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Domínguez García M, Feja Solana C, Vergara Ugarriza A, Bartolomé Moreno C, Melús Palazón E, Magallón Botaya R. Imported malaria cases: the connection with the European ex-colonies. Malar J 2019; 18:397. [PMID: 31801538 PMCID: PMC6891950 DOI: 10.1186/s12936-019-3042-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 11/27/2019] [Indexed: 12/03/2022] Open
Abstract
Background Imported malaria is increasing in non-endemic areas due to the increment of international travels, migration and, probably, other unknown factors. The objective of this study was to describe the epidemiological and clinical characteristics of malaria cases in a region of Spain; analyse the possible association between the variables of interest; compare this series with others; and evaluate the characteristics of imported malaria cases according to the country of origin, particularly cases from Equatorial Guinea (Spanish ex-colony) and from the rest of sub-Saharan Africa. Methods A descriptive observational study was carried out with a retrospective data collection of cases of malaria reported in Aragon from 1996 to 2017. Univariate and bivariate analysis of clinical–epidemiological variables was performed. In addition, an analysis of cases from sub-Saharan Africa was carried out using logistic regression, calculating odds ratio with its 95% confidence interval. Results 609 cases of malaria were recorded in Aragon from 1996 to 2017. An autochthonous case in 2010. 50.33% were between 15 and 39 years old. 45.65% of the cases were notified of the 4-weeks 9 to 12. 82.6% reside in the main province, urban area, of which 65.4% were VFR (Visiting Friends and Relatives), 23.8% new immigrants and 10.9% travellers. The infectious Plasmodium species par excellence was Plasmodium falciparum (88%). Analysing the cases from sub-Saharan Africa (95.2% of the total), 48.1% were from Equatorial Guinea. Comparing these with the cases from the rest of sub-Saharan Africa, it was observed that the cases from the Spanish ex-colony have association with the female gender, being under 5 years old, residing in the main province (urban area) and being a new immigrant. Conclusions The epidemiological profile of imported malaria cases can be defined as VFR between 15 and 39 years old, coming from sub-Saharan Africa, particularly from Equatorial Guinea. Immigrants education about the importance of chemoprophylaxis when travelling to visit friends and relatives, emphasizing on those who are originally from the ex-colonies of destination country, is necessary; as well as to raise awareness among health professionals to make advice in consultations, specially before summer vacations.
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Affiliation(s)
- Marta Domínguez García
- Aragonese Primary Care Research Group, IIS (Instituto de Investigación Sanitaria Aragón) GIIS-011, 50015, Zaragoza, Spain. .,Aragonese Health Service, Zaragoza, Spain. .,Aragonese Primary Care Research Group, B21-17R, Aragon Government, Zaragoza, Spain.
| | | | | | - Cruz Bartolomé Moreno
- Aragonese Primary Care Research Group, IIS (Instituto de Investigación Sanitaria Aragón) GIIS-011, 50015, Zaragoza, Spain.,Aragonese Health Service, Zaragoza, Spain.,Aragonese Primary Care Research Group, B21-17R, Aragon Government, Zaragoza, Spain
| | - Elena Melús Palazón
- Aragonese Primary Care Research Group, IIS (Instituto de Investigación Sanitaria Aragón) GIIS-011, 50015, Zaragoza, Spain.,Aragonese Health Service, Zaragoza, Spain.,Aragonese Primary Care Research Group, B21-17R, Aragon Government, Zaragoza, Spain.,University of Zaragoza, Zaragoza, Spain
| | - Rosa Magallón Botaya
- Aragonese Primary Care Research Group, IIS (Instituto de Investigación Sanitaria Aragón) GIIS-011, 50015, Zaragoza, Spain.,Aragonese Health Service, Zaragoza, Spain.,Aragonese Primary Care Research Group, B21-17R, Aragon Government, Zaragoza, Spain.,University of Zaragoza, Zaragoza, Spain
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Rojo-Marcos G, Rubio-Muñoz JM, Angheben A, Jaureguiberry S, García-Bujalance S, Tomasoni LR, Rodríguez-Valero N, Ruiz-Giardín JM, Salas-Coronas J, Cuadros-González J, García-Rodríguez M, Molina-Romero I, López-Vélez R, Gobbi F, Calderón-Moreno M, Martin-Echevarría E, Elía-López M, Llovo-Taboada J. Prospective comparative multi-centre study on imported Plasmodium ovale wallikeri and Plasmodium ovale curtisi infections. Malar J 2018; 17:399. [PMID: 30376868 PMCID: PMC6208040 DOI: 10.1186/s12936-018-2544-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 10/22/2018] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Few previous retrospective studies suggest that Plasmodium ovale wallikeri seems to have a longer latency period and produces deeper thrombocytopaenia than Plasmodium ovale curtisi. Prospective studies were warranted to better assess interspecies differences. METHODS Patients with imported P. ovale spp. infection diagnosed by thick or thin film, rapid diagnostic test (RDT) or polymerase chain reaction (PCR) were recruited between March 2014 and May 2017. All were confirmed by DNA isolation and classified as P. o. curtisi or P. o. wallikeri using partial sequencing of the ssrRNA gene. Epidemiological, analytical and clinical differences were analysed by statistical methods. RESULTS A total of 79 samples (35 P. o. curtisi and 44 P. o. wallikeri) were correctly genotyped. Males predominate in wallikeri group (72.7%), whereas were 48.6% in curtisi group. Conversely, 74.3% of curtisi group were from patients of African ethnicity, whilst 52.3% of Caucasians were infected by P. o. wallikeri. After performing a multivariate analysis, more thrombocytopaenic patients (p = 0.022), a lower number of platelets (p = 0.015), a higher INR value (p = 0.041), and shorter latency in Caucasians (p = 0.034) were significantly seen in P. o. wallikeri. RDT sensitivity was 26.1% in P. o. curtisi and 42.4% in P. o. wallikeri. Nearly 20% of both species were diagnosed only by PCR. Total bilirubin over 3 mg/dL was found in three wallikeri cases. Two patients with curtisi infection had haemoglobin under 7 g/dL, one of them also with icterus. A wallikeri patient suffered from haemophagocytosis. Chemoprophylaxis failed in 14.8% and 35% of curtisi and wallikeri patients, respectively. All treated patients with various anti-malarials which included artesunate recovered. Diabetes mellitus was described in 5 patients (6.32%), 4 patients of wallikeri group and 1 curtisi. CONCLUSIONS Imported P. o. wallikeri infection may be more frequent in males and Caucasians. Malaria caused by P. o. wallikeri produces more thrombocytopaenia, a higher INR and shorter latency in Caucasians and suggests a more pathogenic species. Severe cases can be seen in both species. Chemoprophylaxis seems less effective in P. ovale spp. infection than in P. falciparum, but any anti-malarial drug is effective as initial treatment. Diabetes mellitus could be a risk factor for P. ovale spp. infection.
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Affiliation(s)
- Gerardo Rojo-Marcos
- Hospital Universitario Príncipe de Asturias, Ctra de Meco s/n, 28805, Alcalá de Henares, Madrid, Spain.
| | | | | | - Stephane Jaureguiberry
- Hôpital Pitié-Salpêtrière, Assistance Publique des Hôpitaux de Paris (APHP), Paris, France
| | | | | | | | | | | | - Juan Cuadros-González
- Hospital Universitario Príncipe de Asturias, Ctra de Meco s/n, 28805, Alcalá de Henares, Madrid, Spain
| | | | | | | | - Federico Gobbi
- Ospedale Sacro Cuore - Don Calabria, Negrar, Verona, Italy
| | | | | | | | - José Llovo-Taboada
- Complejo Hospitalario Universitario de Santiago de Compostela, A Coruña, Spain
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Impact of using artemisinin-based combination therapy (ACT) in the treatment of uncomplicated malaria from Plasmodium falciparum in a non-endemic zone. Malar J 2016; 15:339. [PMID: 27368160 PMCID: PMC4930579 DOI: 10.1186/s12936-016-1408-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 06/20/2016] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Artemisinin-based combination therapy (ACT) has been adopted by the World Health Organization as a first-line treatment for uncomplicated Plasmodium falciparum malaria. In endemic regions, it has proven more effective in treating the disease, and even in reducing its transmission. Nonetheless, there is a scarcity of studies carried out in non-endemic areas on imported uncomplicated malaria. METHODS This is a retrospective, observational study performed on patients diagnosed and admitted with uncomplicated P. falciparum malaria between 2004 and 2015. The objective was to compare the parasite clearance period and the average hospital length of stay for patients treated with ACT vs those receiving other treatment regimens. RESULTS Eighty-five patients were included in the study. Fifty-one received ACT treatment (dihydroartemisinin-piperaquine) and thirty-four patients were treated with quinine sulfate+doxycycline or atovaquone/proguanil. The parasite clearance period was shorter in the group of patients treated with ACT compared to those receiving other treatment types: 24 h (IQR 24) vs 48 h (IQR 48), p < 0.01. The average hospital stay was also shorter in the ACT group with respect to the second group: 2.67 days (IQR 1.08) vs 3.96 days (IQR 2.87), p < 0.001. A mild case of hepatitis was registered in the group treated with ACT. CONCLUSIONS ACT treatment of admitted hospital patients with imported uncomplicated malaria from P. falciparum reduced the days spent hospitalized as well as producing a more rapid parasite clearance compared to classic treatment. In spite of being treated with safe medications, one has to be alert to possible adverse effects such as hepatitis and delayed haemolytic anaemia.
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Gancedo-García A, Terán-Álvarez L, Toyos-Munárriz C, Chudácik M, Suárez-Gil P. Prevención y diagnóstico de paludismo importado en atención primaria. Asturias 2002-2012. Aten Primaria 2014; 46:313-5. [PMID: 24792149 PMCID: PMC6983628 DOI: 10.1016/j.aprim.2014.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2014] [Revised: 01/26/2014] [Accepted: 02/09/2014] [Indexed: 11/23/2022] Open
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Visser BJ, Wieten RW, Nagel IM, Grobusch MP. Serum lipids and lipoproteins in malaria--a systematic review and meta-analysis. Malar J 2013; 12:442. [PMID: 24314058 PMCID: PMC4029227 DOI: 10.1186/1475-2875-12-442] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Accepted: 12/04/2013] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Serum lipid profile changes have been observed during malaria infection. The underlying biological mechanisms remain unclear. The aim of this paper is to provide an overview on those serum lipid profile changes, and to discuss possible underlying biological mechanisms and the role of lipids in malaria pathogenesis. METHODS A systematic review and meta-analysis to determine lipid profile changes during malaria was conducted, following PRISMA guidelines. Without language restrictions, Medline/PubMed, Embase, Cochrane Central Register of Controlled Trials, Web of Science, LILACS, Biosis Previews and the African Index Medicus were searched for studies published up to 11 July, 2013, that measured serum lipid parameters in malaria patients. Also, major trial registries were searched. Mean differences in lipid profile parameters were combined in fixed and random effects meta-analysis, with a separate analysis for different groups of controls (healthy, other febrile illnesses or very low parasitaemia). These parameters were also compared between severe malaria and uncomplicated malaria. Funnel plots were used to test for publication bias. RESULTS Of 2,518 studies reviewed, 42 met the criteria for inclusion in the qualitative analysis, and of these, 15 reported the necessary data for inclusion in the meta-analysis for cholesterol; nine for high-density lipoprotein (HDL), eight for low-density lipoprotein (LDL), and nine for triglycerides, respectively. Total cholesterol, HDL and LDL concentrations were lower in malaria and other febrile diseases compared to healthy controls. The decline was more pronounced and statistically significant during malaria compared to other febrile diseases. These results were consistent across included studies. Triglycerides were raised compared to healthy controls, but not statistically significant when compared to symptomatic controls. CONCLUSIONS This meta-analysis suggests that the observed lipid profile changes are characteristic for malaria. Although a definite link with the pathogenesis of malaria cannot yet be demonstrated, plausible hypotheses of biological mechanisms involving host lipid alterations and the pathogenesis of malaria exist. An increased research effort to elucidate the precise pathways is warranted, since this could lead to better understanding of malaria pathophysiology and consequently to novel treatment approaches.
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Affiliation(s)
| | | | | | - Martin P Grobusch
- Centre of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, PO Box 226601100 DD, Amsterdam, The Netherlands.
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Ramírez-Olivencia G, Rubio JM, Rivas P, Subirats M, Herrero MD, Lago M, Puente S. Imported submicroscopic malaria in Madrid. Malar J 2012; 11:324. [PMID: 22970903 PMCID: PMC3502252 DOI: 10.1186/1475-2875-11-324] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2012] [Accepted: 09/03/2012] [Indexed: 11/13/2022] Open
Abstract
Background Submicroscopic malaria (SMM) can be defined as low-density infections of Plasmodium that are unlikely to be detected by conventional microscopy. Such submicroscopic infections only occasionally cause acute disease, but they are capable of infecting mosquitoes and contributing to transmission. This entity is frequent in endemic countries; however, little is known about imported SMM. The goals of this study were two-fold: a) to know the frequency of imported SMM, and b) to describe epidemiological, laboratorial and clinical features of imported SMM. Methods A retrospective study based on review of medical records was performed. The study population consisted of patients older than 15 years attended at the Tropical Medicine Unit of Hospital Carlos III, between January 1, 2002 and December 31, 2007. Routinely detection techniques for Plasmodium included Field staining and microscopic examination through thick and thin blood smear. A semi-nested multiplex malaria PCR was used to diagnose or to confirm cases with low parasitaemia. Results SMM was diagnosed in 104 cases, representing 35.5% of all malaria cases. Mean age (IC95%) was 40.38 years (37.41-43.34), and sex distribution was similar. Most cases were in immigrants, but some cases were found in travellers. Equatorial Guinea was the main country where infection was acquired (81.7%). Symptoms were present only in 28.8% of all SMM cases, mainly asthenia (73.3% of symptomatic patients), fever (60%) and arthromialgias (53.3%). The associated laboratory abnormalities were anaemia (27.9%), leukopaenia (15.4%) and thrombopaenia (15.4%). Co-morbidity was described in 75 cases (72.1%). Conclusions Results from this study suggest that imported SMM should be considered in some patients attended at Tropical Medicine Units. Although it is usually asymptomatic, it may be responsible of fever, or laboratory abnormalities in patients coming from endemic areas. The possibility of transmission in SMM has been previously described in endemic zones, and presence of vector in Europe has also been reported. Implementation of molecular tests in all asymptomatic individuals coming from endemic area is not economically feasible. So re-emergence of malaria (Plasmodium vivax) in Europe may be speculated.
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Affiliation(s)
- Germán Ramírez-Olivencia
- Unit of Tropical Medicine, Infectious Disease Department, Hospital Carlos III, 1028029, Madrid, Spain.
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Cuadros González J. Malaria importada en España. Rev Clin Esp 2012; 212:24-5. [DOI: 10.1016/j.rce.2011.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2011] [Accepted: 10/16/2011] [Indexed: 10/14/2022]
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