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Olisakwe SC, Thwing J, Dionne JA, Irvin R, Kachur PS, Bruxvoort KJ. Receipt of antimalarials among children aged 6-59 months in Nigeria from 2010 to 2021. Malar J 2024; 23:249. [PMID: 39160583 PMCID: PMC11334568 DOI: 10.1186/s12936-024-05075-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2024] [Accepted: 08/11/2024] [Indexed: 08/21/2024] Open
Abstract
BACKGROUND Nigeria has the highest malaria burden globally, and anti-malarials have been commonly used to treat malaria without parasitological confirmation. In 2012, Nigeria implemented rapid diagnostic tests (RDTs) to reduce the use of anti-malarials for those without malaria and to increase the use of artemisinin-based combination therapy (ACT) for malaria treatment. This study examined changes in anti-malarial receipt among children aged 6-59 months during a 12-year period of increasing RDT availability. METHODS A cross-sectional analysis was conducted using the Nigeria Malaria Indicator Survey (NMIS) data from 2010 (before RDT implementation in 2012), 2015, and 2021. The analysis assessed trends in prevalence of malaria by survey RDT result, and fever and anti-malarial/ACT receipt in the 2 weeks prior to the survey. A multivariable logistic regression was used to account for the complex survey design and to examine factors associated with anti-malarial receipt, stratified by survey RDT result, a proxy for recent/current malaria infection. RESULTS In a nationally-representative, weighted sample of 22,802 children aged 6-59 months, fever prevalence remained stable over time, while confirmed malaria prevalence decreased from 51.2% in 2010 to 44.3% in 2015 and 38.5% in 2021 (trend test p < 0.0001). Anti-malarial use among these children decreased from 19% in 2010 to 10% in 2021 (trend test p < 0.0001), accompanied by an increase in ACT use (2% in 2010 to 8% in 2021; trend test p < 0.0001). Overall, among children who had experienced fever, 30.6% of survey RDT-positive and 36.1% of survey RDT-negative children had received anti-malarials. The proportion of anti-malarials obtained from the private sector increased from 61.8% in 2010 to 80.1% in 2021 for RDT-positive children; most of the anti-malarials received in 2021 were artemisinin-based combinations. Factors associated with anti-malarial receipt for both RDT-positive and RDT-negative children included geographic region, greater household wealth, higher maternal education, and older children. CONCLUSION From 2010 to 2021 in Nigeria, both malaria prevalence and anti-malarial treatments among children aged 6-59 months decreased, as RDT availability increased. Among children who had fever in the prior 2 weeks, anti-malarial receipt was similar between children with either positive or negative survey RDT results, indicative of persistent challenges in reducing inappropriate anti-malarials uptake.
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Affiliation(s)
- Sandra C Olisakwe
- Department of Epidemiology, UAB Division of Hematology & Oncology, University of Alabama at Birmingham, 1808 7th Avenue S, Birmingham, AL, AL 35294, USA.
| | - Julie Thwing
- Malaria Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jodie A Dionne
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ryan Irvin
- Department of Epidemiology, UAB Division of Hematology & Oncology, University of Alabama at Birmingham, 1808 7th Avenue S, Birmingham, AL, AL 35294, USA
| | - Patrick S Kachur
- Heilbrunn Department of Population & Family Health, Columbia University Mailman School of Public Health, New York, USA
| | - Katia J Bruxvoort
- Department of Epidemiology, UAB Division of Hematology & Oncology, University of Alabama at Birmingham, 1808 7th Avenue S, Birmingham, AL, AL 35294, USA
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Agaba BB, Nankabirwa JI, Yeka A, Nsobya S, Gresty K, Anderson K, Mbaka P, Prosser C, Smith D, Opigo J, Namubiru R, Arinaitwe E, Kissa J, Gonahasa S, Won S, Lee B, Lim CS, Karamagi C, Cheng Q, Nakayaga JK, Kamya MR. Correction: Limitations of rapid diagnostic tests in malaria surveys in areas with varied transmission intensity in Uganda 2017-2019: Implications for selection and use of HRP2 RDTs. PLoS One 2024; 19:e0304728. [PMID: 38809835 PMCID: PMC11135688 DOI: 10.1371/journal.pone.0304728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2024] Open
Abstract
[This corrects the article DOI: 10.1371/journal.pone.0244457.].
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Ibekpobaoku AN, Oboh MA, Faal F, Adeniji E, Ajibaye O, Idowu ET, Amambua-Ngwa A. Sub-microscopic Plasmodium falciparum infections and multiple drug resistant single nucleotide polymorphic alleles in pregnant women from southwestern Nigeria. BMC Res Notes 2024; 17:129. [PMID: 38725016 PMCID: PMC11083805 DOI: 10.1186/s13104-024-06763-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 04/02/2024] [Indexed: 05/12/2024] Open
Abstract
OBJECTIVES The study evaluated sub-microscopic malaria infections in pregnancy using two malaria Rapid Diagnostic Tests (mRDTs), microscopy and RT-PCR and characterized Plasmodium falciparum dihydrofolate reductase (Pfdhfr) and Plasmodium falciparum dihydropteroate synthase (Pfdhps) drug resistant markers in positive samples. METHODS This was a cross sectional survey of 121 pregnant women. Participants were finger pricked, blood drops were collected for rapid diagnosis with P. falciparum histidine-rich protein 11 rapid diagnostic test kit and the ultra-sensitive Alere Pf malaria RDT, Blood smears for microscopy and dried blood spots on Whatman filter paper for molecular analysis were made. Real time PCR targeting the var acidic terminal sequence (varATS) gene of P. falciparum was carried out on a CFX 96 real time system thermocycler (BioRad) in discriminating malaria infections. For each run, laboratory strain of P. falciparum 3D7 and nuclease free water were used as positive and negative controls respectively. Additionally, High resolution melt analyses was employed for genotyping of the different drug resistance markers. RESULTS Out of one hundred and twenty-one pregnant women sampled, the SD Bioline™ Malaria Ag P.f HRP2-based malaria rapid diagnostic test (mRDT) detected eight (0.06%) cases, the ultra-sensitive Alere™ malaria Ag P.f rapid diagnostic test mRDT had similar outcome in the same samples as detected by the HRP2-based mRDT. Microscopy and RT-PCR confirmed four out of the eight infections detected by both rapid diagnostic tests as true positive and RT-PCR further detected three false negative samples by the two mRDTs providing a sub-microscopic malaria prevalence of 3.3%. Single nucleotide polymorphism in Pfdhps gene associated with sulphadoxine resistance revealed the presence of S613 mutant genotypes in three of the seven positive isolates and isolates with mixed wild/mutant genotype at codon A613S. Furthermore, four mixed genotypes at the A581G codon were also recorded while the other Pfdhps codons (A436G, A437G and K540E) showed the presence of wild type alleles. In the Pfdhfr gene, there were mutations in 28.6%, 28.6%, and 85.7% at the I51, R59 and N108 codons respectively. Mixed wild and mutant type genotypes were also observed in 28.6% each of the N51I, and C59R codons. For the Pfcrt, two haplotypes CVMNK and CVIET were observed. The SVMNT was altogether absent. Triple mutant CVIET 1(14.3%) and triple mutant + wild genotype CVIET + CVMNK 1(14.3%) were observed. The Pfmdr1 haplotypes were single mutants YYND 1(14.3%); NFND 1(14.3%) and double mutants YFND 4(57.1%); YYDD 1(14.3%).
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Affiliation(s)
| | - Mary A Oboh
- Medical Research Council The Gambia Unit (MRC), Banjul, Gambia.
- Rochester Institute of Technology, Rochester, USA.
- University of Medical Sciences, Ondo, Nigeria.
| | - Fatou Faal
- Medical Research Council The Gambia Unit (MRC), Banjul, Gambia
| | | | - Olusola Ajibaye
- Nigerian Institute of Medical Research (NIMR), Yaba, Lagos, Nigeria
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Agaba BB, Smith D, Travis J, Pasay C, Nabatanzi M, Arinaitwe E, Ssewanyana I, Nabadda S, Cunningham J, Kamya MR, Cheng Q. Limited threat of Plasmodium falciparum pfhrp2 and pfhrp3 gene deletion to the utility of HRP2-based malaria RDTs in Northern Uganda. Malar J 2024; 23:3. [PMID: 38167003 PMCID: PMC10759665 DOI: 10.1186/s12936-023-04830-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 12/21/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Rapid diagnostic tests (RDTs) that detect Plasmodium falciparum histidine-rich protein-2 (PfHRP2) are exclusively deployed in Uganda, but deletion of the pfhrp2/3 target gene threatens their usefulness as malaria diagnosis and surveillance tools. METHODS A cross-sectional survey was conducted at 40 sites across four regions of Uganda in Acholi, Lango, W. Nile and Karamoja from March 2021 to June 2023. Symptomatic malaria suspected patients were recruited and screened with both HRP2 and pan lactate dehydrogenase (pLDH) detecting RDTs. Dried blood spots (DBS) were collected from all patients and a random subset were used for genomic analysis to confirm parasite species and pfhrp2 and pfhrp3 gene status. Plasmodium species was determined using a conventional multiplex PCR while pfhrp2 and pfhrp3 gene deletions were determined using a real-time multiplex qPCR. Expression of the HRP2 protein antigen in a subset of samples was further assessed using a ELISA. RESULTS Out of 2435 symptomatic patients tested for malaria, 1504 (61.8%) were positive on pLDH RDT. Overall, qPCR confirmed single pfhrp2 gene deletion in 1 out of 416 (0.2%) randomly selected samples that were confirmed of P. falciparum mono-infections. CONCLUSION These findings show limited threat of pfhrp2/3 gene deletions in the survey areas suggesting that HRP2 RDTs are still useful diagnostic tools for surveillance and diagnosis of P. falciparum malaria infections in symptomatic patients in this setting. Periodic genomic surveillance is warranted to monitor the frequency and trend of gene deletions and its effect on RDTs.
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Affiliation(s)
- Bosco B Agaba
- Faculty of Medicine, Department of Medical Laboratory Sciences, Mbarara University of Science and Technology, Mbarara, Uganda.
- National Malaria Control Division, Kampala, Uganda.
- London School of Hygiene and Tropical Medicine, London, UK.
- Infectious Diseases Research Collaboration, Kampala, Uganda.
| | - David Smith
- QIMR Berghofer Medical Research Institute, Kelvin Grove, QLD, Australia
- Australian Defence Force Malaria and Infectious Disease Institute, Kelvin Grove, Australia
| | - Jye Travis
- QIMR Berghofer Medical Research Institute, Kelvin Grove, QLD, Australia
- Australian Defence Force Malaria and Infectious Disease Institute, Kelvin Grove, Australia
| | - Cielo Pasay
- QIMR Berghofer Medical Research Institute, Kelvin Grove, QLD, Australia
| | | | | | - Isaac Ssewanyana
- Infectious Diseases Research Collaboration, Kampala, Uganda
- National Health Laboratory Services/Central Public Health Laboratories, Kelvin Grove, Uganda
| | - Susan Nabadda
- National Health Laboratory Services/Central Public Health Laboratories, Kelvin Grove, Uganda
| | - Jane Cunningham
- Global Malaria Programme, World Health Organization, Geneva, Switzerland
| | - Moses R Kamya
- Faculty of Medicine, Department of Medical Laboratory Sciences, Mbarara University of Science and Technology, Mbarara, Uganda
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Qin Cheng
- QIMR Berghofer Medical Research Institute, Kelvin Grove, QLD, Australia
- Australian Defence Force Malaria and Infectious Disease Institute, Kelvin Grove, Australia
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Liu R, Liu T, Dan T, Yang S, Li Y, Luo B, Zhuang Y, Fan X, Zhang X, Cai H, Teng Y. AIDMAN: An AI-based object detection system for malaria diagnosis from smartphone thin-blood-smear images. PATTERNS (NEW YORK, N.Y.) 2023; 4:100806. [PMID: 37720337 PMCID: PMC10499858 DOI: 10.1016/j.patter.2023.100806] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 03/02/2023] [Accepted: 07/07/2023] [Indexed: 09/19/2023]
Abstract
Malaria is a significant public health concern, with ∼95% of cases occurring in Africa, but accurate and timely diagnosis is problematic in remote and low-income areas. Here, we developed an artificial intelligence-based object detection system for malaria diagnosis (AIDMAN). In this system, the YOLOv5 model is used to detect cells in a thin blood smear. An attentional aligner model (AAM) is then applied for cellular classification that consists of multi-scale features, a local context aligner, and multi-scale attention. Finally, a convolutional neural network classifier is applied for diagnosis using blood-smear images, reducing interference caused by false positive cells. The results demonstrate that AIDMAN handles interference well, with a diagnostic accuracy of 98.62% for cells and 97% for blood-smear images. The prospective clinical validation accuracy of 98.44% is comparable to that of microscopists. AIDMAN shows clinically acceptable detection of malaria parasites and could aid malaria diagnosis, especially in areas lacking experienced parasitologists and equipment.
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Affiliation(s)
- Ruicun Liu
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing 100071, China
| | - Tuoyu Liu
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing 100071, China
| | - Tingting Dan
- School of Computer Science and Engineering, South China University of Technology, Guangzhou 510600, China
| | - Shan Yang
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing 100071, China
| | - Yanbing Li
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing 100071, China
| | - Boyu Luo
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing 100071, China
| | - Yingtan Zhuang
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing 100071, China
| | - Xinyue Fan
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing 100071, China
| | - Xianchao Zhang
- Key Laboratory of Medical Electronics and Digital Health of Zhejiang Province, Jiaxing University, Jiaxing 314001, China
- Engineering Research Center of Intelligent Human Health Situation Awareness of Zhejiang Province, Jiaxing University, Jiaxing 314001, China
| | - Hongmin Cai
- School of Computer Science and Engineering, South China University of Technology, Guangzhou 510600, China
| | - Yue Teng
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing 100071, China
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Agaba BB, Rugera SP, Mpirirwe R, Atekat M, Okubal S, Masereka K, Erionu M, Adranya B, Nabirwa G, Odong PB, Mukiibi Y, Ssewanyana I, Nabadda S, Muwanguzi E. Asymptomatic malaria infection, associated factors and accuracy of diagnostic tests in a historically high transmission setting in Northern Uganda. Malar J 2022; 21:392. [PMID: 36550492 PMCID: PMC9783970 DOI: 10.1186/s12936-022-04421-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 12/17/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Asymptomatic malaria infections are important parasite reservoirs and could sustain transmission in the population, but they are often unreported. A community-based survey was conducted to investigate the prevalence and factors associated with asymptomatic malaria infections in a historically high transmission setting in northern Uganda. METHODS Using a cross-sectional design, 288 children aged 2-15 years were enrolled and tested for the presence of malaria parasites using rapid diagnostic tests (RDTs) and blood smear microscopy between January to May 2022. Statistical analysis was performed using the exact binomial and Fisher's exact test with p ≤ 0.05 indicating significance. The logistic regression was used to explore factors associated with asymptomatic malaria infections. RESULTS Overall, the prevalence of asymptomatic infection was 34.7% (95% CI 29.2-40.5) with the highest observed in children 5-10 years 45.9% (95% CI 35.0-57.0). Gweri village accounted for 39.1% (95% CI 27.6-51.6) of malaria infections. Median parasite density was 1500 parasites/µl of blood. Plasmodium falciparum was the dominant species (86%) followed by Plasmodium malariae (5%). Factors associated with asymptomatic malaria infection were sleeping under mosquito net (Adjusted Odds Ratio (aOR) 0.27; 95% CI 0.13-0.56), p = 0.001 and presence of village health teams (VHTs) (aOR 0.02; 95% CI 0.01-0.45), p = 0.001. Sensitivity and specificity were higher for the P. falciparum/pLDH RDTs compared to HRP2-only RDTs, 90% (95% CI 86.5-93.5) and 95.2% (95% CI 92.8-97.7), p = 0.001, respectively. CONCLUSION Asymptomatic malaria infections were present in the study population and this varied with place and person in the different age groups. Plasmodium falciparum was the dominant parasite species however the presence of P. malariae and Plasmodium ovale was observed, which may have implication for the choice and deployment of diagnostic tools. Individuals who slept under mosquito net or had presence of functional VHTs were less likely to have asymptomatic malaria infection. P.f/pLDH RDTs performed better than the routinely used HRP2 RDTs. In view of these findings, investigation and reporting of asymptomatic malaria reservoirs through community surveys is recommended for accurate disease burden estimate and better targeting of control.
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Affiliation(s)
- Bosco B. Agaba
- grid.33440.300000 0001 0232 6272Department of Medical Laboratory Science, Mbarara University of Science and Technology, Mbarara, Uganda ,grid.415705.2National Malaria Control Division, Ministry of Health, Kampala, Uganda ,National Malaria Reference Laboratory, Central Public Health Laboratory Services, Kampala, Uganda ,grid.463352.50000 0004 8340 3103Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Simon P. Rugera
- grid.33440.300000 0001 0232 6272Department of Medical Laboratory Science, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Ruth Mpirirwe
- grid.11194.3c0000 0004 0620 0548Department of Statistics, Makerere University, Kampala, Uganda
| | - Martha Atekat
- grid.33440.300000 0001 0232 6272Department of Medical Laboratory Science, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Samuel Okubal
- grid.33440.300000 0001 0232 6272Department of Medical Laboratory Science, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Khalid Masereka
- grid.33440.300000 0001 0232 6272Department of Medical Laboratory Science, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Miseal Erionu
- grid.33440.300000 0001 0232 6272Department of Medical Laboratory Science, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Bosco Adranya
- grid.33440.300000 0001 0232 6272Department of Medical Laboratory Science, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Gertrude Nabirwa
- grid.33440.300000 0001 0232 6272Department of Medical Laboratory Science, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Patrick B. Odong
- grid.33440.300000 0001 0232 6272Department of Medical Laboratory Science, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Yasin Mukiibi
- Uganda Institute of Allied and Management Sciences, Kampala, Uganda
| | - Isaac Ssewanyana
- National Malaria Reference Laboratory, Central Public Health Laboratory Services, Kampala, Uganda ,grid.463352.50000 0004 8340 3103Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Susan Nabadda
- National Malaria Reference Laboratory, Central Public Health Laboratory Services, Kampala, Uganda
| | - Enoch Muwanguzi
- grid.33440.300000 0001 0232 6272Department of Medical Laboratory Science, Mbarara University of Science and Technology, Mbarara, Uganda ,Uganda Institute of Allied and Management Sciences, Kampala, Uganda
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Maketa V, Kabalu J, Kabena M, Luzolo F, Muhindo-Mavoko H, Schallig HDFH, Kayentao K, Mens PF, Lutumba P, Tinto H. Comparison of intermittent screening (using ultra-sensitive malaria rapid diagnostic test) and treatment (using a newly registered antimalarial pyronaridine-artesunate—PYRAMAX®) to standard intermittent preventive treatment with sulfadoxine-pyrimethamine for the prevention of malaria in pregnant women living in endemic areas: ULTRAPYRAPREG. Trials 2022; 23:963. [DOI: 10.1186/s13063-022-06884-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 11/03/2022] [Indexed: 11/29/2022] Open
Abstract
Abstract
Background
Intermittent preventive treatment in pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP) is an important malaria control strategy in sub-Saharan Africa. Indeed, it overcomes the risk of misdiagnosis due to low peripheral parasitemia during pregnancy by treating women with SP on predetermined schedules. However, over time, the spread of Plasmodium-resistant strains has threatened this strategy in many countries. As an alternative, the intermittent screening and treatment for pregnancy (ISTp) aims at a monthly screening of pregnant women, preferably by using very sensitive tests such as ultrasensitive rapid diagnostic tests (us-RDTs) and the treatment of positive cases with artemisinin-based combination therapy (ACT) regardless of the presence of symptoms. Unlike IPTp-SP, ISTp prevents overuse of antimalarials limiting the drug pressure on parasites, an advantage which can be potentiated by using an ACT like pyronaridine-artesunate (Pyramax®) that is not yet used in pregnant women in the field.
Methods
This study aims to compare the non-inferiority of ISTp using us-RDTs and Pyramax® versus IPTp-SP on malaria in pregnancy through a randomized clinical trial performed in Kisenso, Kinshasa, the Democratic Republic of the Congo, a malaria perennial transmission area.
Discussion
The results will be essential for the National Malaria Control Program to update the malaria prevention policy in pregnant women in the Democratic Republic of the Congo.
Trial registration
ClinicalTrials.gov NCT04783051
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Zhou G, Hemming-Schroeder E, Jeang B, Wang X, Zhong D, Lee MC, Li Y, Bradley L, Gobran SR, David RE, Ondeto BM, Orondo P, Atieli H, Githure JI, Githeko AK, Kazura J, Yan G. Irrigation-Induced Environmental Changes Sustain Malaria Transmission and Compromise Intervention Effectiveness. J Infect Dis 2022; 226:1657-1666. [PMID: 36056912 DOI: 10.1093/infdis/jiac361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 09/01/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Irrigated agriculture enhances food security, but it potentially promotes mosquito-borne disease transmission and affects vector intervention effectiveness. This study was conducted in the irrigated and nonirrigated areas of rural Homa Bay and Kisumu Counties, Kenya. METHODS We performed cross-sectional and longitudinal surveys to determine Plasmodium infection prevalence, clinical malaria incidence, molecular force of infection (molFOI), and multiplicity of infection. We examined the impact of irrigation on the effectiveness of the new interventions. RESULTS We found that irrigation was associated with >2-fold higher Plasmodium infection prevalence and 3-fold higher clinical malaria incidence compared to the nonirrigated area. Residents in the irrigated area experienced persistent, low-density parasite infections and higher molFOI. Addition of indoor residual spraying was effective in reducing malaria burden, but the reduction was more pronounced in the nonirrigated area than in the irrigated area. CONCLUSIONS Our findings collectively suggest that irrigation may sustain and enhance Plasmodium transmission and affects intervention effectiveness.
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Affiliation(s)
- Guofa Zhou
- Program in Public Health, College of Health Sciences, University of California at Irvine, Irvine, California, USA
| | - Elizabeth Hemming-Schroeder
- Program in Public Health, College of Health Sciences, University of California at Irvine, Irvine, California, USA.,Department of Microbiology, Immunology, and Pathology, Colorado State University, Fort Collins, Colorado, USA
| | - Brook Jeang
- Program in Public Health, College of Health Sciences, University of California at Irvine, Irvine, California, USA
| | - Xiaoming Wang
- Program in Public Health, College of Health Sciences, University of California at Irvine, Irvine, California, USA
| | - Daibin Zhong
- Program in Public Health, College of Health Sciences, University of California at Irvine, Irvine, California, USA
| | - Ming-Chieh Lee
- Program in Public Health, College of Health Sciences, University of California at Irvine, Irvine, California, USA
| | - Yiji Li
- Program in Public Health, College of Health Sciences, University of California at Irvine, Irvine, California, USA.,Department of Pathogen Biology, Hainan Medical University, Haikou, China
| | - Lauren Bradley
- Program in Public Health, College of Health Sciences, University of California at Irvine, Irvine, California, USA
| | - Sabrina R Gobran
- Program in Public Health, College of Health Sciences, University of California at Irvine, Irvine, California, USA
| | - Randy E David
- Program in Public Health, College of Health Sciences, University of California at Irvine, Irvine, California, USA
| | - Benyl M Ondeto
- School of Biological Sciences, University of Nairobi, Nairobi, Kenya
| | - Pauline Orondo
- Department of Biochemistry, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - Harrysone Atieli
- School of Public Health and Community Development, Maseno University, Kisumu, Kenya.,International Center of Excellence for Malaria Research, Tom Mboya University College, Homa Bay, Kenya
| | - John I Githure
- International Center of Excellence for Malaria Research, Tom Mboya University College, Homa Bay, Kenya
| | - Andrew K Githeko
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - James Kazura
- Center for Global Health and Disease, Case Western Reserve University, Cleveland, Ohio, USA
| | - Guiyun Yan
- Program in Public Health, College of Health Sciences, University of California at Irvine, Irvine, California, USA
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9
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Where Have All the Diagnostic Morphological Parasitologists Gone? J Clin Microbiol 2022; 60:e0098622. [PMID: 36314793 PMCID: PMC9667774 DOI: 10.1128/jcm.00986-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Advances in laboratory techniques have revolutionized parasitology diagnostics over the past several decades. Widespread implementation of rapid antigen detection tests has greatly expanded access to tests for global parasitic threats such as malaria, while next-generation amplification and sequencing methods allow for sensitive and specific detection of human and animal parasites in complex specimen matrices.
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Tan AF, Sakam SSB, Rajahram G, William T, Abd Rachman Isnadi M, Daim S, Barber B, Kho S, Sutherland CJ, Anstey NM, Yerlikaya S, van Schalkwyk DA, Grigg MJ. Diagnostic accuracy and limit of detection of ten malaria parasite lactate dehydrogenase-based rapid tests for Plasmodium knowlesi and P. falciparum. Front Cell Infect Microbiol 2022; 12:1023219. [PMID: 36325471 PMCID: PMC9618705 DOI: 10.3389/fcimb.2022.1023219] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 09/26/2022] [Indexed: 11/21/2022] Open
Abstract
Background Plasmodium knowlesi causes zoonotic malaria across Southeast Asia. First-line diagnostic microscopy cannot reliably differentiate P. knowlesi from other human malaria species. Rapid diagnostic tests (RDTs) designed for P. falciparum and P. vivax are used routinely in P. knowlesi co-endemic areas despite potential cross-reactivity for species-specific antibody targets. Methods Ten RDTs were evaluated: nine to detect clinical P. knowlesi infections from Malaysia, and nine assessing limit of detection (LoD) for P. knowlesi (PkA1-H.1) and P. falciparum (Pf3D7) cultures. Targets included Plasmodium-genus parasite lactate dehydrogenase (pan-pLDH) and P. vivax (Pv)-pLDH. Results Samples were collected prior to antimalarial treatment from 127 patients with microscopy-positive PCR-confirmed P. knowlesi mono-infections. Median parasitaemia was 788/µL (IQR 247-5,565/µL). Pan-pLDH sensitivities ranged from 50.6% (95% CI 39.6–61.5) (SD BIOLINE) to 87.0% (95% CI 75.1–94.6) (First Response® and CareStart™ PAN) compared to reference PCR. Pv-pLDH RDTs detected P. knowlesi with up to 92.0% (95% CI 84.3-96.7%) sensitivity (Biocredit™). For parasite counts ≥200/µL, pan-pLDH (Standard Q) and Pv-pLDH RDTs exceeded 95% sensitivity. Specificity of RDTs against 26 PCR-confirmed negative controls was 100%. Sensitivity of six highest performing RDTs were not significantly different when comparing samples taken before and after (median 3 hours) antimalarial treatment. Parasite ring stages were present in 30% of pre-treatment samples, with ring stage proportions (mean 1.9%) demonstrating inverse correlation with test positivity of Biocredit™ and two CareStart™ RDTs. For cultured P. knowlesi, CareStart™ PAN demonstrated the lowest LoD at 25 parasites/µL; LoDs of other pan-pLDH ranged from 98 to >2000 parasites/µL. Pv-pLDH LoD for P. knowlesi was 49 parasites/µL. No false-positive results were observed in either P. falciparum-pLDH or histidine-rich-protein-2 channels. Conclusion Selected RDTs demonstrate sufficient performance for detection of major human malaria species including P. knowlesi in co-endemic areas where microscopy is not available, particularly for higher parasite counts, although cannot reliably differentiate among non-falciparum malaria.
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Affiliation(s)
- Angelica F. Tan
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, N T, Australia
- Infectious Diseases Society Kota Kinabalu Sabah – Menzies School of Health Research Clinical Research Unit, Kota Kinabalu, Sabah, Malaysia
- *Correspondence: Angelica F. Tan, ; Matthew J. Grigg,
| | - Sitti Saimah binti Sakam
- Infectious Diseases Society Kota Kinabalu Sabah – Menzies School of Health Research Clinical Research Unit, Kota Kinabalu, Sabah, Malaysia
| | - Giri S. Rajahram
- Infectious Diseases Society Kota Kinabalu Sabah – Menzies School of Health Research Clinical Research Unit, Kota Kinabalu, Sabah, Malaysia
- Clinical Research Centre, Queen Elizabeth Hospital, Ministry of Health, Kota Kinabalu, Sabah, Malaysia
- Department of Medicine, Queen Elizabeth Hospital II, Kota Kinabalu, Sabah, Malaysia
| | - Timothy William
- Infectious Diseases Society Kota Kinabalu Sabah – Menzies School of Health Research Clinical Research Unit, Kota Kinabalu, Sabah, Malaysia
- Clinical Research Centre, Queen Elizabeth Hospital, Ministry of Health, Kota Kinabalu, Sabah, Malaysia
| | | | - Sylvia Daim
- Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia
| | - Bridget E. Barber
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, N T, Australia
- Clinical Malaria, Queensland Institute of Medical Research (QIMR) Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Steven Kho
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, N T, Australia
| | - Colin J. Sutherland
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Nicholas M. Anstey
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, N T, Australia
- Infectious Diseases Society Kota Kinabalu Sabah – Menzies School of Health Research Clinical Research Unit, Kota Kinabalu, Sabah, Malaysia
| | - Seda Yerlikaya
- Malaria and Fever, Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland
| | - Donelly A. van Schalkwyk
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Matthew J. Grigg
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, N T, Australia
- Infectious Diseases Society Kota Kinabalu Sabah – Menzies School of Health Research Clinical Research Unit, Kota Kinabalu, Sabah, Malaysia
- *Correspondence: Angelica F. Tan, ; Matthew J. Grigg,
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11
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Watson JA, Uyoga S, Wanjiku P, Makale J, Nyutu GM, Mturi N, George EC, Woodrow CJ, Day NPJ, Bejon P, Opoka RO, Dondorp AM, John CC, Maitland K, Williams TN, White NJ. Improving the diagnosis of severe malaria in African children using platelet counts and plasma PfHRP2 concentrations. Sci Transl Med 2022; 14:eabn5040. [PMID: 35857826 PMCID: PMC7613613 DOI: 10.1126/scitranslmed.abn5040] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Severe malaria caused by Plasmodium falciparum is difficult to diagnose accurately in children in high-transmission settings. Using data from 2649 pediatric and adult patients enrolled in four studies of severe illness in three countries (Bangladesh, Kenya, and Uganda), we fitted Bayesian latent class models using two diagnostic markers: the platelet count and the plasma concentration of P. falciparum histidine-rich protein 2 (PfHRP2). In severely ill patients with clinical features consistent with severe malaria, the combination of a platelet count of ≤150,000/μl and a plasma PfHRP2 concentration of ≥1000 ng/ml had an estimated sensitivity of 74% and specificity of 93% in identifying severe falciparum malaria. Compared with misdiagnosed children, pediatric patients with true severe malaria had higher parasite densities, lower hematocrits, lower rates of invasive bacterial disease, and a lower prevalence of both sickle cell trait and sickle cell anemia. We estimate that one-third of the children enrolled into clinical studies of severe malaria in high-transmission settings in Africa had another cause of their severe illness.
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Affiliation(s)
- James A. Watson
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK,Corresponding author.
| | - Sophie Uyoga
- KEMRI Wellcome Trust Research Programme, Centre for Geographic Medicine Research, Coast, Kilifi 80108, Kenya
| | - Perpetual Wanjiku
- KEMRI Wellcome Trust Research Programme, Centre for Geographic Medicine Research, Coast, Kilifi 80108, Kenya
| | - Johnstone Makale
- KEMRI Wellcome Trust Research Programme, Centre for Geographic Medicine Research, Coast, Kilifi 80108, Kenya
| | - Gideon M. Nyutu
- KEMRI Wellcome Trust Research Programme, Centre for Geographic Medicine Research, Coast, Kilifi 80108, Kenya
| | - Neema Mturi
- KEMRI Wellcome Trust Research Programme, Centre for Geographic Medicine Research, Coast, Kilifi 80108, Kenya
| | - Elizabeth C. George
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - Charles J. Woodrow
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Nicholas P. J. Day
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Philip Bejon
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK,KEMRI Wellcome Trust Research Programme, Centre for Geographic Medicine Research, Coast, Kilifi 80108, Kenya
| | - Robert O. Opoka
- Makerere University, Department of Paediatrics and Child Health, Kampala, Uganda
| | - Arjen M. Dondorp
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Chandy C. John
- Department of Pediatrics, Indiana University, Indiana, IN, USA
| | - Kathryn Maitland
- KEMRI Wellcome Trust Research Programme, Centre for Geographic Medicine Research, Coast, Kilifi 80108, Kenya,Institute of Global Health Innovation, Department of Surgery and Cancer, Imperial College, London, UK
| | - Thomas N. Williams
- KEMRI Wellcome Trust Research Programme, Centre for Geographic Medicine Research, Coast, Kilifi 80108, Kenya,Institute of Global Health Innovation, Department of Surgery and Cancer, Imperial College, London, UK
| | - Nicholas J. White
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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12
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Manor DU, Grossman DT, Vainer J, Schwartz PE. A nationwide study of imported Plasmodium ovale and mixed infections in Israel 2008-2020. J Travel Med 2022; 29:6463573. [PMID: 34918125 DOI: 10.1093/jtm/taab192] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 11/09/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Plasmodium ovale is a rather neglected plasmodium. Rarity, a milder disease, and diagnostic difficulties compared with P. falciparum and P. vivax have led to this situation. This study's objective is to present the epidemiological and diagnostical characteristics of imported P. ovale malaria in Israel. METHODS Malaria is a reportable disease in Israel. All highly suspected cases are sent to the Ministry of Health central parasitology laboratory for molecular verification. We retrieved epidemiological and diagnostic data on all polymerase chain reaction (PCR)-proven P. ovale infections imported to between 2008 and 2020. RESULTS In total, 508 malaria cases were identified, 489 monoinfections and 19 (3.7%) mixed. Fifty-one (10%) were due to P. ovale, among them 13 (25%) were mixed, comprising 68% of all mixed infections. Forty-eight of 51 (94%) underwent blood microscopy, with a sensitivity of 94% (45/48) for genus identification and 15% (7/48) for P. ovale identification. Only 8% (1/12) of mixed infections were identified as such by microscopy. Forty-two (82%) patients underwent RDTs, with a sensitivity of 69% (29/42) for genus identification, and 62% (26/42) for identifying non-falciparum infections. Cycle threshold (Ct) values of P. ovale were significantly higher compared with P. falciparum and P. vivax in both mono and mixed infections (P < 0.05, P < 0.005). Ct levels in RDT positive vs negative infections differed significantly (P < 0.05). CONCLUSIONS P. ovale is commonly imported to Israel from Africa, with a high rate of mixed infections. The use of RDTs and microscopy is insufficient for the species-specific diagnosis of P. ovale, and must be complemented by PCR.
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Affiliation(s)
- Dr Uri Manor
- Internal Medicine "C", Sheba Medical Center, Dereh Sheba 2, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Klatchkin 35, Tel-Aviv, Israel
| | - Dr Tamar Grossman
- Public Health Laboratories - Jerusalem (PHL-J), Public Health Services (PHS), Ministry of Health (MOH), Eliav Yaakov 9, Jerusalem, Israel
| | - Julia Vainer
- Public Health Laboratories - Jerusalem (PHL-J), Public Health Services (PHS), Ministry of Health (MOH), Eliav Yaakov 9, Jerusalem, Israel
| | - Professor Eli Schwartz
- The Center for Geographic Medicine and Tropical Diseases, Sheba Medical Center, Dereh Sheba 2, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Klatchkin 35, Tel-Aviv, Israel
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13
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Plasmodium falciparum histidine-rich protein 2 and 3 genes deletion in global settings (2010–2021): a systematic review and meta-analysis. Malar J 2022; 21:26. [PMID: 35093092 PMCID: PMC8800273 DOI: 10.1186/s12936-022-04051-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 01/17/2022] [Indexed: 01/10/2023] Open
Abstract
Background The usefulness of histidine-rich protein-2/3 (HRP2/3)-based rapid diagnostic tests of malaria due to Plasmodium falciparum has been threatened by the appearance of mutant PfHRP2/3 genes. This study was undertaken to determine the global pooled estimates of PfHRP2/3gene deletions. Methods Relevant publications were identified from electronic databases such as; PubMed, EMBASE, and MEDLINE online. Besides, all the relevant literatures were retrieved through Google and Google Scholar. STATA software was used for data analysis. The pooled estimates were calculated using random effect model. The summary estimates were presented using forest plots and tables. Results A total of 27 studies were included in the systematic review. However, only 24 and 17 studies were included for PfHRP2 and 3 gene deletion meta-analysis, respectively. The prevalence of PfHRP2 gene deletion across the individual studies ranged from the highest 100% to the lowest 0%. However, the meta-analysis result showed that the global pooled prevalence of PfHRP2 and PfHRP3 gene deletions were 21.30% and 34.50%, respectively. The pooled proportion of PfHRP2 gene deletion among false negative PfHRP2-based RDTs results was found to be 41.10%. The gene deletion status was higher in South America and followed by Africa. The pooled estimate of PfHRP2 gene deletion among studies, which did not follow the WHO PfHRP2/3 gene deletion analysis protocol was higher than their counter parts (21.3% vs 10.5%). Conclusions This review showed that there is a high pooled prevalence of PfHRP2/3 gene deletions in Plasmodium falciparum confirmed isolates and also a high proportion of their deletions among false-negative malaria cases using PfHRP2-based RDT results. Hence, malaria diagnosis based on PfHRP2-based rapid tests seems to be less sensitive and warrants further evaluation of PfHRP2/3 gene deletions.
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14
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Dadgar S, Mahmoudinia M, Akbari A, Zandieh E, Attaranzadeh A, Hoseinpour S, Jahanpak N, Tavanaee Sani A, Mohammadi SA. Placental infection with SARS-CoV-2, analysis of 16 cases and literature review. Arch Gynecol Obstet 2022; 305:1359-1367. [PMID: 35088195 PMCID: PMC8794612 DOI: 10.1007/s00404-021-06372-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 12/15/2021] [Indexed: 12/01/2022]
Abstract
Purpose Since December 2019, the whole world has been affected by coronavirus [severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)]. However, the effects of COVID-19 infection on pregnancy and fetal transmission are still unclear. Therefore, this study was conducted to evaluate placenta samples regarding detection of SARS-CoV-2 RNA in women affected with COVID-19.
Method This study was a part of a cohort study carried out on pregnant women with a diagnosis of COVID-19 infection who had been admitted to the Imam Reza Hospital in Mashhad, Iran, from March 20 to August 5, 2020. Clinical and laboratory information of all the patients was collected and chest computed tomography (CT) scans were reviewed. Totally, 16 placental tissue were prepared for real time polymerase chain reaction (RT-PCR) testing. All samples were tested by PowerChek PCR real-time kit (South Korea) with 2 target genes (E gene and Rd Rp gene), and Pishtaz Teb kit, (Iran) with 2 target genes (N gene and RdRp gene).
Result In the first RT-PCR kit by PowerChek kit, 6 samples were positive for a single gene (E gene) and 2 samples were positive for both genes (E gene and Rd Rp gene). In the second RT-PCR kit by Pishtaz Teb kit, 3 samples were positive for two genes (N gene and RdRp gene).
Conclusion This present study showed that infection of placenta with SARS-CoV-2 may occur in pregnancy. However, whether this infection leads to neonatal infection and serious complication in pregnancy remains unclear.
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Affiliation(s)
- Salmeh Dadgar
- Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Malihe Mahmoudinia
- Department of Obstetrics, Faculty of Medicines, Maternal and Neonatal Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Azam Akbari
- Mashhad University of Medical Sciences, Mashhad, Iran
| | - Elaheh Zandieh
- Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Armin Attaranzadeh
- Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Sajjad Hoseinpour
- Department of Molecular Genetic, Medical Laboratory, Imam Hosein Hospital, Mashhad, Iran
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15
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Agaba BB, Anderson K, Gresty K, Prosser C, Smith D, Nankabirwa JI, Nsobya S, Yeka A, Namubiru R, Arinaitwe E, Mbaka P, Kissa J, Lim CS, Karamagi C, Nakayaga JK, Kamya MR, Cheng Q. Genetic diversity and genetic relatedness in Plasmodium falciparum parasite population in individuals with uncomplicated malaria based on microsatellite typing in Eastern and Western regions of Uganda, 2019-2020. Malar J 2021; 20:242. [PMID: 34059047 PMCID: PMC8165787 DOI: 10.1186/s12936-021-03763-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 05/11/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Genetic diversity and parasite relatedness are essential parameters for assessing impact of interventions and understanding transmission dynamics of malaria parasites, however data on its status in Plasmodium falciparum populations in Uganda is limited. Microsatellite markers and DNA sequencing were used to determine diversity and molecular characterization of P. falciparum parasite populations in Uganda. METHODS A total of 147 P. falciparum genomic DNA samples collected from cross-sectional surveys in symptomatic individuals of 2-10 years were characterized by genotyping of seven highly polymorphic neutral microsatellite markers (n = 85) and genetic sequencing of the Histidine Rich Protein 2 (pfhrp2) gene (n = 62). ArcGIS was used to map the geographical distribution of isolates while statistical testing was done using Student's t-test or Wilcoxon's rank-sum test and Fisher's exact test as appropriate at P ≤ 0.05. RESULTS Overall, 75.5% (95% CI 61.1-85.8) and 24.5% (95% CI14.2-38.9) of parasites examined were of multiclonal (mixed genotype) and single clone infections, respectively. Multiclonal infections occurred more frequently in the Eastern region 73.7% (95% CI 48.8-89.1), P < 0.05. Overall, multiplicity of infection (MOI) was 1.9 (95% CI 1.7-2.1), P = 0.01 that was similar between age groups (1.8 vs 1.9), P = 0.60 and regions (1.9 vs 1.8), P = 0.43 for the < 5 and ≥ 5 years and Eastern and Western regions, respectively. Genomic sequencing of the pfhrp2 exon2 revealed a high level of genetic diversity reflected in 96.8% (60/62) unique sequence types. Repeat type AHHAAAHHATD and HRP2 sequence Type C were more frequent in RDT-/PCR + samples (1.9% vs 1.5%) and (13% vs 8%), P < 0.05 respectively. Genetic relatedness analysis revealed small clusters of gene deleted parasites in Uganda, but no clustering with Eritrean parasites. CONCLUSION High level of genetic diversity of P. falciparum parasites reflected in the frequency of multiclonal infections, multiplicity of infection and variability of the pfhrp2 gene observed in this study is consistent with the high malaria transmission intensity in these settings. Parasite genetic analysis suggested spontaneous emergence and clonal expansion of pfhrp2 deleted parasites that require close monitoring to inform national malaria diagnosis and case management policies.
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Affiliation(s)
- Bosco B Agaba
- College of Health Sciences, Makerere University, Kampala, Uganda.
- National Malaria Control Division, Kampala, Uganda.
| | - Karen Anderson
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
- Australian Defence Force Malaria and Infectious Disease Institute, Brisbane, Australia
| | - Karryn Gresty
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
- Australian Defence Force Malaria and Infectious Disease Institute, Brisbane, Australia
| | - Christiane Prosser
- Australian Defence Force Malaria and Infectious Disease Institute, Brisbane, Australia
| | - David Smith
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
- Australian Defence Force Malaria and Infectious Disease Institute, Brisbane, Australia
| | - Joaniter I Nankabirwa
- College of Health Sciences, Makerere University, Kampala, Uganda
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Sam Nsobya
- College of Health Sciences, Makerere University, Kampala, Uganda
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Adoke Yeka
- College of Health Sciences, Makerere University, Kampala, Uganda
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Rhoda Namubiru
- College of Health Sciences, Makerere University, Kampala, Uganda
| | | | - Paul Mbaka
- World Health Organization Country Office, Kampala, Uganda
| | - John Kissa
- National Health Information Division, Ministry of Health, Kampala, Uganda
| | - Chae Seung Lim
- Department of Laboratory Medicine, College of Health Sciences, Korea University, Seoul, South Korea
| | - Charles Karamagi
- College of Health Sciences, Makerere University, Kampala, Uganda
| | - Joan K Nakayaga
- College of Health Sciences, Makerere University, Kampala, Uganda
| | - Moses R Kamya
- College of Health Sciences, Makerere University, Kampala, Uganda
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Qin Cheng
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
- Australian Defence Force Malaria and Infectious Disease Institute, Brisbane, Australia
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Deep Malaria Parasite Detection in Thin Blood Smear Microscopic Images. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11052284] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Malaria is a disease activated by a type of microscopic parasite transmitted from infected female mosquito bites to humans. Malaria is a fatal disease that is endemic in many regions of the world. Quick diagnosis of this disease will be very valuable for patients, as traditional methods require tedious work for its detection. Recently, some automated methods have been proposed that exploit hand-crafted feature extraction techniques however, their accuracies are not reliable. Deep learning approaches modernize the world with their superior performance. Convolutional Neural Networks (CNN) are vastly scalable for image classification tasks that extract features through hidden layers of the model without any handcrafting. The detection of malaria-infected red blood cells from segmented microscopic blood images using convolutional neural networks can assist in quick diagnosis, and this will be useful for regions with fewer healthcare experts. The contributions of this paper are two-fold. First, we evaluate the performance of different existing deep learning models for efficient malaria detection. Second, we propose a customized CNN model that outperforms all observed deep learning models. It exploits the bilateral filtering and image augmentation techniques for highlighting features of red blood cells before training the model. Due to image augmentation techniques, the customized CNN model is generalized and avoids over-fitting. All experimental evaluations are performed on the benchmark NIH Malaria Dataset, and the results reveal that the proposed algorithm is 96.82% accurate in detecting malaria from the microscopic blood smears.
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