Malaria mortality in Venezuela: focus on deaths due to Plasmodium vivax in children

Morbidity and mortality burden of malaria in the childhood represents a public health threat not only in countries with high levels of transmission, but also in those, such as Venezuela and others in Latin America, with moderate to low transmission. Usually its mortality has been attributed just to Plasmodium falciparum malaria, but the changing patterns of increase in Plasmodium vivax malaria morbidity and mortality are now causing concern. We studied malaria mortality by analyzing different epidemiological variables during a 10-year period in Venezuela, finding mortality rates ranging 0.10-0.36 deaths/100,000 population, with almost a third of deaths in children (<10 years old), corresponding 270 deaths to P. falciparum cases and 30 to P. vivax; but along the period with a decrease trend for P. falciparum and an increase trend for P. vivax.

Haemoglobin and haematocrit: the threefold conversion is also non valid for assessing anaemia in Plasmodium vivax malaria-endemic settings

It has been recently reported that the standard threefold conversion from haematocrit to haemoglobin underestimates the prevalence of anaemia and low levels of haemoglobin in children living in areas endemic for Plasmodium falciparum malaria. The data presented herein describes the experience in a malaria-endemic zone in northeastern Venezuela (state of Sucre), where a similar bias between haematocrit and haemoglobin in patients with Plasmodium vivax infection was found. In summary, the relationship between haematocrit and haemoglobin needs to be specifically evaluated according to each particular region or epidemiological setting.

Intestinal parasitic infections among pregnant women in Venezuela

Introduction. Intestinal parasitic infections, especially due to helminths, increase anemia in pregnant women. The results of this are low pregnancy weight gain and IUGR, followed by LBW, with its associated greater risks of infection and higher perinatal mortality rates. For these reasons, in the setting of no large previous studies in Venezuela about this problem, a national multicentric study was conducted. Methods. Pregnant women from nine states were studied, a prenatal evaluation with a coproparasitological study. Univariated and multivariated analyses were made to determine risk factors for intestinal parasitosis and related anemia. Results. During 19 months, 1038 pregnant women were included and evaluated. Intestinal parasitosis was evidenced in 73.9%: A lumbricoides 57.0%, T trichiura 36.0%, G lamblia 14.1%, E hystolitica 12.0%, N americanus 8.1%, E vermicularis 6.3%, S stercoralis 3.3%. Relative risk for anemia in those women with intestinal parasitosis was 2.56 (P < .01). Discussion. Intestinal parasitoses could be associated with conditions for development of anemia at pregnancy. These features reflect the need of routine coproparasitological study among pregnant women in rural and endemic zones for intestinal parasites. Further therapeutic and prophylactic protocols are needed. Additional research on pregnant intestinal parasitic infection impact on newborn health is also considered.

Congenital syphilis in Valera, Venezuela

Congenital syphilis still poses a significant public health problem in many countries of the world. We studied epidemiology of syphilis and other sexually transmitted infections among pregnant women and their newborns during a 5-year period at a general hospital in Valera, western Venezuela finding a high incidence of disease among those newborns from infected mothers.

Outcomes of imported malaria during pregnancy within Venezuelan states: implications for travel advice

Prevention of malaria in pregnant women is an utmost priority because the disease can cause serious maternal and neonatal complications. Maternal complications include marked anemia, increased risk of severe disease, and mortality, while the fetus or neonate is at risk of prematurity, anemia, and low birthweight. Pregnant women living in malaria endemic areas may be semiimmune to a particular Plasmodium spp. but when traveling to other regions, sometimes within their same country, where malaria epidemiology is different, may develop severe malaria complications. Here, we describe our experience in northeastern Venezuela associated with unfavorable outcomes of imported malaria cases among pregnant women who traveled to other Venezuelan regions with different malaria epidemiology. Travel medicine practitioners should be aware and educate their pregnant patients regarding the risk of malaria even when living in malaria endemic areas and traveling to other endemic areas such as occurs in Venezuela.

Pregnancy outcomes associated with Plasmodium vivax malaria in northeastern Venezuela

Although Plasmodium vivax is increasingly recognized as an important cause of morbidity in pregnancy in low malaria-transmission areas of Asia, little is know about the epidemiologic and clinical profiles of P. vivax in pregnant women in Latin America. We describe the clinical features and pregnancy outcomes in a series of 12 cases of P. vivax malaria in pregnant women complicated in some by miscarriage or preterm deliveries and in others with significant degrees of anemia and thrombocytopenia in a population where P. vivax is endemic in northeastern Venezuela.

Anemia and thrombocytopenia in children with Plasmodium vivax malaria

Clinico-epidemiological features of pediatric patients with malaria due Plasmodium vivax that developed anemia and thrombocytopenia requiring hospitalization are herein reported. Over a 3-year period, 78 children with P. vivax infection were admitted to our Hospital in Sucre, Venezuela. Clinical manifestations at admission were 93.59 per cent fever, 41.03 per cent chills and 14.10 per cent headache, among others. On paraclinical evaluations 94.87 percent presented with anemia (10.26 per cent severe), 25.64 percent with malnutrition, and 10.26 percent had intestinal parasitosis. The mean hemoglobin levels on admission were 8.09 g/dl and mean platelet counts 127 402 cells/mm3. Among these patients 58.97 per cent developed thrombocytopenia (24.36 per cent severe) requiring transfusion in 25.64 per cent of patients. After antimalarial treatment with chloroquine and primaquine and supportive care all patients were successfully discharged. No deaths or further complications were seen, except for persistent mild thrombocytopenia in 17.95 per cent of the patients.

Lepidopterism due to exposure to the moth Hylesia metabus in northeastern Venezuela

Lepidopterism refers to a spectrum of medical conditions in humans that usually involves the skin and results from contact with the adult or larval forms of certain butterflies and moths. We analyzed the epidemiologic and clinical features associated with exposure to the moth Hylesia metabus between 1970 and 2002 in the Cajigal district, Sucre, Venezuela. Fifty cases of lepidopterism mostly affecting individuals under 18 years of age were identified during this period and manifested as pruritic dermatitis with or without associated respiratory symptoms. With increased travel to endemic areas of lepidopterism, travel and tropical medicine practitioners should be aware of the clinical spectrum of this condition.