiles (RCC, PLT and Hgb) should be used as an alternative marker to predict the severity of HIV infection and may provide supportive information for evidence-based interventions and early diagnosis of infections.

Assessment of intestinal and blood protozoan infections among pregnant women visiting ante-natal care at Tafo Hospital, Ghana

Introduction

Intestinal and blood protozoans cause morbidity and mortality in both pregnant women and developing foetuses worldwide. It constitutes a major health problem in many tropical areas in Africa. This study assessed the prevalence of intestinal and blood protozoans’ parasitic load and their risk factors among pregnant women visiting antenatal care at Tafo Hospital, Ghana from November 2016 to January 2017.

Method

A pilot cross-sectional study was conducted among consented pregnant women who visited antenatal care at Tafo Government Hospital, Kumasi Ghana. Structured questionnaires were administered to obtain socio-demographic data, knowledge on protozoan infections, and their risk factors among study participants. A stool sample was obtained from each participant for the microscopic examination of the intestinal protozoa. Venous blood was taken from participants for the detection of Plasmodium and Toxoplasma gondii infections. Wet mount and the faecal protozoan concentrated method were done for the identification of intestinal parasites. Blood films and serological examination for malaria rapid diagnostic tests (RDT) were done for identification of Plasmodium parasites while an Enzyme-linked immunosorbent assay (ELISA) was used for detecting the antibodies of T. gondii among participants. Data were analyzed using statistical packages for the social sciences (SPSS).

Results

The mean age of the study participants was 27.83, and ranges from 18 to 40 years. The majority of the participants (82.2%) had never experienced stillbirth nor spontaneous abortion. Intestinal parasites were found in 36.7% of participants. Giardia lamblia (28.1%), Cryptosporidium parvum (5.3%), and Entamoeba histolytica/dispar (3.3%) were among the intestinal protozoans detected. T. gondii antibodies were detected by high levels of immunoglobulins, resulting in IgG (48.0%) and IgM (11.3%) being found among participants, with 7.3% testing positive for both IgM and IgG. The prevalence of malaria infection among the study participants was 2.7%. The consumption of raw or cooked vegetables had significant influence on their intestinal and blood protozoan infections status (p = 0.004) (OR = 0.32, CI = 0.12–0.86). There was a significant association between Hb levels and malaria (p = 0.014) and that of intestinal protozoans (p = 0.035).

Conclusion

The prevalence of intestinal protozoans and blood protozoans such as T. gondii were high and therefore effective measures should be put in place to reduce the infectivity. Environmental hygiene should be improved and education by relevant agencies should be intensified on the possible transmission of intestinal and blood parasite infections given the possible role of these infections in adverse pregnancy outcomes.