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Krampa FD, Aniweh Y, Awandare GA, Kanyong P. Recent Progress in the Development of Diagnostic Tests for Malaria. Diagnostics (Basel) 2017; 7:diagnostics7030054. [PMID: 28925968 PMCID: PMC5617953 DOI: 10.3390/diagnostics7030054] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Revised: 09/13/2017] [Accepted: 09/14/2017] [Indexed: 02/07/2023] Open
Abstract
The impact of malaria on global health has continually prompted the need to develop effective diagnostic strategies. In malaria endemic regions, routine diagnosis is hampered by technical and infrastructural challenges to laboratories. These laboratories lack standard facilities, expertise or diagnostic supplies; thus, therapy is administered based on clinical or self-diagnosis. There is the need for accurate diagnosis of malaria due to the continuous increase in the cost of medication, and the emergence and spread of drug resistant strains. However, the widely utilized Giemsa-stained microscopy and immunochromatographic tests for malaria are liable to several drawbacks, including inadequate sensitivity and false-positive outcomes. Alternative methods that offer improvements in performance are either expensive, have longer turnaround time or require a level of expertise that makes them unsuitable for point-of-care (POC) applications. These gaps necessitate exploration of more efficient detection techniques with the potential of POC applications, especially in resource-limited settings. This minireview discusses some of the recent trends and new approaches that are seeking to improve the clinical diagnosis of malaria.
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Affiliation(s)
- Francis D Krampa
- West African Centre for Cell Biology of Infectious Pathogens (WACCBIP), University of Ghana, Legon, Accra, Ghana.
- Department of Biochemistry, Cell & Molecular Biology, University of Ghana, Legon, Accra, Ghana.
| | - Yaw Aniweh
- West African Centre for Cell Biology of Infectious Pathogens (WACCBIP), University of Ghana, Legon, Accra, Ghana.
| | - Gordon A Awandare
- West African Centre for Cell Biology of Infectious Pathogens (WACCBIP), University of Ghana, Legon, Accra, Ghana.
- Department of Biochemistry, Cell & Molecular Biology, University of Ghana, Legon, Accra, Ghana.
| | - Prosper Kanyong
- West African Centre for Cell Biology of Infectious Pathogens (WACCBIP), University of Ghana, Legon, Accra, Ghana.
- Nanotechnology & Integrated Bioengineering Centre, Ulster University, Jordanstown BT37 0QB, UK.
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Harris P, Price S, Senthuran S, Cochupanachimootil J, Norton R. Automated erythrocytapheresis for severe falciparum malaria. Intern Med J 2011; 41:60-3. [PMID: 21265962 DOI: 10.1111/j.1445-5994.2010.02362.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We describe a case of severe falciparum malaria with hyperparasitaemia. Treatment with automated erythrocytapheresis, in conjunction with parenteral artesunate, produced a rapid and sustained fall in parasite burden. Several poor prognostic features were present at admission. Despite the development of a severe headache with abnormal cerebrospinal fluid parameters and transient pulmonary oedema, a complete recovery was observed. Erythrocytapheresis can be considered in selected cases where facilities exist and has theoretical and practical advantages over traditional methods of red cell exchange transfusion. The paucity of systematic or trial evidence convincingly demonstrating a benefit in terms of morbidity or mortality has limited its application. However, the lack of robust trial data should not in itself invalidate considering this therapeutic option in the appropriate context.
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Affiliation(s)
- P Harris
- Pathology QueenslandDepartments of Haematology and Oncology Department of Intensive Care Medicine, Townsville Hospital, Townsville, Queensland, Australia.
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Kestler A, Kestler M, Morchi R, Lowenstein S, Anderson B. Developing and testing a high-fidelity simulation scenario for an uncommon life-threatening disease: severe malaria. J Trop Med 2011; 2011:310524. [PMID: 21760807 PMCID: PMC3134186 DOI: 10.1155/2011/310524] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2010] [Revised: 01/25/2011] [Accepted: 03/13/2011] [Indexed: 11/22/2022] Open
Abstract
Background. Severe malaria is prevalent globally, yet it is an uncommon disease posing a challenge to education in nonendemic countries. High-fidelity simulation (sim) may be well suited to teaching its management. Objective. To develop and evaluate a teaching tool for severe malaria, using sim. Methods. A severe malaria sim scenario was developed based on 5 learning objectives. Sim sessions, conducted at an academic center, utilized METI ECS mannequin. After sim, participants received standardized debriefing and completed a test assessing learning and a survey assessing views on sim efficacy. Results. 29 participants included 3rd year medical students (65%), 3rd year EM residents (28%), and EM nurses (7%). Participants scored average 85% on questions related to learning objectives. 93% felt that sim was effective or very effective in teaching severe malaria, and 83% rated it most effective. All respondents felt that sim increased their knowledge on malaria. Conclusion. Sim is an effective tool for teaching severe malaria in and may be superior to other modalities.
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Affiliation(s)
- Andrew Kestler
- Department of Emergency Medicine, University of Colorado School of Medicine, 12401 E. 17th Avenue, B215, Aurora, CO 80045, USA
| | - Mary Kestler
- Department of Emergency Medicine, University of Colorado School of Medicine, 12401 E. 17th Avenue, B215, Aurora, CO 80045, USA
| | - Ravi Morchi
- Department of Emergency Medicine, University of Colorado School of Medicine, 12401 E. 17th Avenue, B215, Aurora, CO 80045, USA
| | - Steven Lowenstein
- Department of Emergency Medicine, University of Colorado School of Medicine, 12401 E. 17th Avenue, B215, Aurora, CO 80045, USA
| | - Britney Anderson
- Department of Emergency Medicine, University of Colorado School of Medicine, 12401 E. 17th Avenue, B215, Aurora, CO 80045, USA
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Schwake L, Streit JP, Edler L, Encke J, Stremmel W, Junghanss T. Early treatment of imported falciparum malaria in the intermediate and intensive care unit setting: an 8-year single-center retrospective study. Crit Care 2008; 12:R22. [PMID: 18294371 PMCID: PMC2374613 DOI: 10.1186/cc6796] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2007] [Revised: 12/12/2007] [Accepted: 02/22/2008] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Imported falciparum malaria is characterized by a broad spectrum of potentially life-threatening complications that may arise even after initiation of appropriate antimalarial drug therapy. Hence, at Heidelberg University Hospital, all patients with newly diagnosed falciparum malaria are initially treated in the intermediate care unit (IMC) or intensive care unit (ICU). The present study was undertaken to evaluate critically the benefit of this strategy, which includes daily consultation with senior specialists in tropical medicine. METHODS We conducted a retrospective cohort study at the 14-bed combined IMC/ICU of a 1,685-bed university hospital. A cohort of 122 patients with imported falciparum malaria admitted from 1 January 1996 to 31 December 2003 was included. RESULTS Thirty-four patients (27.9%) developed complications, defined according to the current World Health Organization classification. Most patients (80.3%) studied did not take the recommended chemoprophylaxis against malaria. The majority of patients (89.3% [n = 109]) could be adequately treated in the IMC. Life-threatening complications requiring ICU support occurred in 13 patients (10.7%). All complications were successfully managed. Fifty-five patients (45.1%) fulfilling recently published criteria for outpatient treatment had an excellent therapeutic response and did not require ICU support. CONCLUSION This retrospective evaluation demonstrated favourable therapeutic results in hospitalized patients with imported falciparum malaria. Both initial treatment in the medical IMC/ICU and close collaboration between intensivists and specialists in tropical medicine may improve disease outcome among affected patients. Prospective studies are needed to confirm these preliminary findings.
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Affiliation(s)
- Lukas Schwake
- Department of Internal Medicine IV (Gastroenterology, Infectious Diseases and Intensive Care Medicine), University Hospital Heidelberg, Im Neuenheimer Feld, D-69120 Heidelberg, Germany
| | - Judith Pamela Streit
- Department of Internal Medicine IV (Gastroenterology, Infectious Diseases and Intensive Care Medicine), University Hospital Heidelberg, Im Neuenheimer Feld, D-69120 Heidelberg, Germany
| | - Lutz Edler
- Department of Biostatistics, German Cancer Research Center, Im Neuenheimer Feld, D-69120 Heidelberg, Germany
| | - Jens Encke
- Department of Internal Medicine IV (Gastroenterology, Infectious Diseases and Intensive Care Medicine), University Hospital Heidelberg, Im Neuenheimer Feld, D-69120 Heidelberg, Germany
| | - Wolfgang Stremmel
- Department of Internal Medicine IV (Gastroenterology, Infectious Diseases and Intensive Care Medicine), University Hospital Heidelberg, Im Neuenheimer Feld, D-69120 Heidelberg, Germany
| | - Thomas Junghanss
- Section of Clinical Tropical Medicine, University Hospital Heidelberg, Im Neuenheimer Feld, D-69120 Heidelberg, Germany
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Carod-Artal FJ. Stroke in central nervous system infections. Ann Indian Acad Neurol 2008; 11:S64-S78. [PMID: 35721447 PMCID: PMC9204120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2007] [Revised: 02/27/2008] [Accepted: 04/29/2008] [Indexed: 12/03/2022] Open
Abstract
Background Stroke subtypes and etiology may differ between developing and developed countries. Infections are a relatively common cause of stroke in tropical regions. Objective To review the main infectious diseases associated with stroke. Discussion Prevalence of stroke in HIV patients is around 1%. Pathogenic mechanisms include HIV vasculopathy, vasculitis, cardioembolism, acquired hypercoagulability, and the effect of opportunistic infections. Treatment with protease inhibitors has been associated with premature atherosclerotic vascular disease. Emerging viral infections that are associated with stroke include viral hemorrhagic fevers, Japanese encephalitis, dengue, and West Nile virus. Vasculitis involving perforating vessels of the brain is a cerebrovascular complication of tuberculous meningitis. Small, medium, and large arteries of the anterior circulation can be involved. A progressive intracranial arteriopathy afterLeptospira interrogansinfection has been described, which involves the large intracranial arteries. Cerebrovascular complications of mycosis are associated with large vessel vasculitis, direct vessel damage by invasion or embolization, and subarachnoid hemorrhage due to mycotic aneurysm rupture. Pathological findings of cerebral malaria include diffuse cerebral edema, perivascular ring hemorrhages, white matter necrosis, parenchyma petechial hemorrhages, occlusion of brain vessels, and sequestration of infected erythrocytes in cortical and perforating arteries. Stroke can occur in subarachnoid neurocysticercosis and the lesions in such cases consist mostly of deep lacunar infarctions resulting from endarteritis of small penetrating arteries. Cardiac arrhythmias, congestive heart failure, apical aneurysm, and mural thrombus are the conditions that predispose patients with American trypanosomiasis to cardioembolism. Gnathostoma spinigerum infestation is a cause of hemorrhagic stroke in Asia. Conclusion Infectious and tropical diseases should be included in the differential diagnoses of stroke.
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Bottieau E, Clerinx J, Van Gompel A. Hospitalization criteria in imported falciparum malaria. J Travel Med 2008; 15:60; author reply 60-1. [PMID: 18217874 DOI: 10.1111/j.1708-8305.2007.00180_1.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Cherian S, Burgner D. Selective ambulatory management of Plasmodium falciparum malaria in paediatric refugees. Arch Dis Child 2007; 92:983-6. [PMID: 17604304 PMCID: PMC2083582 DOI: 10.1136/adc.2006.114801] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/25/2007] [Indexed: 11/04/2022]
Abstract
BACKGROUND Plasmodium falciparum (Pf) malaria is a leading cause of childhood mortality and morbidity. In developed countries, it is widely recommended that even patients with uncomplicated Pf malaria are hospitalised for at least 24 h, whereas ambulatory treatment is usual for uncomplicated infections in developing countries. This observational study assessed the safety of selective admission of paediatric refugees with Pf malaria in Australia. METHODS Data were collected on African humanitarian refugee children (<16 years of age) presenting with malaria between February 2005 and April 2006. Children were treated as outpatients if they fulfilled specific criteria devised to maximise the safety of outpatient management of this potentially life-threatening condition. RESULTS Ninety paediatric refugees were infected with P falciparum, of whom 56 were treated as outpatients. Of the 34 children admitted to hospital, four had parasite loads > or =4%. Most children were treated with oral atovaquone-proguanil. Eighty eight patients attended follow-up; all were compliant and none reported side-effects. One infant failed treatment and was subsequently readmitted; he did not meet criteria for severe malaria on either occasion and had been initially treated as an inpatient. CONCLUSIONS Using this protocol, outpatient management of refugee children with Pf malaria appears safe, with minimal complication and treatment failure rates. This approach has rationalised management of paediatric malaria in this carefully selected population and substantially reduced utilisation of hospital resources.
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Affiliation(s)
- Sarah Cherian
- School of Paediatrics and Child Health, University of Western Australia and Paediatric Infectious Diseases and Refugee Health, Princess Margaret Hospital for Children, Perth, Western Australia, Australia
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Affiliation(s)
- Ashley M Croft
- Medical Branch, Headquarters 5th Division, Copthorne Barracks, Shrewsbury SY3 8LZ, UK.
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Affiliation(s)
- Ashley M Croft
- Medical Branch, Headquarters 5th Division, Copthorne Barracks, Shrewsbury SY3 8LZ, UK.
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