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Cao P, Kho S, Grigg MJ, Barber BE, Piera KA, William T, Poespoprodjo JR, Jang IK, Simpson JA, McCaw JM, Anstey NM, McCarthy JS, Britton S. Characterisation of Plasmodium vivax lactate dehydrogenase dynamics in P. vivax infections. Commun Biol 2024; 7:355. [PMID: 38519588 PMCID: PMC10959993 DOI: 10.1038/s42003-024-05956-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 02/22/2024] [Indexed: 03/25/2024] Open
Abstract
Plasmodium vivax lactate dehydrogenase (PvLDH) is an essential enzyme in the glycolytic pathway of P. vivax. It is widely used as a diagnostic biomarker and a measure of total-body parasite biomass in vivax malaria. However, the dynamics of PvLDH remains poorly understood. Here, we developed mathematical models that capture parasite and matrix PvLDH dynamics in ex vivo culture and the human host. We estimated key biological parameters characterising in vivo PvLDH dynamics based on longitudinal data of parasitemia and PvLDH concentration collected from P. vivax-infected humans, with the estimates informed by the ex vivo data as prior knowledge in a Bayesian hierarchical framework. We found that the in vivo accumulation rate of intraerythrocytic PvLDH peaks at 10-20 h post-invasion (late ring stage) with a median estimate of intraerythrocytic PvLDH mass at the end of the life cycle to be 9.4 × 10-3ng. We also found that the median estimate of in vivo PvLDH half-life was approximately 21.9 h. Our findings provide a foundation with which to advance our quantitative understanding of P. vivax biology and will facilitate the improvement of PvLDH-based diagnostic tools.
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Affiliation(s)
- Pengxing Cao
- School of Mathematics and Statistics, University of Melbourne, Melbourne, VIC, Australia
| | - Steven Kho
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, NT, Australia
- Papuan Community Health and Development Foundation, Timika, Papua, Indonesia
| | - Matthew J Grigg
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, NT, Australia
| | - Bridget E Barber
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Kim A Piera
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, NT, Australia
| | - Timothy William
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, NT, Australia
| | - Jeanne R Poespoprodjo
- Papuan Community Health and Development Foundation, Timika, Papua, Indonesia
- Department of Pediatrics, Timika General Hospital, Timika, Papua, Indonesia
| | | | - Julie A Simpson
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - James M McCaw
- School of Mathematics and Statistics, University of Melbourne, Melbourne, VIC, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Nicholas M Anstey
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, NT, Australia
| | - James S McCarthy
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia.
- Department of Infectious Diseases, Melbourne Medical School, Melbourne, VIC, Australia.
| | - Sumudu Britton
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia.
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Srivastava B, Sharma S, Swarnkar D, Ahmed N, Valecha N, Anvikar AR. Benefits of Lot Testing to Improve the Quality of Malaria Rapid Diagnostic Tests in India. Am J Trop Med Hyg 2024; 110:431-435. [PMID: 38350136 PMCID: PMC10919188 DOI: 10.4269/ajtmh.23-0339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 11/02/2023] [Indexed: 02/15/2024] Open
Abstract
Since 2010, malaria rapid diagnostic tests (RDTs) are widely used to detect malaria. The Indian Council of Medical Research-National Institute of Malaria Research performed lot testing (LT) according to WHO procedures since 2016. Lot testing is performed to evaluate the lot-to-lot variation in performance of malaria RDTs. Four sets of positive quality control (QC) panels for P. falciparum (Pf) and P. vivax (Pv) and 10 negative panels tested RDTs. RDTs were reported as pass, failed, or deferred on the basis of WHO criteria. In the past 5 years, 275 lots containing 15,488 RDT kits for malaria diagnosis were subjected to LT. The monovalent RDTs (n = 1,216), based on either Pf histidine rich protein 2 (HRP2) or Pan-Plasmodium lactate dehydrogenase (Pan-pLDH) antigens, showed 90.4% sensitivity and 100% specificity, whereas RDTs based on HRP2 + Pan-pLDH or HRP2 + pLDH (n = 13,924) had sensitivity 95.6% and specificity 99.5%, respectively. RDTs based on PfHRP2 + Pv-pLDH + Pan-pLDH (n = 348) had 100% sensitivity and specificity. In a comparison between HRP2 + pLDH or HRP2 + Pan-pLDH to HRP2 + pLDH + Pan-pLDH RDTs, it was found that the sensitivity of PfHRP2 with Pan-pLDH RDTs (n = 2,382) was only 83%. Of the 275 lots analyzed, 15 lots of PfHRP2 with Pan-pLDH were deferred. The QC panel for Pf revealed a faint Pan band in the tested lots, which is a cause for concern. The results of deferred lots were reported to concerned government agencies. Quality-compromised RDTs may lead to an incorrect diagnosis. It is critical to have a QC system in place for effective malaria management.
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Affiliation(s)
- Bina Srivastava
- Indian Council of Medical Research, National Institute of Malaria Research, Dwarka, New Delhi, India
| | - Supriya Sharma
- Indian Council of Medical Research, National Institute of Malaria Research, Dwarka, New Delhi, India
| | - Deendayal Swarnkar
- Indian Council of Medical Research, National Institute of Malaria Research, Dwarka, New Delhi, India
| | - Naseem Ahmed
- Indian Council of Medical Research, National Institute of Malaria Research, Dwarka, New Delhi, India
| | - Neena Valecha
- Independent Malaria Technical Expert, New Delhi, India
| | - Anupkumar R. Anvikar
- Indian Council of Medical Research, National Institute of Malaria Research, Dwarka, New Delhi, India
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Çulha G, Önlen Y, Çabalak M, Kaya T, Küçükeser B. Investigation of Sensitivity of Rapid Diagnosis Tests in Patients with Suspected Malaria. Turkiye Parazitol Derg 2024; 48:1-7. [PMID: 38449360 DOI: 10.4274/tpd.galenos.2024.38358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
Objective Malaria has been eradicated in Türkiye as of 2010, but there are imported cases. In this study, we aimed to compare the diagnostic value of two rapid tests; SD Bioline Malaria Ag Pf/Pan (SD-Pf/Pan) and SD Bioline Malaria Ag Pf/Pv (SD-Pf/Pv) with microscopy and real time-polymerase chain reaction (RT-PCR). Methods Blood samples were taken from all participants. Thick drop smears were prepared. Thick drop smears were examined for malaria positive/negative distinction under the light microscopy. Then, two rapid diagnostic tests (SD-Pf/Pan and SD-Pf/Pv) were performed. After DNA extraction from blood samples, RT-PCR was typed. The data were evaluated with SPSS 21 program of statistics. Results A total of 30 cases out of 66 suspected malaria cases were detected as positive with microscopy and RT-PCR. Twenty-seven patients were found positive with both SD-Pf/Pan and SD-Pf/Pv tests. Based on the microscopic results as a reference method, SD-Pf/Pan and SD-Pf/Pv rapid diagnostic tests had a 90% sensitivity, 100% specificity, 100% positive predictive value (PPV), and 92.86% negative predictive value (NPV). Based on the RT-PCR results as a reference method, for detection of P. falciparum, both tests had a 95.65% sensitivity, 100% specificity, 100% PPV, and 88.89% NPV. Moreover, while SD-Pf/Pv had a sensitivity, specificity, PPV, and NPV of 100% in detection of P. vivax; SD-Pf/Pan has a 77.78% sensitivity of, 61.90% specificity of, 46.67% PPV, and 86.67% NPV SD-Pf/Pan for detection of PAN. Conclusion As a result, high sensitivity and specificity were detected in both kits in the diagnosis of malaria infections caused by P. falciparum and P. vivax. Rapid diagnostic tests can be used safely in diagnosis however the diagnosis should be supported by microscopy and RT-PCR methods when they are applicable.
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Affiliation(s)
- Gülnaz Çulha
- Hatay Mustafa Kemal University Faculty of Medicine, Department of Parasitology, Hatay, Türkiye
| | - Yusuf Önlen
- Hatay Mustafa Kemal University Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Hatay, Türkiye
| | - Mehmet Çabalak
- Hatay Mustafa Kemal University Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Hatay, Türkiye
| | - Tuğba Kaya
- Hatay Mustafa Kemal University Faculty of Medicine, Department of Parasitology, Hatay, Türkiye
| | - Burcu Küçükeser
- Hatay Mustafa Kemal University Faculty of Medicine, Department of Parasitology, Hatay, Türkiye
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Lai MY, Ponnampalavanar SSLS, Omar SFS, Lau YL. A visualized hybrid PCR-LAMP assay for the detection of human Plasmodium species. Acta Trop 2024; 251:107120. [PMID: 38199452 DOI: 10.1016/j.actatropica.2024.107120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 01/05/2024] [Accepted: 01/07/2024] [Indexed: 01/12/2024]
Abstract
Combining the advantages of PCR and LAMP, we described a new technique, namely PCR-LAMP, for malaria diagnosis. The whole process of DNA amplification can be completed in 35 min. This hybrid amplification technique markedly improved the sensitivity of detection compared to the classic single PCR or LAMP assay alone. PCR-LAMP assay had a detection limit of 1 copy/µL for P. knowlesi and P. ovale, 0.1 copy/µL for P. vivax, P. falciparum and P. malariae, respectively. To facilitate the endpoint detection, xylenol orange was added. Positive samples were indicated in orange while negative reactions were violet. The inclusion of xylenol orange into the LAMP reaction mix significantly reduces the post-amplification workload. Without relying on the use of specific instruments, the color changes of the amplicons could be visualized directly through the naked eye. In conclusion, PCR-LAMP poses the potential to be developed as a new malaria molecular diagnosis tool.
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Affiliation(s)
- Meng Yee Lai
- Department of Parasitology, Faculty of Medicine, Universiti Malaya, 50603 Kuala Lumpur, Malaysia
| | | | | | - Yee Ling Lau
- Department of Parasitology, Faculty of Medicine, Universiti Malaya, 50603 Kuala Lumpur, Malaysia.
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Ahmad SS, Verma R, Commons RJ, Nitika, Singh-Phulgenda S, Chhajed R, Bharti PK, Behera B, Naser SM, Pal SK, Ranjit PH, Baharia RK, Solanki B, Upadhyay KJ, Guerin PJ, Sharma A, Price RN, Rahi M, Thriemer K. A randomised controlled trial to compare the efficacy, safety, and tolerability of low dose, short course primaquine in adults with uncomplicated P. vivax malaria in two hospitals in India. Trials 2024; 25:154. [PMID: 38424577 PMCID: PMC10905854 DOI: 10.1186/s13063-024-07987-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 02/15/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Plasmodium vivax remains a major challenge for malaria control and elimination due to its ability to cause relapsing illness. To prevent relapses the Indian National Center for Vector Borne Diseases Control (NCVBDC) recommends treatment with primaquine at a dose of 0.25 mg/kg/day provided over 14 days. Shorter treatment courses may improve adherence and treatment effectiveness. METHODS This is a hospital-based, randomised, controlled, open-label trial in two centres in India. Patients above the age of 16 years, with uncomplicated vivax malaria, G6PD activity of ≥ 30% of the adjusted male median (AMM) and haemoglobin levels ≥ 8 g/dL will be recruited into the study and randomised in a 1:1 ratio to receive standard schizonticidal treatment plus 7-day primaquine at 0.50 mg/kg/day or standard care with schizonticidal treatment plus 14-day primaquine at 0.25 mg/kg/day. Patients will be followed up for 6 months. The primary endpoint is the incidence risk of any P. vivax parasitaemia at 6 months. Safety outcomes include the incidence risk of severe anaemia (haemoglobin < 8 g/dL), the risk of blood transfusion, a > 25% fall in haemoglobin and an acute drop in haemoglobin of > 5 g/dL during primaquine treatment. DISCUSSION This study will evaluate the efficacy and safety of a 7-day primaquine regimen compared to the standard 14-day regimen in India. Results from this trial are likely to directly inform national treatment guidelines. TRIAL REGISTRATION Trial is registered on CTRI portal, Registration No: CTRI/2022/12/048283.
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Affiliation(s)
| | - Reena Verma
- ICMR-National Institute of Malaria Research, New Delhi, India
| | - Robert J Commons
- WorldWide Antimalarial Resistance Network, Asia-Pacific Regional Hub, Melbourne, Australia
- Menzies School of Health Research and Charles Darwin University, Darwin, Australia
- General and Subspecialty Medicine, Grampians Health, Ballarat, Australia
| | - Nitika
- ICMR-National Institute of Malaria Research, New Delhi, India
| | - Sauman Singh-Phulgenda
- Infectious Diseases Data Observatory - IDDO, Oxford, UK
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, New Richards Building, Old Road Campus, Roosevelt Drive, Oxford, OX3 7LG, UK
| | - Rutuja Chhajed
- Infectious Diseases Data Observatory - IDDO, Oxford, UK
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, New Richards Building, Old Road Campus, Roosevelt Drive, Oxford, OX3 7LG, UK
| | | | - Beauty Behera
- Delhi Skill and Entrepreneurship University, New Delhi, India
| | | | - Salil Kumar Pal
- Calcutta National Medical College, Kolkata, West Bengal, India
| | | | - Rajendra Kumar Baharia
- NIMR Field Unit, Academy of Scientific and Innovative Research, Ghaziabad, Gujarat, India
| | - Bhavin Solanki
- Ahmedabad Municipal Corporation, Ahmedabad, Gujarat, India
| | | | - Philippe J Guerin
- Infectious Diseases Data Observatory - IDDO, Oxford, UK
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, New Richards Building, Old Road Campus, Roosevelt Drive, Oxford, OX3 7LG, UK
| | - Amit Sharma
- International Centre for Genetic Engineering and Biotechnology, New Delhi, India
| | - Ric N Price
- WorldWide Antimalarial Resistance Network, Asia-Pacific Regional Hub, Melbourne, Australia
- Menzies School of Health Research and Charles Darwin University, Darwin, Australia
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, New Richards Building, Old Road Campus, Roosevelt Drive, Oxford, OX3 7LG, UK
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Manju Rahi
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India.
- Indian Council of Medical Research, New Delhi, India.
| | - Kamala Thriemer
- Menzies School of Health Research and Charles Darwin University, Darwin, Australia.
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Grimée M, Tacoli C, Sandfort M, Obadia T, Taylor AR, Vantaux A, Robinson LJ, Lek D, Longley RJ, Mueller I, Popovici J, White MT, Witkowski B. Using serological diagnostics to characterize remaining high-incidence pockets of malaria in forest-fringe Cambodia. Malar J 2024; 23:49. [PMID: 38360625 PMCID: PMC10870639 DOI: 10.1186/s12936-024-04859-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 01/23/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Over the last decades, the number of malaria cases has drastically reduced in Cambodia. As the overall prevalence of malaria in Cambodia declines, residual malaria transmission becomes increasingly fragmented over smaller remote regions. The aim of this study was to get an insight into the burden and epidemiological parameters of Plasmodium infections on the forest-fringe of Cambodia. METHODS 950 participants were recruited in the province of Mondulkiri in Cambodia and followed up from 2018 to 2020. Whole-blood samples were processed for Plasmodium spp. identification by PCR as well as for a serological immunoassay. A risk factor analysis was conducted for Plasmodium vivax PCR-detected infections throughout the study, and for P. vivax seropositivity at baseline. To evaluate the predictive effect of seropositivity at baseline on subsequent PCR-positivity, an analysis of P. vivax infection-free survival time stratified by serological status at baseline was performed. RESULTS Living inside the forest significantly increased the odds of P. vivax PCR-positivity by a factor of 18.3 (95% C.I. 7.7-43.5). Being a male adult was also a significant predictor of PCR-positivity. Similar risk profiles were identified for P. vivax seropositivity. The survival analysis showed that serological status at baseline significantly correlated with subsequent infection. Serology is most informative outside of the forest, where 94.0% (95% C.I. 90.7-97.4%) of seronegative individuals survived infection-free, compared to 32.4% (95% C.I.: 22.6-46.6%) of seropositive individuals. CONCLUSION This study justifies the need for serological diagnostic assays to target interventions in this region, particularly in demographic groups where a lot of risk heterogeneity persists, such as outside of the forest.
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Affiliation(s)
- Mathilde Grimée
- Infectious Disease Epidemiology and Analytics, Institut Pasteur, Université Paris Cité, Paris, France.
- Collège Doctoral, Sorbonne Université, Paris, France.
| | - Costanza Tacoli
- Malaria Research Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Mirco Sandfort
- Collège Doctoral, Sorbonne Université, Paris, France
- Malaria Parasites and Hosts, Institut Pasteur, Université Paris Cité, Paris, France
| | - Thomas Obadia
- Infectious Disease Epidemiology and Analytics, Institut Pasteur, Université Paris Cité, Paris, France
- Bioinformatics and Biostatistics Hub, Institut Pasteur, Université Paris Cité, Paris, France
| | - Aimee R Taylor
- Infectious Disease Epidemiology and Analytics, Institut Pasteur, Université Paris Cité, Paris, France
| | - Amélie Vantaux
- Malaria Research Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Leanne J Robinson
- Burnet Institute, Melbourne, Australia
- Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea
- Population Health and Immunity, The Walter and Eliza Hall Institute of Medical Research, Parkville, Australia
| | - Dysoley Lek
- National Centre for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia
- School of Public Health, National Institute of Public Health, Phnom Penh, Cambodia
| | - Rhea J Longley
- Population Health and Immunity, The Walter and Eliza Hall Institute of Medical Research, Parkville, Australia
- Department of Medical Biology, The University of Melbourne, Parkville, Australia
| | - Ivo Mueller
- Malaria Parasites and Hosts, Institut Pasteur, Université Paris Cité, Paris, France
- Population Health and Immunity, The Walter and Eliza Hall Institute of Medical Research, Parkville, Australia
- National Centre for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia
| | - Jean Popovici
- Malaria Research Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Michael T White
- Infectious Disease Epidemiology and Analytics, Institut Pasteur, Université Paris Cité, Paris, France.
- Malaria Parasites and Hosts, Institut Pasteur, Université Paris Cité, Paris, France.
| | - Benoît Witkowski
- Malaria Research Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia.
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Kotepui M, Mahittikorn A, Wilairatana P, Masangkay FR, Wangdi K, Kotepui KU. Methemoglobin levels in malaria: a systematic review and meta-analysis of its association with Plasmodium falciparum and Plasmodium vivax infections and disease severity. Sci Rep 2024; 14:3276. [PMID: 38332023 PMCID: PMC10853561 DOI: 10.1038/s41598-024-53741-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 02/04/2024] [Indexed: 02/10/2024] Open
Abstract
Reports indicate that Plasmodium infections influence methemoglobin levels. However, findings have been inconclusive or have varied across different geographic and demographic contexts. This systematic review and meta-analysis aimed to consolidate existing data regarding the association between Plasmodium infections and alterations in methemoglobin levels related to the severity of the infection. A comprehensive literature search of several databases, including Ovid, ProQuest, Embase, Scopus, MEDLINE, and PubMed, was conducted to identify relevant studies that examined methemoglobin levels in patients with malaria. Qualitative synthesis and meta-analysis of the pooled standardized mean difference were conducted to synthesize the differences in methemoglobin levels between: (1) patients with malaria and those without malaria and (2) patients with severe malaria and those with uncomplicated malaria based on various themes including publication year, study design, study area, Plasmodium species, age group, symptomatic status, severity status, and method of malaria detection. Of the 1846 studies that were initially identified from the main databases and additional searches on Google Scholar, 10 studies met the eligibility criteria and were selected for this review. The systematic review distinctly highlighted an association between malaria and elevated methemoglobin levels, an observation consistent across diverse geographical regions and various Plasmodium species. Furthermore, the meta-analysis confirmed this by demonstrating increased methemoglobin levels in patients with malaria compared to those without malaria (P < 0.001, Hedges' g 2.32, 95% CI 1.36-3.29, I2 97.27, 8 studies). Moreover, the meta-analysis found elevated methemoglobin levels in patients with severe malaria compared to those with uncomplicated malaria (P < 0.001, Hedges' g 2.20, 95% CI 0.82-3.58, I2 96.20, 5 studies). This systematic review and meta-analysis revealed increased methemoglobin levels in patients with P. falciparum and P. vivax infections, with a notable association between elevated methemoglobin levels and severe malaria. Future research should focus on elucidating the specific mechanisms by which changes in methemoglobin levels are related to infections by P. falciparum and P. vivax, particularly in terms of severity, and how these alterations could potentially impact patient management and treatment outcomes.
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Affiliation(s)
- Manas Kotepui
- Medical Technology, School of Allied Health Sciences, Walailak University, Thasala, Nakhon Si Thammarat, 80160, Thailand.
| | - Aongart Mahittikorn
- Department of Protozoology, Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400, Thailand.
| | - Polrat Wilairatana
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400, Thailand
| | | | - Kinley Wangdi
- QIMR Medical Research Institute, 300 Herston Road, Herston, QLD, 4006, Australia
| | - Kwuntida Uthaisar Kotepui
- Medical Technology, School of Allied Health Sciences, Walailak University, Thasala, Nakhon Si Thammarat, 80160, Thailand
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Xiang Z, Zhou L, Pan M, Qin Y, Bai Y, Qin P, Zeng W, Wei X, Lu Y, Somboonwit C, Menezes L, Huang Y, Cui L, Yang Z. An imported malaria case with repeated episodes of neurological syndromes resulting from different Plasmodium species. BMC Infect Dis 2024; 24:41. [PMID: 38172708 PMCID: PMC10763073 DOI: 10.1186/s12879-023-08872-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 12/05/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Imported cerebral malaria (CM) cases in non-endemic areas are often misdiagnosed, which delays treatment. Post-malaria neurological syndrome (PMNS) after recovery from severe malaria can also complicate diagnosis. CASE We report an imported malaria case from West Africa with two sequential episodes with neurological syndromes within about a month. The first episode was diagnosed as CM with microscopy-positive Plasmodium falciparum infection. The second episode, occurring a month after the recovery from the first CM episode, was consistent with PMNS, since malaria parasites were not detected by microscopy in peripheral blood smears. However, this diagnosis was complicated by the detection of Plasmodium vivax in peripheral blood by PCR, suggesting a potential cause of the second episode by P. vivax. CONCLUSION This study suggests that PMNS often occurs after severe falciparum malaria. Concurrent P. vivax infection with pathogenic biomass being predominantly extravascular further complicates accurate diagnosis.
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Affiliation(s)
- Zheng Xiang
- Department of Pathogen Biology and Immunology, Kunming Medical University, Kunming, Yunnan Province, China.
| | - Longcan Zhou
- Shanglin County People's Hospital, Shanglin, Guangxi, China
| | - Maohua Pan
- Shanglin County People's Hospital, Shanglin, Guangxi, China
| | - Yucheng Qin
- Shanglin County People's Hospital, Shanglin, Guangxi, China
| | - Yao Bai
- Department of Pathogen Biology and Immunology, Kunming Medical University, Kunming, Yunnan Province, China
| | - Pien Qin
- Shanglin County People's Hospital, Shanglin, Guangxi, China
| | - Weilin Zeng
- Department of Pathogen Biology and Immunology, Kunming Medical University, Kunming, Yunnan Province, China
| | - Xiaosheng Wei
- Shanglin County People's Hospital, Shanglin, Guangxi, China
| | - Yuxin Lu
- Shanglin County People's Hospital, Shanglin, Guangxi, China
| | - Charurut Somboonwit
- Department of Internal Medicine, Morsani College of Medicine, University of South Florida, 3720 Spectrum Boulevard, Suite 304, Tampa, FL, 33612, USA
| | - Lynette Menezes
- Department of Internal Medicine, Morsani College of Medicine, University of South Florida, 3720 Spectrum Boulevard, Suite 304, Tampa, FL, 33612, USA
| | - Yaming Huang
- Guangxi Zhuang Autonomous Region Center for Disease Control and Prevention, Nanning, Guangxi, China.
| | - Liwang Cui
- Department of Internal Medicine, Morsani College of Medicine, University of South Florida, 3720 Spectrum Boulevard, Suite 304, Tampa, FL, 33612, USA.
| | - Zhaoqing Yang
- Department of Pathogen Biology and Immunology, Kunming Medical University, Kunming, Yunnan Province, China.
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9
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Price DJ, Nekkab N, Monteiro WM, Villela DAM, Simpson JA, Lacerda MVG, White MT, Devine A. Tafenoquine following G6PD screening versus primaquine for the treatment of vivax malaria in Brazil: A cost-effectiveness analysis using a transmission model. PLoS Med 2024; 21:e1004255. [PMID: 38194420 PMCID: PMC10775976 DOI: 10.1371/journal.pmed.1004255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 11/29/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND Malaria transmission modelling has demonstrated the potential impact of semiquantitative glucose-6-phosphate dehydrogenase (G6PD) testing and treatment with single-dose tafenoquine for Plasmodium vivax radical cure but has not investigated the associated costs. This study evaluated the cost-effectiveness of P. vivax treatment with tafenoquine after G6PD testing using a transmission model. METHODS AND FINDINGS We explored the cost-effectiveness of using tafenoquine after G6PD screening as compared to usual practice (7-day low-dose primaquine (0.5 mg/kg/day) without G6PD screening) in Brazil using a 10-year time horizon with 5% discounting considering 4 scenarios: (1) tafenoquine for adults only assuming 66.7% primaquine treatment adherence; (2) tafenoquine for adults and children aged >2 years assuming 66.7% primaquine adherence; (3) tafenoquine for adults only assuming 90% primaquine adherence; and (4) tafenoquine for adults only assuming 30% primaquine adherence. The incremental cost-effectiveness ratios (ICERs) were estimated by dividing the incremental costs by the disability-adjusted life years (DALYs) averted. These were compared to a willingness to pay (WTP) threshold of US$7,800 for Brazil, and one-way and probabilistic sensitivity analyses were performed. All 4 scenarios were cost-effective in the base case analysis using this WTP threshold with ICERs ranging from US$154 to US$1,836. One-way sensitivity analyses showed that the results were most sensitive to severity and mortality due to vivax malaria, the lifetime and number of semiquantitative G6PD analysers needed, cost per malaria episode and per G6PD test strips, and life expectancy. All scenarios had a 100% likelihood of being cost-effective at the WTP threshold. The main limitations of this study are due to parameter uncertainty around our cost estimates for low transmission settings, the costs of G6PD screening, and the severity of vivax malaria. CONCLUSIONS In our modelling study that incorporated impact on transmission, tafenoquine prescribed after a semiquantitative G6PD testing was highly likely to be cost-effective in Brazil. These results demonstrate the potential health and economic importance of ensuring safe and effective radical cure.
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Affiliation(s)
- David J. Price
- Department of Infectious Diseases, The University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Victoria, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Narimane Nekkab
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Wuelton M. Monteiro
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Brazil
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
| | - Daniel A. M. Villela
- Programa de Computacão Científica, Fundacão Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Julie A. Simpson
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Marcus V. G. Lacerda
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Brazil
- Instituto Leônidas & Maria Deane–ILMD, Fundação Oswaldo Cruz, Manaus, Brazil
| | - Michael T. White
- Institut Pasteur, Université de Paris, G5 Épidémiologie et Analyse des Maladies Infectieuses, Département de Santé Globale, F-75015 Paris, France
| | - Angela Devine
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
- Melbourne Health Economics, Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
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Pacheco Souza RS, Dos Reis MF, de Lima Ferreira LC, Morais MC, Lima AKS, Albuquerque Barbosa LR, de Melo GC, de Lacerda MVG. Standardization of DNA extraction from paraffinized spleen samples: molecular diagnosis of human malaria. Malar J 2023; 22:361. [PMID: 38012686 PMCID: PMC10683280 DOI: 10.1186/s12936-023-04764-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 10/22/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Plasmodium vivax is the main species responsible for human malaria in Brazil, and one of its manifestations is splenic malaria, though there are still challenges in its diagnosis. The present study aimed to standardize Plasmodium sp. DNA extraction from histological slices of spleen and diagnosis using real-time qPCR. METHODS This study performed a microtomy of a paraffin-embedded spleen as a positive control for P. vivax from a patient who had been previously diagnosed with the parasite. The sample was deparaffinized with xylol and ethanol, then DNA extraction was performed with two commercial kits. qPCR was carried out with the Taqman system for detection of Plasmodium sp. and was made species-specific using PvmtCOX1 gene. From 2015 to 2019, 200 spleen samples were obtained from trauma patients subjected to splenectomy in Manaus, Amazonas. All the samples were tested for cell-free human DNA (cfDNA). RESULTS The deparaffinization and the Plasmodium vivax DNA extraction method was successfully standardized, and the control sample was positive for P. vivax. Of the 200 samples, all qPCRs were negative, but they were positive for human PCR. CONCLUSION Paraffinization is practical and efficient for the preservation of samples, but the formation of bonds between proteins and DNA makes extraction difficult. Despite this, in this study, it was possible to standardize a method of DNA extraction for detecting P. vivax.
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Affiliation(s)
| | | | - Luiz Carlos de Lima Ferreira
- Amazonas State University (UEA), Manaus, Amazonas, 69040-000, Brazil
- Doctor Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, Amazonas, 69040-000, Brazil
| | - Manuela C Morais
- Federal University of Amazonas, Manaus, Amazonas, 69080-900, Brazil
| | | | - Laila Rowena Albuquerque Barbosa
- Amazonas State University (UEA), Manaus, Amazonas, 69040-000, Brazil
- Doctor Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, Amazonas, 69040-000, Brazil
| | - Gisely Cardoso de Melo
- Amazonas State University (UEA), Manaus, Amazonas, 69040-000, Brazil.
- Doctor Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, Amazonas, 69040-000, Brazil.
| | - Marcus Vinicius Guimaraes de Lacerda
- Leonidas & Maria Deane Institute (ILMD), Fiocruz, Manaus, Amazonas, 69057-070, Brazil
- Doctor Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, Amazonas, 69040-000, Brazil
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McCallum F, Mond K, Cheng Q, Furuya-Kanamori L, Auliff A, Kaminiel P. A Health Survey Revealing Prevalence of Vector-Borne Diseases and Tuberculosis in Papua New Guinea Defence Force Personnel and Families. Am J Trop Med Hyg 2023; 109:1086-1094. [PMID: 37748766 PMCID: PMC10622466 DOI: 10.4269/ajtmh.23-0341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 07/26/2023] [Indexed: 09/27/2023] Open
Abstract
The Papua New Guinean Defence Force (PNGDF) and the Australian Defence Force (ADF) work and train closely. Infectious diseases pose a health threat to both forces, but recent knowledge about the risk at military bases in Papua New Guinea is limited. To improve understanding, a collaborative cross-sectional survey was conducted (March-April 2019) at Lombrum Naval base (Manus province) and Moem Army barracks (Wewak, East Sepik province) plus its Vanimo outpost (Sandaun province). Clinical data, venous blood, and sputum were collected from PNGDF personnel (DF) from the three sites, with point-of-care testing conducted for malaria (microscopy and rapid diagnostic test [RDT]), lymphatic filariasis (RDT), glucose-6-phosphate-dehydrogenase (G6PD) deficiency (RDT), tuberculosis (GeneXpert), and hemoglobin level. Finger prick blood collected from family members residing at the Wewak base was tested for malaria and hemoglobin level. Overall, 235 DF and 793 family members completed the survey. Microscopy revealed malaria prevalence as 0.4% Plasmodium falciparum and 3.1% Plasmodium vivax among DF and 3.5% P. falciparum, 14.3% P. vivax, and 0.3% mixed P. falciparum/P. vivax among family members. Among DF, 3.9% were G6PD deficient and none tested positive for tuberculosis or for lymphatic filariasis antigen. Anemia was present in 6.5% of DF and 47.3% of family members, predominantly females. Results suggest ongoing exposure to malaria, particularly P. vivax, at study sites, whereas infections of lymphatic filariasis and tuberculosis were not detected. Survey results will inform the PNGDF and the ADF regarding vector-borne disease risk for future sustainable health and disease control interventions.
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Affiliation(s)
- Fiona McCallum
- Australian Defence Force Malaria and Infectious Disease Institute, Brisbane, Australia
| | - Krond Mond
- Papua New Guinea Defence Force Health Services, Port Moresby, Papua New Guinea
| | - Qin Cheng
- Australian Defence Force Malaria and Infectious Disease Institute, Brisbane, Australia
| | - Luis Furuya-Kanamori
- School of Public Health, Faculty of Medicine, The University of Queensland, Herston, Australia
| | - Alyson Auliff
- Australian Defence Force Malaria and Infectious Disease Institute, Brisbane, Australia
| | - Peter Kaminiel
- Papua New Guinea Defence Force Health Services, Port Moresby, Papua New Guinea
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Zaw AS, Win ESS, Yan SW, Thein KS, Verma V, McLean ARD, Kyaw TT, White NJ, Smithuis FM. Successful elimination of falciparum malaria following the introduction of community-based health workers in Eastern Myanmar: A retrospective analysis. PLoS Med 2023; 20:e1004318. [PMID: 38033155 PMCID: PMC10721164 DOI: 10.1371/journal.pmed.1004318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 12/14/2023] [Accepted: 11/03/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Myanmar has a large majority of all malaria in the Greater Mekong Subregion. In the past decade, substantial progress was made in malaria control. The residual burden of malaria is in remote areas where currently recommended malaria elimination approaches are generally not feasible. In such hard-to-reach communities in Mon state, East Myanmar, Medical Action Myanmar introduced community health workers (CHWs) to deliver early diagnosis and treatment for malaria. We conducted a retrospective analysis to assess the impact of this intervention. METHODS AND FINDINGS This retrospective analysis involved data collected routinely from a CHW programme in Mon state conducted between 2011 and 2018. A network of 172 CHWs serving a population of 236,340 was deployed. These CHWs carried out 260,201 malaria rapid diagnostic tests (RDTs) to investigate patients with acute febrile illness. The median blood examination rate was 1.33%; interquartile range (IQR) (0.38 to 3.48%); 95% CI [1.28%, 1.36%] per month. The changes in malaria incidence and prevalence in patients presenting with fever were assessed using negative binomial regression mixed effects models fitted to the observed data. The incidence of Plasmodium falciparum malaria (including mixed infections) declined by 70%; 95% CI [65%, 75%]; p < 0.001 for each year of CHW operation. The incidence of P. vivax malaria declined by 56%; 95% CI [50%, 62%]; p < 0.001 per year. Malaria RDT positivity rates for P. falciparum and P. vivax declined by 69%; 95% CI [62%, 75%]; p < 0.001 and 53%; 95% CI [47%, 59%]; p < 0.001 per year, respectively. Between 2017 and 2018, only 1 imported P. falciparum case was detected in 54,961 RDTs. The main limitations of the study are use of retrospective data with possible unidentified confounders and uncharacterised population movement. CONCLUSIONS The introduction of CHWs providing community-based malaria diagnosis and treatment and basic health care services in remote communities in Mon state was associated with a substantial reduction in malaria. Within 6 years, P. falciparum was eliminated and the incidence of P. vivax fell markedly.
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Affiliation(s)
- Aye Sandar Zaw
- Medical Action Myanmar, Yangon, Myanmar
- Myanmar Oxford Clinical Research Unit, Yangon, Myanmar
| | | | | | | | | | - Alistair R. D. McLean
- Medical Action Myanmar, Yangon, Myanmar
- Myanmar Oxford Clinical Research Unit, Yangon, Myanmar
| | - Thar Tun Kyaw
- Medical Action Myanmar, Yangon, Myanmar
- Myanmar Oxford Clinical Research Unit, Yangon, Myanmar
- Department of Public Health, Ministry of Health and Sports, Nay Pyi Taw, Myanmar
| | - Nicholas J. White
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Frank M. Smithuis
- Medical Action Myanmar, Yangon, Myanmar
- Myanmar Oxford Clinical Research Unit, Yangon, Myanmar
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
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Stojanovic M, Barac A, Miskovic R, Jovanovic D, Bolpacic J, Ljubicic J, Stevanovic G, Jovanovic S, Bogdanovic A. Myositis-specific autoantibodies in a non-traveler, patient from a non-endemic country, with Plasmodium vivax malaria. J Infect Dev Ctries 2023; 17:1497-1500. [PMID: 37956374 DOI: 10.3855/jidc.18482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 05/14/2023] [Indexed: 11/15/2023] Open
Abstract
INTRODUCTION Autoantibodies (AAb) are a hallmark of immune-mediated inflammatory diseases. Malaria is a parasitic disease caused by Plasmodium protozoa. Individuals with malaria may present with a wide range of symptoms. It is frequently linked to the development of different AAb. CASE DESCRIPTION A 35-year-old male presented with repeated episodes of fever, malaise, myalgia, dark urine, and yellowish sclera. Initial diagnostic workup revealed severe Coombs-positive anemia, increased C-reactive protein, and procalcitonin, pathological liver tests, high concentration of serum IgE, IgG, IgM, IgA, positive antinuclear antibodies (ANA), and positive antineutrophil cytoplasmatic antibodies (ANCA). In addition, myositis-specific antibodies directed to polymiositis-scleroderma 75 protein (PmScl75), threonyl-tRNA synthetase (PL-7), alanyl-tRNA synthetase (PL-12), Mi-2 antigen (Mi-2), Ku DNA helicase complex (Ku), signal recognition particle (SRP), and antiaminoacyl tRNA synthetase (EJ) were detected. The patient was suspected of having systemic lupus erythematosus and sent to the Clinic of Allergy and Immunology for further evaluation and treatment. A peripheral blood film examined by the hematologist during an episode of fever revealed intra-erythrocytic parasitic forms of Plasmodium vivax (P. vivax). After being diagnosed with P. vivax malaria, he was transferred to the Clinic for Infective and Tropical Diseases. The therapy consisted of artesunate/mefloquine and prednisone led to a complete clinical recovery and autoantibodies gradually disappeared. CONCLUSIONS Malaria would not normally be considered during the initial diagnostic workup in a non-traveler and a patient from a non-endemic country. However, a thorough parasitic evaluation in patients presenting with a broad range of autoantibodies might be of particular importance.
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Affiliation(s)
- Maja Stojanovic
- Clinic of Allergy and Immunology, University Clinical Center of Serbia, Belgrade, Serbia
| | | | - Rada Miskovic
- Clinic of Allergy and Immunology, University Clinical Center of Serbia, Belgrade, Serbia
| | - Dragana Jovanovic
- Clinic of Allergy and Immunology, University Clinical Center of Serbia, Belgrade, Serbia
| | - Jasna Bolpacic
- Clinic of Allergy and Immunology, University Clinical Center of Serbia, Belgrade, Serbia
| | - Jelena Ljubicic
- University of Belgrade, Faculty of Medicine, Belgrade, Serbia
| | | | - Snezana Jovanovic
- Department of Microbiology, University Clinical Center of Serbia, Belgrade, Serbia
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Biruksew A, Demeke A, Birhanu Z, Golassa L, Getnet M, Yewhalaw D. Schoolchildren with asymptomatic malaria are potential hotspot for malaria reservoir in Ethiopia: implications for malaria control and elimination efforts. Malar J 2023; 22:311. [PMID: 37845680 PMCID: PMC10580533 DOI: 10.1186/s12936-023-04736-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 09/30/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND Schoolchildren with asymptomatic malaria infections often go undiagnosed and untreated, serving as reservoirs for infection that hamper malaria control and elimination efforts. In this context, little is known about the magnitude of asymptomatic malaria infections in apparently healthy schoolchildren in Ethiopia. This study was aimed at determining the prevalence of asymptomatic malaria infection and its associated factors in apparently healthy schoolchildren in Ethiopia. METHODS From September 2021 to January 2022, a school-based cross-sectional study was conducted on 994 apparently healthy schoolchildren (aged 6-15 years) selected from 21 primary schools in the Gomma district, of Jimma zone, southwestern Oromia, Ethiopia. A multi-stage sampling technique was used to select schools and participants. After allocating the total sample proportionally to each school and then to each grade, participants were selected using the lottery method from a list of student records (rosters). Finger-pricked blood samples were collected for microscopy blood film preparation and malaria rapid diagnostic test (RDT) (SD Bioline Malaria Ag Pf/Pv). Moreover, dry blood spots (DBSs) were prepared onto filter papers for quantitative real time polymerase chain reaction (qPCR) analysis. RESULTS As determined by RDT and microscopy, the prevalence of asymptomatic malaria was 2.20% and 1.51%, respectively. Using qPCR, the overall prevalence was 5.03% (50/994). Of this, Plasmodium falciparum, Plasmodium vivax and mixed infections accounted for 90%, 6% and 4%, respectively. Submicroscopic asymptomatic malaria infection was also accounted for 70% (35/50) of the overall prevalence. Household head age, nighttime outdoor activities of household heads, family history of malaria, absence of insecticide-treated nets (ITN), and presence of stagnant water around the houses are all significantly associated with asymptomatic malaria infections among schoolchildren. CONCLUSIONS This study found that both RDT and microscopy underestimated the prevalence of asymptomatic malaria in schoolchildren. However, qPCR was able to detect even low levels of parasitaemia and revealed a higher prevalence of asymptomatic submicroscopic malaria infections. The findings imply that schoolchildren with asymptomatic malaria infection are potential hotspot for malaria reservoir that fuels ongoing transmission. Therefore, it is imperative to include schoolchildren and schools in malaria intervention package and equally important is the adoption of more advanced and sensitive diagnostic tools, which would be crucial for successful malaria control and elimination efforts. Targeted interventions for asymptomatic malaria-infected schoolchildren can provide invaluable support to the National Malaria Control Programme in controlling and eventually eliminating the disease.
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Affiliation(s)
- Abdissa Biruksew
- School of Medical Laboratory Sciences, Faculty of Health Sciences, Institute of Health, Jimma University, Jimma, Ethiopia
- Tropical and Infectious Diseases Research Center (TIRC), Jimma University, Jimma, Ethiopia
| | | | - Zewdie Birhanu
- Department of Health, Behavior, and Society, Faculty of Public Health, Institute of Health Jimma University, Jimma, Ethiopia
| | - Lemu Golassa
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Masrie Getnet
- Department of Biostatistics and Epidemiology, Faculty of Public Health, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Delenasaw Yewhalaw
- School of Medical Laboratory Sciences, Faculty of Health Sciences, Institute of Health, Jimma University, Jimma, Ethiopia
- Tropical and Infectious Diseases Research Center (TIRC), Jimma University, Jimma, Ethiopia
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López AR, Martins EB, de Pina-Costa A, Pacheco-Silva AB, Ferreira MT, Mamani RF, Detepo PJT, Lupi O, Bressan CS, Calvet GA, Silva MFB, de Fátima Ferreira-da-Cruz M, de Bruycker-Nogueira F, Filippis AMB, Daniel-Ribeiro CT, Siqueira A, Brasil P. A fatal respiratory complication of malaria caused by Plasmodium vivax. Malar J 2023; 22:303. [PMID: 37814260 PMCID: PMC10563287 DOI: 10.1186/s12936-023-04720-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 09/17/2023] [Indexed: 10/11/2023] Open
Abstract
BACKGROUND Malaria is endemic and represents an important public health issue in Brazil. Knowledge of risk factors for disease progression represents an important step in preventing and controlling malaria-related complications. Reports of severe forms of Plasmodium vivax malaria are now becoming a common place, but respiratory complications are described in less than 3% of global literature on severe vivax malaria. CASE PRESENTATION A severe respiratory case of imported vivax malaria in a previously healthy 40-year-old woman has been reported. The patient died after the fifth day of treatment with chloroquine and primaquine due to acute respiratory distress syndrome. CONCLUSIONS Respiratory symptoms started 48 h after the initiation of anti-malarial drugs, raising the hypothesis that the drugs may have been involved in the genesis of the complication. The concept that vivax malaria is a benign disease that can sometimes result in the development of serious complications must be disseminated. This report highlights, once more, the crucial importance of malaria early diagnosis, a true challenge in non-endemic areas, where health personnel are not familiar with the disease and do not consider its diagnosis promptly.
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Affiliation(s)
- Angie R. López
- Instituto Nacional de Infectologia Evandro Chagas Fiocruz, Rio de Janeiro, Brazil
| | - Ezequias B. Martins
- Instituto Nacional de Infectologia Evandro Chagas Fiocruz, Rio de Janeiro, Brazil
- Centro de Pesquisa, Diagnóstico e Treinamento em Malária da Fiocruz e da Secretaria de Vigilância em Saúde, Ministério da Saúde, Brasília, Brazil
| | - Anielle de Pina-Costa
- Instituto Nacional de Infectologia Evandro Chagas Fiocruz, Rio de Janeiro, Brazil
- Centro de Pesquisa, Diagnóstico e Treinamento em Malária da Fiocruz e da Secretaria de Vigilância em Saúde, Ministério da Saúde, Brasília, Brazil
| | | | - Marcel T. Ferreira
- Instituto Nacional de Infectologia Evandro Chagas Fiocruz, Rio de Janeiro, Brazil
| | - Roxana F. Mamani
- Instituto Nacional de Infectologia Evandro Chagas Fiocruz, Rio de Janeiro, Brazil
- Centro de Pesquisa, Diagnóstico e Treinamento em Malária da Fiocruz e da Secretaria de Vigilância em Saúde, Ministério da Saúde, Brasília, Brazil
| | - Paula J. T. Detepo
- Instituto Nacional de Infectologia Evandro Chagas Fiocruz, Rio de Janeiro, Brazil
| | - Otilia Lupi
- Instituto Nacional de Infectologia Evandro Chagas Fiocruz, Rio de Janeiro, Brazil
- Centro de Pesquisa, Diagnóstico e Treinamento em Malária da Fiocruz e da Secretaria de Vigilância em Saúde, Ministério da Saúde, Brasília, Brazil
| | - Clarisse S. Bressan
- Instituto Nacional de Infectologia Evandro Chagas Fiocruz, Rio de Janeiro, Brazil
- Centro de Pesquisa, Diagnóstico e Treinamento em Malária da Fiocruz e da Secretaria de Vigilância em Saúde, Ministério da Saúde, Brasília, Brazil
| | - Guilherme A. Calvet
- Instituto Nacional de Infectologia Evandro Chagas Fiocruz, Rio de Janeiro, Brazil
- Centro de Pesquisa, Diagnóstico e Treinamento em Malária da Fiocruz e da Secretaria de Vigilância em Saúde, Ministério da Saúde, Brasília, Brazil
| | - Michele F. B. Silva
- Instituto Nacional de Infectologia Evandro Chagas Fiocruz, Rio de Janeiro, Brazil
- Centro de Pesquisa, Diagnóstico e Treinamento em Malária da Fiocruz e da Secretaria de Vigilância em Saúde, Ministério da Saúde, Brasília, Brazil
| | - Maria de Fátima Ferreira-da-Cruz
- Centro de Pesquisa, Diagnóstico e Treinamento em Malária da Fiocruz e da Secretaria de Vigilância em Saúde, Ministério da Saúde, Brasília, Brazil
- Laboratório de Pesquisa em Malária, Instituto Oswaldo Cruz, Fiocruz, Av. Brasil, 4365, Manguinhos, Rio de Janeiro, 21045-900 Brazil
| | | | | | - Cláudio Tadeu Daniel-Ribeiro
- Centro de Pesquisa, Diagnóstico e Treinamento em Malária da Fiocruz e da Secretaria de Vigilância em Saúde, Ministério da Saúde, Brasília, Brazil
- Laboratório de Pesquisa em Malária, Instituto Oswaldo Cruz, Fiocruz, Av. Brasil, 4365, Manguinhos, Rio de Janeiro, 21045-900 Brazil
| | - André Siqueira
- Instituto Nacional de Infectologia Evandro Chagas Fiocruz, Rio de Janeiro, Brazil
- Laboratório de Pesquisa em Malária, Instituto Oswaldo Cruz, Fiocruz, Av. Brasil, 4365, Manguinhos, Rio de Janeiro, 21045-900 Brazil
| | - Patrícia Brasil
- Instituto Nacional de Infectologia Evandro Chagas Fiocruz, Rio de Janeiro, Brazil
- Laboratório de Pesquisa em Malária, Instituto Oswaldo Cruz, Fiocruz, Av. Brasil, 4365, Manguinhos, Rio de Janeiro, 21045-900 Brazil
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Arya A, Meena SS, Matlani M, Chaudhry S, Singh V. Trends in clinical features and severity of Plasmodium vivax malaria among children at tertiary care center in North India. J Trop Pediatr 2023; 69:fmad034. [PMID: 37864522 DOI: 10.1093/tropej/fmad034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2023]
Abstract
BACKGROUND Malaria is a significant cause of morbidity and mortality in adults and children. Plasmodium falciparum is the primary cause of severe malaria, but recently Plasmodium vivax is also recognized to cause severe malaria-associated morbidity and mortality. The study focuses on determining the mortality related to severity parameters in individuals under 12 years and their critical presentation in P.vivax malaria-infected children. METHODS A prospective cross-sectional hospital-based study was conducted at Safdarjung Hospital, New Delhi, and ICMR-NIMR, New Delhi. All clinically suspected cases were admitted for screening. Exclusion criteria (rapid malaria antigen test, microscopy and medication history) were applied to all the admitted patients (n = 221) to obtain P.vivax patients only. Patients aged ≤ 12 years were included in the study. DNA was extracted from dried blood spots and amplified by nested PCR, followed by visualization on gel electrophoresis. RESULT A total of 221 clinically suspected cases of malaria were screened for P.vivax. After implementing various exclusion criteria, 45/221 cases were enrolled for the study, among which 44.4% (20/45) of children had the symptoms of severe malaria in terms of cerebral malaria, thrombocytopenia, anemia, pancytopenia, acute respiratory distress syndrome and hemophagocytic lymphohistiocytosis. CONCLUSION Plasmodium vivax mono-infection can cause severe manifestation and must be treated as P.falciparum without any delay because it may lead to increased morbidity and mortality. A changing trend in clinical symptoms has shown in P.vivax which was an earlier phenomenon of P.falciparum.
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Affiliation(s)
- Aditi Arya
- Cell Biology Laboratory and Malaria Parasite Bank, ICMR-National Institute of Malaria Research, New Delhi 110077, India
| | - Shyam Sundar Meena
- Department of Pediatrics, VMMC, Safdarjung Hospital Campus, New Delhi 110029, India
| | - Monika Matlani
- Department of Microbiology, VMMC, Safdarjung Hospital Campus, New Delhi 110029, India
| | - Shewta Chaudhry
- Cell Biology Laboratory and Malaria Parasite Bank, ICMR-National Institute of Malaria Research, New Delhi 110077, India
| | - Vineeta Singh
- Cell Biology Laboratory and Malaria Parasite Bank, ICMR-National Institute of Malaria Research, New Delhi 110077, India
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17
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Adissu W, Brito M, Garbin E, Macedo M, Monteiro W, Mukherjee SK, Myburg J, Alam MS, Bancone G, Bansil P, Pal S, Sharma A, Zobrist S, Bryan A, Chu CS, Das S, Domingo GJ, Hann A, Kublin J, Lacerda MVG, Layton M, Ley B, Murphy SC, Nosten F, Pereira D, Price RN, Talukdar A, Yilma D, Gerth-Guyette E. Clinical performance validation of the STANDARD G6PD test: A multi-country pooled analysis. PLoS Negl Trop Dis 2023; 17:e0011652. [PMID: 37824592 PMCID: PMC10597494 DOI: 10.1371/journal.pntd.0011652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 10/24/2023] [Accepted: 09/08/2023] [Indexed: 10/14/2023] Open
Abstract
INTRODUCTION Screening for G6PD deficiency can inform disease management including malaria. Treatment with the antimalarial drugs primaquine and tafenoquine can be guided by point-of-care testing for G6PD deficiency. METHODS AND FINDINGS Data from similar clinical studies evaluating the performance of the STANDARD G6PD Test (SD Biosensor, South Korea) conducted in Bangladesh, Brazil, Ethiopia, India, Thailand, the United Kingdom, and the United States were pooled. Test performance was assessed in a retrospective analysis on capillary and venous specimens. All study sites used spectrophotometry for reference G6PD testing, and either the HemoCue or complete blood count for reference hemoglobin measurement. The sensitivity of the STANDARD G6PD Test using the manufacturer thresholds for G6PD deficient and intermediate cases in capillary specimens from 4212 study participants was 100% (95% Confidence Interval (CI): 97.5%-100%) for G6PD deficient cases with <30% activity and 77% (95% CI 66.8%-85.4%) for females with intermediate activity between 30%-70%. Specificity was 98.1% (95% CI 97.6%-98.5%) and 92.8% (95% CI 91.6%-93.9%) for G6PD deficient individuals and intermediate females, respectively. Out of 20 G6PD intermediate females with false normal results, 12 had activity levels >60% on the reference assay. The negative predictive value for females with G6PD activity >60% was 99.6% (95% CI 99.1%-99.8%) on capillary specimens. Sensitivity among 396 P. vivax malaria cases was 100% (69.2%-100.0%) for both deficient and intermediate cases. Across the full dataset, 37% of those classified as G6PD deficient or intermediate resulted from true normal cases. Despite this, over 95% of cases would receive correct treatment with primaquine, over 87% of cases would receive correct treatment with tafenoquine, and no true G6PD deficient cases would be treated inappropriately based on the result of the STANDARD G6PD Test. CONCLUSIONS The STANDARD G6PD Test enables safe access to drugs which are contraindicated for individuals with G6PD deficiency. Operational considerations will inform test uptake in specific settings.
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Affiliation(s)
- Wondimagegn Adissu
- School of Medical Laboratory Sciences, Jimma University, Jimma, Ethiopia
- Clinical Trial Unit, Jimma University, Jimma, Ethiopia
| | - Marcelo Brito
- Fundação de Medicina Tropical Dr Heitor Vieira Dourado (FMT-HVD), Manaus, Amazonas, Brazil
- Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil
| | - Eduardo Garbin
- Centro de Pesquisa Em Medicina Tropical (CEPEM), Porto Velho, Rondônia, Brazil
| | - Marcela Macedo
- Centro de Pesquisa Em Medicina Tropical (CEPEM), Porto Velho, Rondônia, Brazil
| | - Wuelton Monteiro
- Fundação de Medicina Tropical Dr Heitor Vieira Dourado (FMT-HVD), Manaus, Amazonas, Brazil
- Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil
| | | | - Jane Myburg
- Special Haematology Laboratory, Hammersmith Hospital, London, United Kingdom
| | - Mohammad Shafiul Alam
- Infectious Diseases Division, International Centre for Diarrheal Diseases Research, Bangladesh (icddr,b), Mohakhali, Dhaka, Bangladesh
| | - Germana Bancone
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Pooja Bansil
- Diagnostics, PATH, Seattle, Washington, United States of America
| | - Sampa Pal
- Diagnostics, PATH, Seattle, Washington, United States of America
| | - Abhijit Sharma
- Diagnostics, PATH, Seattle, Washington, United States of America
| | | | - Andrew Bryan
- Departments of Laboratory Medicine and Microbiology, University of Washington School of Medicine, Seattle, Washington, United States of America
| | - Cindy S. Chu
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Santasabuj Das
- National Institute of Cholera and Enteric Diseases, Kolkata, India
| | | | - Amanda Hann
- Special Haematology Laboratory, Hammersmith Hospital, London, United Kingdom
| | - James Kublin
- Departments of Laboratory Medicine and Microbiology, University of Washington School of Medicine, Seattle, Washington, United States of America
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
| | - Marcus V. G. Lacerda
- Fundação de Medicina Tropical Dr Heitor Vieira Dourado (FMT-HVD), Manaus, Amazonas, Brazil
- Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil
- Instituto Leônidas & Maria Deane (ILMD), Fiocruz, Manaus, Amazonas, Brazil
| | - Mark Layton
- Special Haematology Laboratory, Hammersmith Hospital, London, United Kingdom
| | - Benedikt Ley
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia
| | - Sean C. Murphy
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, United States of America
- Center for Emerging and Reemerging Infectious Diseases, University of Washington, Seattle, Washington, United States of America
| | - Francois Nosten
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Dhélio Pereira
- Centro de Pesquisa Em Medicina Tropical (CEPEM), Porto Velho, Rondônia, Brazil
- Universidade Federal de Rondônia (UNIR), Porto Velho, Rondônia, Brazil
| | - Ric N. Price
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia
| | | | - Daniel Yilma
- Clinical Trial Unit, Jimma University, Jimma, Ethiopia
- Department of Internal Medicine, Jimma University, Jimma, Ethiopia
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18
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Gülen H, Türedi Yıldırım A, Çavuş İ, Türkmen H, Özbilgin A. [Autochthonous Case of Malaria Prediagnosed as Leukemia]. MIKROBIYOL BUL 2023; 57:698-706. [PMID: 37885398 DOI: 10.5578/mb.20239958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
Malaria is a parasitic disease transmitted by infected female Anopheles mosquitoes. There are five species of Plasmodium species that can infect humans. Of these species, especially P.falciparum and P.vivax pose the greatest threat to human health. In the 2014 report of the World Health Organization, it was reported that there were no locally acquired cases of malaria in 16 countries including Türkiye. Malaria cases originating from outside the country and imported due to migration, travel and working abroad are reported as import cases. In this report, a case of non-imported malaria followed with a preliminary diagnosis of leukemia was presented. A 14-year-old female patient who was admitted to a health institution with complaints of high fever, headache, chills, nausea-vomiting, and diarrhea that had been going on for two weeks, was pre-diagnosed as leukemia and was referred to Manisa Celal Bayar University Faculty of Medicine, Hafsa Sultan Hospital, Department of Pediatric Hematology and after pancytopenia was detected in the complete blood count. The anamnesis of the patient revealed that she had no history of international travel and that she had been prescribed medications such as paracetamol, amoxicillin, and metoclopramide for flu-like complaints while working in the Southeastern Anatolia, Aegean, and Mediterranean Regions of Türkiye. Bone marrow aspiration was performed for the etiological examination of pancytopenia. Giemsa-stained blood smears, rapid diagnostics, and real-time quantative polymerase chain reaction (qRt-PCR) analyses were performed in the medical parasitology laboratory and malaria was suspected in both bone marrow and peripheral blood smears. P.vivax erythrocytic forms and gametocytes were present in abundance in smear preparations stained with Giemsa, and rapid diagnosis kit was positive for P.vivax. The strain was genotyped as P.vivax by qRt-PCR analysis. For the treatment of the patient, airalam (artemether + lumefantrine) tablets were provided with 2 x 4 daily posology for three days after the diagnosis, and primaquine was provided after one week of the diagnosis as 1 x 2 tablets (1 x 15 mg) for 14 days, and the patient was discharged without complications following the treatment regimen. The fight against malaria continues uninterruptedly since the establishment of the Republic of Türkiye. Tropical diseases, especially malaria, is of great importance for Türkiye due to numerous reasons such as its location in the subtropical region where Anopheles mosquitoes are capable of malaria transmission, it is situated at the crossroads on the migration routes between continents where human traffic is busy, there are many people who go abroad for work and most importantly rising temperatures due to climate change. For this reason, this case report is important to emphasize the importance of malaria for the country and to increase the awareness of clinicians and laboratories about malaria and the possibility of autochthonous malaria transmission in Türkiye.
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Affiliation(s)
- Hüseyin Gülen
- Manisa Celal Bayar University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Hematology, Manisa, Türkiye
| | - Ayşe Türedi Yıldırım
- Manisa Celal Bayar University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Hematology, Manisa, Türkiye
| | - İbrahim Çavuş
- Manisa Celal Bayar University, Institute of Health Sciences, Manisa, Türkiye
| | - Hülya Türkmen
- Manisa Celal Bayar University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Hematology, Manisa, Türkiye
| | - Ahmet Özbilgin
- Manisa Celal Bayar University Faculty of Medicine, Department of Medical Parasitology, Manisa, Türkiye
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19
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Yigezu E, Wondale B, Abebe D, Tamiru G, Eligo N, Lindtjørn B, Gadisa E, Tadesse FG, Massebo F. Malaria misdiagnosis in the routine health system in Arba Minch area district in southwest Ethiopia: an implication for malaria control and elimination. Malar J 2023; 22:273. [PMID: 37710252 PMCID: PMC10503053 DOI: 10.1186/s12936-023-04711-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 09/10/2023] [Indexed: 09/16/2023] Open
Abstract
BACKGROUND Plasmodium falciparum and Plasmodium vivax are coendemic in Ethiopia, with different proportion in different settings. Microscopy is the diagnostic tool in Ethiopian health centres. Accurate species-specific diagnosis is vital for appropriate treatment of cases to interrupt its transmission. Therefore, this study assessed the status of species-specific misdiagnosis by microscope compared with polymerase chain reaction (PCR). METHODS A health facility based cross-sectional study was conducted from November 2019 to January 2020 in Kolla Shelle Health centre, Arba Minch Zuria district. The study population were suspected malaria cases, who visited the health centre for a diagnosis and treatment. Consecutive microscopy positive cases as well as a sample of microscopically negative cases were included for molecular analysis by polymerase chain reaction (PCR). RESULTS 254 microscopically negative and 193 microscopically positive malaria suspects were included. Of the 193 malaria positive cases, 46.1% [95% confidence interval (CI) 38.9-53.4] (89/193) were P. falciparum infection, 52.3% (95% CI 45.0-59.5) (101/193) were P. vivax infection, and 1.6% (3/193) had mixed infection of P. falciparum and P. vivax. Of the microscopically positive cases of P. falciparum, 3.4% (3/89) were P. vivax and 11.2% (10/89) were mixed infections with P. falciparum and P. vivax and a single case was negative molecularly. Similarly, of the microscopically positive P. vivax cases, 5.9% (6/101) were P. falciparum and 1% (1/101) was mixed infection. Single case was negative by molecular technique. Of the 254 microscopically negative cases, 0.8% were tested positive for P. falciparum and 2% for P. vivax by PCR. Considering molecular technique as a reference, the sensitivity of microscopy for detecting P. falciparum was 89.2% and for P. vivax, it was 91.2%. The specificity of microscopy for detecting P. falciparum was 96.1% and for P. vivax, it was 97.7%. However, the sensitivity of microscopy in detecting mixed infection of P. falciparum and P. vivax was low (8.3%). CONCLUSION There were cases left untreated or inappropriately treated due to the species misidentification. Therefore, to minimize this problem, the gaps in the microscopic-based malaria diagnosis should be identified. It is recommended to regularly monitor the competency of malaria microscopists in the study area to improve species identification and diagnosis accuracy.
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Affiliation(s)
- Engida Yigezu
- Department of Biology, Arba Minch University, Arba Minch, Ethiopia
| | - Biniam Wondale
- Department of Biology, Arba Minch University, Arba Minch, Ethiopia
| | - Daniel Abebe
- Institute of Biotechnology, Addis Ababa University, Addis Ababa, Ethiopia
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Girum Tamiru
- Department of Biology, Arba Minch University, Arba Minch, Ethiopia
| | - Nigatu Eligo
- Department of Biology, Arba Minch University, Arba Minch, Ethiopia
| | - Bernt Lindtjørn
- Centre for International Health, University of Bergen, Bergen, Norway
| | | | | | - Fekadu Massebo
- Department of Biology, Arba Minch University, Arba Minch, Ethiopia
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20
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van Loon W, Oliveira R, Bergmann C, Habarugira F, Tacoli C, Jäger J, Savelsberg D, Mbarushimana D, Ndoli JM, Sendegeya A, Bayingana C, Mockenhaupt FP. Plasmodium vivax Malaria in Duffy-Positive Patients in Rwanda. Am J Trop Med Hyg 2023; 109:621-623. [PMID: 37549894 PMCID: PMC10484245 DOI: 10.4269/ajtmh.23-0143] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 05/21/2023] [Indexed: 08/09/2023] Open
Abstract
Plasmodium vivax is the second-most common malaria pathogen globally, but is considered very rare in the predominantly Duffy-negative sub-Saharan African population. In 259 malaria patients from highland southern Rwanda, we assessed Plasmodium species and Duffy blood group status by polymerase chain reaction (PCR). Plasmodium falciparum, P. vivax, Plasmodium malariae, and Plasmodium ovale were seen in 90.7%, 8.1%, 11.6%, and 5.0%, respectively. Plasmodium vivax occurred more frequently as a monoinfection than in combination with P. falciparum. All P. vivax-infected individuals showed heterozygous Duffy positivity, whereas this was the case for only 3.1% of patients with P. falciparum monoinfection and malaria-negative control subjects (P < 0.01). Based on PCR diagnosis, P. vivax is not rare in southern Rwanda. All episodes of P. vivax were observed in heterozygous Duffy-positive patients, whereas elsewhere in Africa, P. vivax is also reported in Duffy-negative individuals. Refined mapping of Plasmodium species is required to establish control and elimination strategies including all malaria species.
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Affiliation(s)
- Welmoed van Loon
- Institute of International Health, Center for Global Health, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Rafael Oliveira
- Institute of International Health, Center for Global Health, Charité–Universitätsmedizin Berlin, Berlin, Germany
- John Curtin School of Medical Research, Australian National University, Canberra, Australia
| | - Clara Bergmann
- Institute of International Health, Center for Global Health, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Felix Habarugira
- Pathology Department, University Teaching Hospital of Butare, Huye, Rwanda
| | - Costanza Tacoli
- Malaria Molecular Epidemiology Unit Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Julia Jäger
- Associatid Group Immune Ontogeny and Viral Infections, Leibniz Institute of Virology, Hamburg, Germany
| | - Darius Savelsberg
- Institute of International Health, Center for Global Health, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | | | - Jules M. Ndoli
- Clinical Education and Research Division, University Teaching Hospital of Butare, Huye, Rwanda
| | | | | | - Frank P. Mockenhaupt
- Institute of International Health, Center for Global Health, Charité–Universitätsmedizin Berlin, Berlin, Germany
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21
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Kambuaya NN, Rini H, Shanti PAI, Alexander K, Candrawati F, Prayoga P, Leonardo L, Margayani DS, Yayang BTG, Kenangalem E, Buffet PA, Anstey NM, Poespoprodjo JR, Kho S. Case Report: Severe Plasmodium vivax Malaria after Splenectomy. Am J Trop Med Hyg 2023; 109:284-287. [PMID: 37339765 PMCID: PMC10397454 DOI: 10.4269/ajtmh.23-0147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 04/26/2023] [Indexed: 06/22/2023] Open
Abstract
Severe malaria after splenectomy has been reported with infections with Plasmodium falciparum, Plasmodium knowlesi, and Plasmodium malariae, but is less well-characterized with Plasmodium vivax. We describe a case of severe P. vivax malaria with hypotension, prostration, and acute kidney injury occurring 2 months after splenectomy in Papua, Indonesia. The patient was treated successfully with intravenous artesunate.
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Affiliation(s)
- Noy Norman Kambuaya
- Timika Malaria Research Facility, Papuan Health and Community Development Foundation, Timika, Papua, Indonesia
| | - Hasrini Rini
- Timika Malaria Research Facility, Papuan Health and Community Development Foundation, Timika, Papua, Indonesia
| | | | - King Alexander
- Rumah Sakit Umum Daerah Kabupaten Mimika, Timika, Papua, Indonesia
| | - Freis Candrawati
- Timika Malaria Research Facility, Papuan Health and Community Development Foundation, Timika, Papua, Indonesia
| | - Pak Prayoga
- Timika Malaria Research Facility, Papuan Health and Community Development Foundation, Timika, Papua, Indonesia
| | - Leo Leonardo
- Timika Malaria Research Facility, Papuan Health and Community Development Foundation, Timika, Papua, Indonesia
| | - Dewi Sri Margayani
- Timika Malaria Research Facility, Papuan Health and Community Development Foundation, Timika, Papua, Indonesia
| | - Bagus Tesa Gina Yayang
- Timika Malaria Research Facility, Papuan Health and Community Development Foundation, Timika, Papua, Indonesia
| | - Enny Kenangalem
- Timika Malaria Research Facility, Papuan Health and Community Development Foundation, Timika, Papua, Indonesia
- Rumah Sakit Umum Daerah Kabupaten Mimika, Timika, Papua, Indonesia
| | | | - Nicholas M. Anstey
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia
| | - Jeanne Rini Poespoprodjo
- Timika Malaria Research Facility, Papuan Health and Community Development Foundation, Timika, Papua, Indonesia
- Rumah Sakit Umum Daerah Kabupaten Mimika, Timika, Papua, Indonesia
- Department of Pediatrics, Gadjah Mada University, Yogyakarta, Indonesia
| | - Steven Kho
- Timika Malaria Research Facility, Papuan Health and Community Development Foundation, Timika, Papua, Indonesia
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia
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22
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Erdoğan E, Türe Yüce Z, Ayrık Demir A, Yaman O, Yürük M, Yıldız O. [A Marginal Case of Malaria: An Interesting Malaria Story of Cameroon Origin]. MIKROBIYOL BUL 2023; 57:498-505. [PMID: 37462313 DOI: 10.5578/mb.20239942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
Malaria is a serious, contagious infection caused by single-celled parasites. About 200 species of Plasmodium have been described that can cause infection in vertebrates. Five different species of Plasmodium are known to cause infection in humans to date. Infection with more than one type of pathogen is called coinfection. This type of infections can be caused by different species of the same genus, as well as by different species. Malaria coinfections are mostly caused by the combination of Plasmodium vivax and Plasmodium falciparum. In this study, a case of malaria admitted to the hospital and diagnosed was presented. Thin smear blood preparations were prepared from the peripheral blood of a 54 year-old Republic of Türkiye citizen male patient who applied to the emergency department with fever and chills. The preparations were stained with Giemsa and examined under a microscope with a x 100 objective, and trophozoite and gametocyte forms belonging to Plasmodium genus were determined. As a result of probe-based quantitative real-time polymerase chain reaction (qRt-PCR) study with primers specific to Plasmodium vivax, Plasmodium malariae, Plasmodium falciparum, Plasmodium ovale and Plasmodium knowlesi for definitive species identification, co-infection of P.vivax, P.falciparum, P.ovale and P.knowlesi was detected in the patient. In addition, it was proved that our patient was infected with four different species by conventional PCR study in which five species were studied and then by DNA sequence analysis. On the fourth day of artemether-lumefantrine treatment, the patient's fever response was observed and the trophozoite forms disappeared from the third day in the daily peripheral smear follow-up. Since P.vivax and P.ovale species were also detected after species determination by molecular methods, primaquine 1 x 30 mg tablet was added to the existing drugs for the treatment of hypnozoite forms of the parasite. In recent years, there has been an increase in malaria imported cases, especially after visits to African countries. Such rare cases of malaria coinfection may be encountered during visits to geographies located at the intersection of endemic regions. According to the data of the World Health Organization, maximum attention should be paid to the prevention and prophylaxis protocols from vectors, especially in travels to countries with the highest mortality and morbidity. In co-infection cases similar to our patient, for tertian malaria and tertiary ovale malaria, hypnozoid therapy should not be overlooked. When the insecticide-resistant vectors and drug-resistant Plasmodium strains encountered in recent years are evaluated as a whole, there is a need to develop more effective strategies in the fight against malaria. In addition to microscopic examination, which is accepted as the gold standard, we believe that evaluating molecular studies together in diagnosis is extremely important for the treatment process when hypnozoite periods are considered.
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Affiliation(s)
- Emrah Erdoğan
- Erciyes University Faculty of Medicine, Department of Medical Parasitology, Kayseri, Türkiye
| | - Zeynep Türe Yüce
- Erciyes University Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Kayseri, Türkiye
| | - Atiye Ayrık Demir
- Erciyes University Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Kayseri, Türkiye
| | - Ozan Yaman
- Erciyes University Faculty of Medicine, Department of Medical Parasitology, Kayseri, Türkiye
| | - Merve Yürük
- Erciyes University Faculty of Medicine, Department of Medical Parasitology, Kayseri, Türkiye
| | - Orhan Yıldız
- Erciyes University Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Kayseri, Türkiye
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23
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Abebe A, Menard D, Dugassa S, Assefa A, Juliano JJ, Lo E, Golassa L. Significant number of Plasmodium vivax mono-infections by PCR misidentified as mixed infections (P. vivax/P. falciparum) by microscopy and rapid diagnostic tests: malaria diagnostic challenges in Ethiopia. Malar J 2023; 22:201. [PMID: 37393257 PMCID: PMC10314452 DOI: 10.1186/s12936-023-04635-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 06/24/2023] [Indexed: 07/03/2023] Open
Abstract
BACKGROUND Plasmodium vivax malaria is now recognized as a cause of severe morbidity and mortality, resulting in a substantial negative effect on health especially in endemic countries. Accurate and prompt diagnosis and treatment of P. vivax malaria is vital for the control and elimination of the disease. METHODS A cross-sectional study was conducted from February 2021 to September 2022 at five malaria endemic sites in Ethiopia including Aribaminch, Shewarobit, Metehara, Gambella, and Dubti. A total of 365 samples that were diagnosed positive for P. vivax (mono and mixed infection) using RDT, site level microscopists and expert microscopists were selected for PCR. Statistical analyses were performed to calculate the proportions, agreement (k), frequencies, and ranges among different diagnostic methods. Fisher's exact tests and correlation test were used to detect associations and relationship between different variables. RESULTS Of the 365 samples, 324 (88.8%), 37(10.1%), 2 (0.5%), and 2 (0.5%) were P. vivax (mono), P. vivax/Plasmodium falciparum (mixed), P. falciparum (mono) and negative by PCR, respectively. The overall agreement of rapid diagnostic test (RDT), site level microscopy and expert microscopists result with PCR was 90.41% (k: 0.49), 90.96% (k: 0.53), and 80.27% (k: 0.24). The overall prevalence of sexual (gametocyte) stage P. vivax in the study population was 215/361 (59.6%). The majority of these 215 samples (180; 83.7%) had below 1000 parasites/µl, with only four samples (1.9%) had ≥ 5000 parasites/µl. The gametocyte density was found to be weakly positive but statically significant with asexual parasitaemia (r = 0.31; p < 0.001). CONCLUSION Both microscopy and RDT showed moderate agreement with PCR in the detection and identification of P. vivax (mono) and P. vivax/P. falciparum (mixed) infections. Therefore, to achieve malaria elimination goals, strengthening routine malaria diagnostic methods by implementing diagnostic tools with a good performance in detecting and accurately identifying malaria species in clinical settings is recommended.
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Affiliation(s)
- Abnet Abebe
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia.
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia.
| | - Didier Menard
- Laboratory of Parasitology and Mycology, University of Strasbourg, Strasbourg, France
| | - Sisay Dugassa
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Ashenafi Assefa
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
- Division of Infectious Disease, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jonathan J Juliano
- Division of Infectious Disease, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Eugenia Lo
- Department of Biological Sciences, Bioinformatics Research Center, University of North Carolina at Charlotte, Charlotte, North Carolina, USA
| | - Lemu Golassa
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
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Ahmed RA, Kumar A, Swargiary A, Suri HS, Shankar H, Hussain SSA, Kumar G, Singh K, Kalita D, begum A. Impact assessment of Intensified Malaria Control Project in transitioning a high malaria-endemic district to a low-endemic district: an epidemiological aspect. Pathog Glob Health 2023; 117:493-504. [PMID: 36960929 PMCID: PMC10262807 DOI: 10.1080/20477724.2023.2194498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2023] Open
Abstract
Intensified Malaria Control Project (IMCP) was implemented in 2005 to control malaria in all North-Eastern and Odisha states of India. The present study aimed to investigate the impact of IMCP in reducing the malaria burden in Udalguri district, Assam state of North-East India. Malaria epidemiological data were obtained for IMCP intervention (Udalguri) and nonintervention district (West Singhbhumi, Jharkhand state). IMCP activities include introducing bi-valent rapid diagnostic kits (RDTs), Artemether-Lumefantrine drug in North-East India, long-lasting insecticidal nets (LLINs) distribution, and creating awareness programs about malaria in an intensified mode. The data revealed a significant decline in annual parasite incidence (API) from 14.94 (2005) to 2.61 (2018), -37% (95%CI: -57%, -19%, p = 001) after using LLINs in 2009 and -64% (95%CI: -116%, -14%, p = 013) after the introduction of RDTs in district Udalguri. Whereas control district showed a -28% (95%CI: -63%, 6.3%, p = 0.051) decrease in API using LLINs and a 10% (95%CI: -7.6%, 28%, p = 0.122) increase after the introduction of RDTs. Plasmodium falciparum (Pf) and P. vivax (Pv) were the major malarial parasites in Udalguri. Pv-malaria was much higher (71%) than Pf-malaria (29%) during the study period. An increasing trend of Pf cases was observed in Udalguri. Udalguri and Khoirabari BPHCs showed an overall reduction of 94% (95%CI: -143%, -45%, p = 0.001) and 84% (95%CI: -126%, -39%, p = 0.003), respectively; however, only a 10% (95%CI: -65%, -41%, p = 0.360) reduction in API was observed in Orang BPHC. An overall decrease in malaria indicates the effective implementation of vector and disease control strategies in the Udalguri district.
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Affiliation(s)
- Rahim Ali Ahmed
- National Vector Borne Disease Control Programme, Udalguri, Darrang, Assam, India
- Department of Parasite – Host Biology, ICMR – National Institute of Malaria Research, Dwarka, New Delhi, India
- Academy of Scientific & Innovative Research, Ghaziabad, Uttar Pradesh, India
| | - Avdhesh Kumar
- National Vector Borne Disease Control Programme, Ministry of Health & Family Welfare, Government of India, New Delhi, India
| | - Ananta Swargiary
- Department of Zoology, Bodoland University, Kokrajhar, Assam, India
| | - Harpal Singh Suri
- National Vector Borne Disease Control Programme, Udalguri, Darrang, Assam, India
| | - Hari Shankar
- Department of Parasite – Host Biology, ICMR – National Institute of Malaria Research, Dwarka, New Delhi, India
- Indian Council of Medical Research, Ansari Nagar, New Delhi, India
| | - Syed Shah Areeb Hussain
- Department of Parasite – Host Biology, ICMR – National Institute of Malaria Research, Dwarka, New Delhi, India
| | - Gaurav Kumar
- Department of Parasite – Host Biology, ICMR – National Institute of Malaria Research, Dwarka, New Delhi, India
| | - Kuldeep Singh
- Department of Parasite – Host Biology, ICMR – National Institute of Malaria Research, Dwarka, New Delhi, India
- Academy of Scientific & Innovative Research, Ghaziabad, Uttar Pradesh, India
| | - Dipika Kalita
- Department of Zoology, Bhattadev University, Pathshala, Assam, India
| | - Afluza begum
- Department of Chemistry, Bhattadev University, Pathshala, Assam, India
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Deshkar S, Patil N, Yadav S, Balmiki P, Lad A, Sharan S. Concurrent Staphylococcus aureus bacteraemia in Plasmodium vivax malaria Infection: A report of two cases from western India. J Vector Borne Dis 2023; 60:336-339. [PMID: 37843247 DOI: 10.4103/0972-9062.374237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2023] Open
Abstract
Malaria and concurrent bacteraemia cases have been reported globally, mostly in association with Plasmodium falciparum malaria. In comparison, concurrent bacteraemia with Plasmodium vivax infected patients is reported rarely. However, considering unavailability of blood culture testing and widespread community and empirical antibiotic usage in low- and middle-income countries (LMICs), the frequency of bacteraemia and P. vivax co-infection may be much higher. We reported two cases of Staphylococcus aureus bacteraemia with P. vivax malaria infection. Both patients presented with high grade fever and chills with unremarkable systemic examination. Liver enzymes were raised along with inflammatory markers. Simultaneous diagnosis of methicillin sensitive S. aureus bacteraemia was done using automated blood culture, automated identification and sensitivity testing system. P. vivax malaria was confirmed with microscopy, antigen detection test and molecular test. Patients recovered uneventfully with antimalarial drugs and antibiotics.
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Affiliation(s)
- Smita Deshkar
- Infectious Diseases Department, Metropolis Healthcare Ltd, Global Reference Laboratory, Mumbai, India
| | - Niranjan Patil
- Infectious Diseases Department, Metropolis Healthcare Ltd, Global Reference Laboratory, Mumbai, India
| | - Sunita Yadav
- Infectious Diseases Department, Metropolis Healthcare Ltd, Global Reference Laboratory, Mumbai, India
| | - Pranali Balmiki
- Infectious Diseases Department, Metropolis Healthcare Ltd, Global Reference Laboratory, Mumbai, India
| | - Ashish Lad
- Infectious Diseases Department, Metropolis Healthcare Ltd, Global Reference Laboratory, Mumbai, India
| | - Swati Sharan
- Infectious Diseases Department, Metropolis Healthcare Ltd, Global Reference Laboratory, Mumbai, India
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Malpartida-Cardenas K, Moser N, Ansah F, Pennisi I, Ahu Prah D, Amoah LE, Awandare G, Hafalla JCR, Cunnington A, Baum J, Rodriguez-Manzano J, Georgiou P. Sensitive Detection of Asymptomatic and Symptomatic Malaria with Seven Novel Parasite-Specific LAMP Assays and Translation for Use at Point-of-Care. Microbiol Spectr 2023; 11:e0522222. [PMID: 37158750 PMCID: PMC10269850 DOI: 10.1128/spectrum.05222-22] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 04/18/2023] [Indexed: 05/10/2023] Open
Abstract
Human malaria is a life-threatening parasitic disease with high impact in the sub-Saharan Africa region, where 95% of global cases occurred in 2021. While most malaria diagnostic tools are focused on Plasmodium falciparum, there is a current lack of testing non-P. falciparum cases, which may be underreported and, if undiagnosed or untreated, may lead to severe consequences. In this work, seven species-specific loop-mediated isothermal amplification (LAMP) assays were designed and evaluated against TaqMan quantitative PCR (qPCR), microscopy, and enzyme-linked immunosorbent assays (ELISAs). Their clinical performance was assessed with a cohort of 164 samples of symptomatic and asymptomatic patients from Ghana. All asymptomatic samples with a parasite load above 80 genomic DNA (gDNA) copies per μL of extracted sample were detected with the Plasmodium falciparum LAMP assay, reporting 95.6% (95% confidence interval [95% CI] of 89.9 to 98.5) sensitivity and 100% (95% CI of 87.2 to 100) specificity. This assay showed higher sensitivity than microscopy and ELISA, which were 52.7% (95% CI of 39.7 to 67%) and 67.3% (95% CI of 53.3 to 79.3%), respectively. Nine samples were positive for P. malariae, indicating coinfections with P. falciparum, which represented 5.5% of the tested population. No samples were detected as positive for P. vivax, P. ovale, P. knowlesi, or P. cynomolgi by any method. Furthermore, translation to the point-of-care was demonstrated with a subcohort of 18 samples tested locally in Ghana using our handheld lab-on-chip platform, Lacewing, showing comparable results to a conventional fluorescence-based instrument. The developed molecular diagnostic test could detect asymptomatic malaria cases, including submicroscopic parasitemia, and it has the potential to be used for point-of-care applications. IMPORTANCE The spread of Plasmodium falciparum parasites with Pfhrp2/3 gene deletions presents a major threat to reliable point-of-care diagnosis with current rapid diagnostic tests (RDTs). Novel molecular diagnostics based on nucleic acid amplification are needed to address this liability. In this work, we overcome this challenge by developing sensitive tools for the detection of Plasmodium falciparum and non-P. falciparum species. Furthermore, we evaluate these tools with a cohort of symptomatic and asymptomatic malaria patients and test a subcohort locally in Ghana. The findings of this work could lead to the implementation of DNA-based diagnostics to fight against the spread of malaria and provide reliable, sensitive, and specific diagnostics at the point of care.
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Affiliation(s)
- Kenny Malpartida-Cardenas
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, United Kingdom
- Department of Electrical and Electronic Engineering, Faculty of Engineering, Imperial College London, London, United Kingdom
| | - Nicolas Moser
- Department of Electrical and Electronic Engineering, Faculty of Engineering, Imperial College London, London, United Kingdom
| | - Felix Ansah
- West African Centre for Cell Biology of Infectious Pathogens, Department of Biochemistry, Cell and Molecular Biology, University of Ghana, Legon, Ghana
| | - Ivana Pennisi
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Diana Ahu Prah
- West African Centre for Cell Biology of Infectious Pathogens, Department of Biochemistry, Cell and Molecular Biology, University of Ghana, Legon, Ghana
- Department of Infection Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Linda Eva Amoah
- West African Centre for Cell Biology of Infectious Pathogens, Department of Biochemistry, Cell and Molecular Biology, University of Ghana, Legon, Ghana
- Immunology Department, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | - Gordon Awandare
- West African Centre for Cell Biology of Infectious Pathogens, Department of Biochemistry, Cell and Molecular Biology, University of Ghana, Legon, Ghana
| | - Julius Clemence R. Hafalla
- Department of Infection Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Immunology Department, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | - Aubrey Cunnington
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Jake Baum
- Department of Life Sciences, Faculty of Natural Sciences, Imperial College London, London, United Kingdom
- School of Biomedical Sciences, University of New South Wales Sydney, Sydney, Australia
| | - Jesus Rodriguez-Manzano
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Pantelis Georgiou
- Department of Electrical and Electronic Engineering, Faculty of Engineering, Imperial College London, London, United Kingdom
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27
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Naik H, Acharya A, Rout S. Clinical Profile and Treatment Outcomes of Patients with Malaria Complicated by Acute Kidney Injury. Saudi J Kidney Dis Transpl 2023; 34:117-124. [PMID: 38146720 DOI: 10.4103/1319-2442.391889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2023] Open
Abstract
As Odisha is an endemic region for malaria with many acute kidney injury (AKI) cases, this study evaluated the clinical profile and treatment outcomes of patients with malaria complicated by AKI. This prospective observational study was conducted between December 2015 and September 2017. Detailed histories and clinical examinations were recorded. On admission, tests for routine hematology, plasma glucose, liver function, renal function, serum electrolytes, thick smears, thin smears, and malarial parasites were performed. Of the 958 AKI malarial patients admitted, 202 (82.6 % males) were included in the study, with a mean age of 38.37 years. In total, 86.14%, 3.46%, and 10.39% of patients had Plasmodium falciparum, Plasmodium vivax, and mixed malaria, respectively. Headache and decreased urination (83.66% each) were the most common symptoms after fever (100%). Anuria and oliguria were reported in 5.95% and 67.82% of patients, respectively, whereas 26.23% reported a urine output of >400 mL/24 h. All patients had raised serum creatinine and urea levels, and >60% had anemia, proteinuria, and/or hyponatremia. Multiple organ dysfunction syndrome was observed in 62.87% of patients. Acute tubular necrosis was seen in 60% of renal biopsy specimens (n = 15). Of the 75.75% of patients requiring dialysis, 82.12% and 17.88% of patients required hemodialysis and peritoneal dialysis, respectively, during which 11 patients died. AKI, a serious complication of P. falciparum or P. vivax malaria, is a life-threatening condition. Fever, anemia, oligo/anuria, hepatic involvement, cerebral malaria, high serum creatinine and urea, and disseminated intravascular coagulation were the main predictors of mortality in our study.
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Affiliation(s)
- Haladhar Naik
- Department of Nephrology, Srirama Chandra Bhanja Medical College, Cuttack, Odisha, India
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28
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Trimarsanto H, Amato R, Pearson RD, Sutanto E, Noviyanti R, Trianty L, Marfurt J, Pava Z, Echeverry DF, Lopera-Mesa TM, Montenegro LM, Tobón-Castaño A, Grigg MJ, Barber B, William T, Anstey NM, Getachew S, Petros B, Aseffa A, Assefa A, Rahim AG, Chau NH, Hien TT, Alam MS, Khan WA, Ley B, Thriemer K, Wangchuck S, Hamedi Y, Adam I, Liu Y, Gao Q, Sriprawat K, Ferreira MU, Laman M, Barry A, Mueller I, Lacerda MVG, Llanos-Cuentas A, Krudsood S, Lon C, Mohammed R, Yilma D, Pereira DB, Espino FEJ, Chu CS, Vélez ID, Namaik-Larp C, Villegas MF, Green JA, Koh G, Rayner JC, Drury E, Gonçalves S, Simpson V, Miotto O, Miles A, White NJ, Nosten F, Kwiatkowski DP, Price RN, Auburn S. A molecular barcode and web-based data analysis tool to identify imported Plasmodium vivax malaria. Commun Biol 2022; 5:1411. [PMID: 36564617 PMCID: PMC9789135 DOI: 10.1038/s42003-022-04352-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 12/08/2022] [Indexed: 12/25/2022] Open
Abstract
Traditionally, patient travel history has been used to distinguish imported from autochthonous malaria cases, but the dormant liver stages of Plasmodium vivax confound this approach. Molecular tools offer an alternative method to identify, and map imported cases. Using machine learning approaches incorporating hierarchical fixation index and decision tree analyses applied to 799 P. vivax genomes from 21 countries, we identified 33-SNP, 50-SNP and 55-SNP barcodes (GEO33, GEO50 and GEO55), with high capacity to predict the infection's country of origin. The Matthews correlation coefficient (MCC) for an existing, commonly applied 38-SNP barcode (BR38) exceeded 0.80 in 62% countries. The GEO panels outperformed BR38, with median MCCs > 0.80 in 90% countries at GEO33, and 95% at GEO50 and GEO55. An online, open-access, likelihood-based classifier framework was established to support data analysis (vivaxGEN-geo). The SNP selection and classifier methods can be readily amended for other use cases to support malaria control programs.
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Affiliation(s)
- Hidayat Trimarsanto
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, NT, Australia
- Eijkman Institute for Molecular Biology, Jakarta, Indonesia
| | - Roberto Amato
- Wellcome Sanger Institute, Wellcome Genome Campus, Cambridge, UK
| | | | - Edwin Sutanto
- Eijkman Institute for Molecular Biology, Jakarta, Indonesia
- Exeins Health Initiative, Jakarta, Indonesia
| | | | - Leily Trianty
- Eijkman Institute for Molecular Biology, Jakarta, Indonesia
| | - Jutta Marfurt
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, NT, Australia
| | - Zuleima Pava
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, NT, Australia
| | - Diego F Echeverry
- International Training and Medical Research Center (CIDEIM), Cali, Colombia
- Departamento de Microbiología, Universidad del Valle, Cali, Colombia
- Universidad Icesi, Cali, Colombia
| | | | | | | | - Matthew J Grigg
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, NT, Australia
- Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit, Kota Kinabalu, Sabah, Malaysia
| | - Bridget Barber
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, NT, Australia
- Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit, Kota Kinabalu, Sabah, Malaysia
| | - Timothy William
- Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit, Kota Kinabalu, Sabah, Malaysia
- Clinical Research Centre, Queen Elizabeth Hospital, Sabah, Malaysia
| | - Nicholas M Anstey
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, NT, Australia
| | - Sisay Getachew
- College of Natural Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Beyene Petros
- College of Natural Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Abraham Aseffa
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | | | - Awab G Rahim
- Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
- Nangarhar Medical Faculty, Nangarhar University, Ministry of Higher Education, Jalalabad, Afghanistan
| | - Nguyen H Chau
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Tran T Hien
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Mohammad S Alam
- Infectious Diseases Division, International Centre for Diarrheal Diseases Research, Dhaka, Bangladesh
| | - Wasif A Khan
- Infectious Diseases Division, International Centre for Diarrheal Diseases Research, Dhaka, Bangladesh
| | - Benedikt Ley
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, NT, Australia
| | - Kamala Thriemer
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, NT, Australia
| | - Sonam Wangchuck
- Royal Center for Disease Control, Department of Public Health, Ministry of Health, Thimphu, Bhutan
| | - Yaghoob Hamedi
- Infectious and Tropical Diseases Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Hormozgan Province, Iran
| | - Ishag Adam
- Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | - Yaobao Liu
- National Health Commission Key Laboratory of Parasitic Disease Control and Prevention, Jiangsu Provincial Key Laboratory on Parasite and Vector Control Technology, Jiangsu Institute of Parasitic Diseases, Wuxi, China
- School of Public Health, Nanjing Medical University, Nanjing, China
| | - Qi Gao
- National Health Commission Key Laboratory of Parasitic Disease Control and Prevention, Jiangsu Provincial Key Laboratory on Parasite and Vector Control Technology, Jiangsu Institute of Parasitic Diseases, Wuxi, China
| | - Kanlaya Sriprawat
- Shoklo Malaria Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Marcelo U Ferreira
- Department of Parasitology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
- Global Health and Tropical Medicine, Institute of Hygiene and Tropical Medicine, NOVA University of Lisbon, Lisbon, Portugal
| | - Moses Laman
- Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea
| | - Alyssa Barry
- Deakin University, Victoria, Australia
- Population Health and Immunity Division, The Walter and Eliza Hall Institute of Medical Research, Victoria, Australia
- Department of Medical Biology, The University of Melbourne, Victoria, Australia
| | - Ivo Mueller
- Population Health and Immunity Division, The Walter and Eliza Hall Institute of Medical Research, Victoria, Australia
- Department of Parasites and Insect Vectors, Institut Pasteur, Paris, France
| | - Marcus V G Lacerda
- Fundação de Medicina Tropical, Manaus, Brazil
- Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro, Brazil
| | | | | | - Chanthap Lon
- Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | | | | | | | - Fe E J Espino
- Research Institute for Tropical Medicine, Manilla, Philippines
| | - Cindy S Chu
- Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
- Shoklo Malaria Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Iván D Vélez
- Malaria Group, Universidad de Antioquia, Medellin, Colombia
| | | | | | | | | | - Julian C Rayner
- Wellcome Sanger Institute, Wellcome Genome Campus, Cambridge, UK
- Cambridge Institute for Medical Research, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Eleanor Drury
- Wellcome Sanger Institute, Wellcome Genome Campus, Cambridge, UK
| | - Sónia Gonçalves
- Wellcome Sanger Institute, Wellcome Genome Campus, Cambridge, UK
| | - Victoria Simpson
- Wellcome Sanger Institute, Wellcome Genome Campus, Cambridge, UK
| | - Olivo Miotto
- Wellcome Sanger Institute, Wellcome Genome Campus, Cambridge, UK
- Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
| | - Alistair Miles
- Wellcome Sanger Institute, Wellcome Genome Campus, Cambridge, UK
| | - Nicholas J White
- Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Francois Nosten
- Shoklo Malaria Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | | | - Ric N Price
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, NT, Australia
- Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Sarah Auburn
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, NT, Australia.
- Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand.
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
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29
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Kumari P, Sinha S, Gahtori R, Quadiri A, Mahale P, Savargaonkar D, Pande V, Srivastava B, Singh H, Anvikar AR. Comparative Assessment of Diagnostic Performance of Cytochrome Oxidase Multiplex PCR and 18S rRNA Nested PCR. Korean J Parasitol 2022; 60:295-299. [PMID: 36041492 PMCID: PMC9441448 DOI: 10.3347/kjp.2022.60.4.295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 05/16/2022] [Indexed: 11/23/2022]
Abstract
Malaria elimination and control require prompt and accurate diagnosis for treatment plan. Since microscopy and rapid diagnostic test (RDT) are not sensitive particularly for diagnosing low parasitemia, highly sensitive diagnostic tools are required for accurate treatment. Molecular diagnosis of malaria is commonly carried out by nested polymerase chain reaction (PCR) targeting 18S rRNA gene, while this technique involves long turnaround time and multiple steps leading to false positive results. To overcome these drawbacks, we compared highly sensitive cytochrome oxidase gene-based single-step multiplex reaction with 18S rRNA nested PCR. Cytochrome oxidase (cox) genes of P. falciparum (cox-III) and P. vivax (cox-I) were compared with 18S rRNA gene nested PCR and microscopy. Cox gene multiplex PCR was found to be highly specific and sensitive, enhancing the detection limit of mixed infections. Cox gene multiplex PCR showed a sensitivity of 100% and a specificity of 97%. This approach can be used as an alternative diagnostic method as it offers higher diagnostic performance and is amenable to high throughput scaling up for a larger sample size at low cost.
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Affiliation(s)
- Preeti Kumari
- ICMR-National Institute of Malaria Research, Sector-8, Dwarka, New Delhi, India
- Kumaun University, Nainital, Uttarakhand, India
| | - Swati Sinha
- ICMR-National Institute of Malaria Research, Sector-8, Dwarka, New Delhi, India
- Kumaun University, Nainital, Uttarakhand, India
| | - Renuka Gahtori
- ICMR-National Institute of Malaria Research, Sector-8, Dwarka, New Delhi, India
- Kumaun University, Nainital, Uttarakhand, India
| | - Afshana Quadiri
- ICMR-National Institute of Malaria Research, Sector-8, Dwarka, New Delhi, India
| | - Paras Mahale
- ICMR-National Institute of Malaria Research, Sector-8, Dwarka, New Delhi, India
- Kumaun University, Nainital, Uttarakhand, India
| | | | - Veena Pande
- Kumaun University, Nainital, Uttarakhand, India
| | - Bina Srivastava
- ICMR-National Institute of Malaria Research, Sector-8, Dwarka, New Delhi, India
| | - Himmat Singh
- ICMR-National Institute of Malaria Research, Sector-8, Dwarka, New Delhi, India
| | - Anupkumar R Anvikar
- ICMR-National Institute of Malaria Research, Sector-8, Dwarka, New Delhi, India
- Corresponding author ()
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30
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Pessoa RC, Oliveira-Pessoa GF, Souza BKA, Sampaio VS, Pinto ALCB, Barboza LL, Mouta GS, Silva EL, Melo GC, Monteiro WM, Silva-Filho JH, Lacerda MVG, Baía-da-Silva DC. Impact of Plasmodium vivax malaria on executive and cognitive functions in elderlies in the Brazilian Amazon. Sci Rep 2022; 12:10361. [PMID: 35725784 PMCID: PMC9208538 DOI: 10.1038/s41598-022-14175-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 05/16/2022] [Indexed: 11/09/2022] Open
Abstract
The exact path leading to cognitive impairment that goes beyond malaria is unclear, but it appears to be the result of interactive factors. Time of exposure to disease and recurrences are potentially major determinant variables. Cognitive impairment is described mainly in children, rarely in adults. The disease in high endemic areas usually does not affect elderlies, because of acquired immunity over time. However, this population is relatively more frequently sick in lower endemic areas, such as in the Amazon. This study assessed the effect of Plasmodium vivax malaria on the executive and cognitive functions of elderlies, in the Brazilian Amazon. A cohort study was conducted to evaluate executive and cognitive functions one week (T0), two months (T2) and eight months (T8) after the malaria episode. Mini-Mental State Examination (MMSE), Beck Depression Inventory II (BDI-II), Clock Drawing Test (CDT), Wechsler adult intelligence scale (WAIS-III), and Wisconsin Card Sorting Test (WCST) were used to assess executive and cognitive functions. One hundred-forty elderlies were enrolled (70 with P. vivax malaria and 70 without malaria). P. vivax malaria was associated with impairment of the executive and cognitive functions in elderlies for up to 8 months after acute P. vivax malaria. Prior history of malaria, recurrences and higher parasitemia were independently associated with various surrogates of executive and cognitive impairment. With the increase in life expectancy, elderlies living in malaria endemic areas will deserve more attention from health authorities, to guarantee improvement of their quality of life in the tropics.
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Affiliation(s)
- Rockson C Pessoa
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil
| | | | - Brenda K A Souza
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil
| | - Vanderson S Sampaio
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Av Pedro Teixeira, 25, Manaus, Amazonas, 69040-000, Brazil
- Instituto Leônidas & Maria Deane, Fundação Oswaldo Cruz, Manaus, Brazil
- Fundação de Vigilância em Saúde do Amazonas, Manaus, Brazil
| | - André Luiz C B Pinto
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Av Pedro Teixeira, 25, Manaus, Amazonas, 69040-000, Brazil
| | - Larissa L Barboza
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil
| | - Gabriel S Mouta
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil
| | - Emanuelle Lira Silva
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Av Pedro Teixeira, 25, Manaus, Amazonas, 69040-000, Brazil
| | - Gisely C Melo
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Av Pedro Teixeira, 25, Manaus, Amazonas, 69040-000, Brazil
| | - Wuelton M Monteiro
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Av Pedro Teixeira, 25, Manaus, Amazonas, 69040-000, Brazil
| | | | - Marcus V G Lacerda
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil.
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Av Pedro Teixeira, 25, Manaus, Amazonas, 69040-000, Brazil.
- Instituto Leônidas & Maria Deane, Fundação Oswaldo Cruz, Manaus, Brazil.
| | - Djane Clarys Baía-da-Silva
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Av Pedro Teixeira, 25, Manaus, Amazonas, 69040-000, Brazil
- Instituto Leônidas & Maria Deane, Fundação Oswaldo Cruz, Manaus, Brazil
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Cardona-Arias JA, Carmona-Fonseca J. Frequency of placental malaria and its associated factors in northwestern Colombia, pooled analysis 2009–2020. PLoS One 2022; 17:e0268949. [PMID: 35609045 PMCID: PMC9129008 DOI: 10.1371/journal.pone.0268949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 05/12/2022] [Indexed: 11/18/2022] Open
Abstract
Knowledge about placental malaria (PM) is insufficient in the world, and incipient in Colombia where studies are few and recent. In this country, PM has been reported by Plasmodium vivax, Plasmodium falciparum, and mixed infection. The objective was to determine the frequency of PM and its associated clinical-epidemiological factors in mothers and neonates in northwestern Colombia, 2009–2020. A Retrospective pooled analysis with 602 placentas captured in five investigations. The diagnosis of PM was made with thick blood smear (TBS) and qPCR. The groups with and without PM were compared using the Chi-square test, Mann-Whitney test, and crude and adjusted prevalence ratios in a log-binomial model. The prevalence of PM was 27.7% with 92% (155/167) of submicroscopic cases; 41.3% by P. vivax, 44,3% by P. falciparum, and 14.4% by mixed infections. In the multivariate adjustment, PM was associated with the diagnosis of congenital malaria, low neonatal weight, gestational malaria, maternal anemia, previous malaria during pregnancy, and age between 25–43 years. This research is the investigation with the largest number of subjects for studying PM in Colombia, in the ecoepidemiological zone that produces more cases of malaria per year, finding a high prevalence of submicroscopic PM that caused serious maternal (anemia) and neonatal (congenital malaria and low neonatal weight) effects. The results show limitations in the timely diagnosis and treatment, given that the epidemiological surveillance program in Colombia is based on thick blood smear, which generates a substantial underestimation of the magnitude of PM, with serious effects and clinical risks. It is urgent to demand that the health authorities adopt measures such as prenatal control visits as soon as the pregnancy begins, monthly implementation of TBS, and active search for infected pregnant women in their homes and workplaces.
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Affiliation(s)
- Jaiberth Antonio Cardona-Arias
- School of Microbiology, University of Antioquia, Medellín, Colombia
- “Grupo de investigación César Uribe Piedrahíta”, Faculty of Medicine, University of Antioquia, Medellín, Colombia
- * E-mail:
| | - Jaime Carmona-Fonseca
- “Grupo de investigación César Uribe Piedrahíta”, Faculty of Medicine, University of Antioquia, Medellín, Colombia
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Aung YN, Tun STT, Vanisaveth V, Chindavongsa K, Kanya L. Cost-effectiveness analysis of G6PD diagnostic test for Plasmodium vivax radical cure in Lao PDR: An economic modelling study. PLoS One 2022; 17:e0267193. [PMID: 35468145 PMCID: PMC9037946 DOI: 10.1371/journal.pone.0267193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 04/04/2022] [Indexed: 11/19/2022] Open
Abstract
Background
Plasmodium vivax (Pv) infections were 68% of the total malaria burden in Laos in 2019. The parasite causes frequent relapses, which can be prevented by primaquine (PMQ). Testing for glucose-6-phosphate-dehydrogenase (G6PD) deficiency is recommended before giving PMQ to avoid haemolysis. Because of the risk of haemolysis in G6PD intermediate deficiencies among females, Laos uses the PMQ 14-days regimen only in G6PD normal females. Among G6PD point-of-care tests, qualitative tests cannot differentiate between G6PD normal and intermediate females. Quantitative tests are required to differentiate between G6PD normal and intermediate deficiencies. However, the quantitative test lacks the cost-effectiveness evidence necessary for decision-making for large-scale adoption. This study examined the cost-effectiveness of quantitative G6PD test, with either supervised PMQ treatment or unsupervised PMQ treatment, against the usual unsupervised PMQ 8-weeks strategy. Supervised PMQ 8-weeks strategy without G6PD testing was also compared against the unsupervised PMQ 8-weeks strategy since the former had recently been adopted in malaria high burden villages that had village malaria volunteers. A budget impact analysis was conducted to understand the incremental cost and effect needed for a nationwide scale-up of the chosen strategy.
Methods
A decision tree model compared the cost-effectiveness of implementing four strategies at one health facility with an average of 14 Pv cases in one year. The strategies were unsupervised PMQ strategy, supervised PMQ strategy, G6PD test with unsupervised PMQ strategy, and G6PD test with supervised PMQ strategy. Disability Adjusted Life Years (DALYs) was the effect measure. Costs were calculated from a payer perspective, and sensitivity analyses were conducted. One Gross Domestic Product (GDP) per capita of Laos was set as the cost-effectiveness threshold. Budget impact analysis was conducted using the health facility wise Pv data in Laos in 2020.
Findings
Supervised PMQ strategy was extendedly dominated by G6PD test strategies. When compared against the unsupervised PMQ strategy, both G6PD test strategies were more costly but more effective. Their Incremental Cost-Effectiveness Ratios (ICER) were 96.72US$ for the G6PD test with unsupervised PMQ strategy and 184.86US$ for the G6PD test with supervised PMQ strategy. Both ICERs were lower than one GDP per capita in Laos. Following the sensitivity analysis, low adherence for PMQ 14 days made both G6PD test strategies less cost-effective. The lower the Pv case number reported in a health facility, the higher the ICER was. In the budget impact analysis, the expected budget need was only half a million US$ when the G6PD test rollout was discriminately done depending on the Pv case number reported at the health facilities. Indiscriminate roll out of G6PD test to all health facilities was most expensive with least effect impact.
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Affiliation(s)
- Yu Nandar Aung
- Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
- * E-mail:
| | - Sai Thein Than Tun
- 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, United Kingdom
| | - Viengxay Vanisaveth
- Center for Malaria, Parasitology and Entomology, Ministry of Health, Vientiane, Lao PDR
| | | | - Lucy Kanya
- Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
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Obaldía N, Barahona I, Lasso J, Avila M, Quijada M, Nuñez M, Marti M. Comparison of PvLAP5 and Pvs25 qRT-PCR assays for the detection of Plasmodium vivax gametocytes in field samples preserved at ambient temperature from remote malaria endemic regions of Panama. PLoS Negl Trop Dis 2022; 16:e0010327. [PMID: 35394999 PMCID: PMC9020738 DOI: 10.1371/journal.pntd.0010327] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 04/20/2022] [Accepted: 03/14/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND As the elimination of malaria in Mesoamerica progresses, detection of Plasmodium vivax using light microscopy (LM) becomes more difficult. Highly sensitive molecular tools have been developed to help determine the hidden reservoir of malaria transmission in low transmission settings. In this study we compare the performance of PvLAP5 and Pvs25 qRT-PCR assays to LM for the detection of Plasmodium vivax gametocytes in field samples preserved at ambient temperature from malaria endemic regions of Panama. METHODS For this purpose, we collected a total of 83 malaria field samples during 2017-2020 preserved in RNAprotect (RNAp) of which 63 (76%) were confirmed P. vivax by LM and selected for further analysis. Additionally, 16 blood samples from local healthy malaria smear negative volunteers, as well as, from 15 malaria naïve lab-bred Aotus monkeys were used as controls. To optimize the assays, we first determined the minimum blood volume sufficient for detection of PvLAP5 and Pv18SrRNA using P. vivax infected Aotus blood that was preserved in RNAp and kept either at ambient temperature for up to 8 days before freezing or was snap-frozen at -80° Celsius at the time of bleeding. We then compared the mean differences in gametocyte detection rates of both qRT-PCR assays to LM and performed a multivariate correlation analysis of study variables. Finally, we determined the sensitivity (Se) and specificity (Sp) of the assays at detecting gametocytes compared to LM. RESULTS Blood volume optimization indicated that a blood volume of at least 60 μL was sufficient for detection of PvLAP5 and Pv18SrRNA and no significant differences were found between RNA storage conditions. Both PvLAP5 and Pvs25 qRT-PCR assays showed a 37-39% increase in gametocyte detection rate compared to LM respectively. Strong positive correlations were found between gametocytemia and parasitemia and both PvLAP5 and Pvs25 gametocyte markers. However, no significant differences were detected in the Se and Sp of the Pvs25 and PvLAP5 qRT-PCR assays, even though data from control samples suggested Pvs25 to be more abundant than PvLAP5. CONCLUSIONS This study shows that the PvLAP5 qRT-PCR assay is as Se and Sp as the gold standard Pvs25 assay and is at least 37% more sensitive than LM at detecting P. vivax gametocytes in field samples preserved in RNAp at ambient temperature from malaria endemic regions of Panama. AUTHOR SUMMARY Plasmodium vivax is one of the five species of malaria (P. falciparum, P. malariae, P. ovale and P. knowlesi) that are transmitted to man by the bite of female anopheles mosquitoes. It causes ~14.3 million cases mainly in Southeast Asia, India, the Western Pacific and the Americas annually. In the Americas, malaria remains a major problem in underdeveloped areas and indigenous communities in the Amazon region and eastern Panama, where it is endemic and difficult to eliminate. As malaria elimination progresses, detection of P. vivax by light microscopy (LM) becomes more difficult. Therefore, highly sensitive molecular tools have been developed that use genetic markers for the parasite to help determine the hidden reservoir of malaria transmission. This study compares the performance of two molecular assays based on the genetic markers of mature gametocytes PvLAP5 and Pvs25 with LM. The study shows that the PvLAP5 qRT-PCR assay is as sensitive and specific as the gold standard Pvs25 assay and is at least 37% more sensitive than LM at detecting P. vivax gametocytes. These data suggest that the PvLAP5 qRT-PCR assay can be a useful tool to help determine the hidden reservoir of transmission in endemic foci approaching elimination.
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Affiliation(s)
- Nicanor Obaldía
- Departamento de Investigaciones en Parasitología, Instituto Conmemorativo Gorgas de Estudios de la Salud, Panamá City, Panamá, Republic of Panamá
- Department of Immunology and Infectious Diseases, Harvard T.H. CHAN School of Public Health, Boston, Massachusetts, United States of America
- Wellcome Centre for Integrative Parasitology, Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, Scotland, United Kingdom
| | - Itza Barahona
- Departamento de Control de Vectores, Dirección General de Salud Pública, Ministerio de Salud de Panamá, Panamá, Republic of Panamá
| | - José Lasso
- Departamento de Control de Vectores, Dirección General de Salud Pública, Ministerio de Salud de Panamá, Panamá, Republic of Panamá
| | - Mario Avila
- Departamento de Control de Vectores, Dirección General de Salud Pública, Ministerio de Salud de Panamá, Panamá, Republic of Panamá
| | - Mario Quijada
- Departamento de Investigaciones en Parasitología, Instituto Conmemorativo Gorgas de Estudios de la Salud, Panamá City, Panamá, Republic of Panamá
| | - Marlon Nuñez
- Departamento de Investigaciones en Parasitología, Instituto Conmemorativo Gorgas de Estudios de la Salud, Panamá City, Panamá, Republic of Panamá
| | - Matthias Marti
- Department of Immunology and Infectious Diseases, Harvard T.H. CHAN School of Public Health, Boston, Massachusetts, United States of America
- Wellcome Centre for Integrative Parasitology, Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, Scotland, United Kingdom
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Yun SG, Yoon J, Kim K, Choi JM, Jeon Y, Kim GA, Choi MK, Cho Y, Lee CK, Lim CS. Detection of Plasmodium vivax using Automated Hematology Analyzer in the Korean Army. Clin Lab 2022; 68. [PMID: 35023668 DOI: 10.7754/clin.lab.2021.210301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND This study aimed to evaluate whether our equation model developed from the Sysmex hematology analyzer can discriminate patients with Plasmodium vivax (P. vivax) infection from those with acute febrile illness (AFI) and healthy controls. Besides, we compared our model with the previously studied models. METHODS A total of 312 blood samples were collected from the P. vivax, AFI, and healthy control groups. All samples were tested for routine complete blood count conducted by using a Sysmex XE-2100 or XE-5000 analyzer. We compared the reportable and research parameters generated from the Sysmex analyzer among the three groups. The selected parameters that showed a significant difference between the P. vivax and the other group were included in the logistic regression analysis to develop our model (N-OIpv model). Moreover, we analyzed the CBC data according to the previous models, such as the presence of abnormal blue coded events in the WBC/BASO scattergram called the observer-interpretation (OIpv) model, and the previous equation model (N-OD1pv model) developed by Campuzano-Zuluaga et al. Results: The N-OIpv model, which consists of three parameters, such as mean cell volume, plateletcrit, and Lymph-X, showed the best performance for detection of malaria (97.4% accuracy). Also, this model can increase the sensitivity by about 11.9% to 18.1% compared with the OIpv and N-OD1pv models, respectively. CONCLUSIONS We concluded that the N-OIpv model using the Sysmex hematology analyzer is a useful diagnostic tool in the routine laboratory workup for malaria.
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Lisbôa PGS, Medeiros JMR, de Souza AV, dos Santos BFB, Sanches HOC, da Rocha JLG, Correa Junior WDJP, Costa GG, Chaves TDSS, da Silva Ventura AMR, Libonati RMF. Analysis of malaria clinical-epidemiological predictors in individuals from Brazilian Amazon. Parasitology 2022; 149:10-14. [PMID: 34218833 PMCID: PMC11010514 DOI: 10.1017/s0031182021001165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 06/26/2021] [Accepted: 06/27/2021] [Indexed: 11/06/2022]
Abstract
This research aims to determine whether the combination of epidemiological and clinical features can predict malaria. Diagnostic investigation detected 22.3% of individuals with Plasmodium vivax (P. vivax) malaria, with significant predominance of the male gender. The malaria triad (fever, chills and headache) had a more expressive frequency (81.1%) in individuals with positive thick blood than those with negative thick blood smear (65.1%), although there was no statistical significance. Among the variables analysed as predictive for positive thick blood smear, it was observed that personal history of travel to an endemic malaria area and past malaria infection (PMI) were significantly associated with malaria, even in multiple logistic regression. Fever had the higher sensitivity (94.6%) and past malaria history had the greater specificity (68.2%), with accuracy of 23.5% and 67.5%, respectively. In combined analysis, fever with chills had the highest sensitivity (91.9%), but low accuracy (38.5%). High specificity (91.5%) was found in the association of malaria triad, PMI and history of travel to endemic malaria area (which along with anorexia, was higher 94.6%), with good accuracy (80.7%), suggesting that the screening of patients for performing thick blood smear can be based on these data. The epidemiological features and the malaria triad (fever, chills and headache) can be predictors for identification of malaria patients, concurring to precocious diagnosis and immediate treatment of individuals with malaria.
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Affiliation(s)
| | | | | | | | | | | | | | - Gabriela Góes Costa
- Instituto de Ciências da Saúde, Universidade Federal do Pará, Belém, Pará, Brazil
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Ruwanpura V, Neukom J, Grietens KP, Price RN, Thriemer K, Lynch CA. Opening the policy blackbox: unravelling the process for changing national diagnostic and treatment guidelines for vivax malaria in seven countries. Malar J 2021; 20:428. [PMID: 34717642 PMCID: PMC8556862 DOI: 10.1186/s12936-021-03959-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 10/18/2021] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND The changing global health landscape has highlighted the need for more proactive, efficient and transparent health policy-making. After more than 60 years of limited development, novel tools for vivax malaria are finally available, but need to be integrated into national policies. This paper maps the malaria policy-making processes in seven endemic countries, to identify areas where it can be improved to align with best practices and optimal efficiency. METHODS Data were collected during a workshop, convened by the Asia Pacific Malaria Elimination Network's Vivax Working Group in 2019, and subsequent interviews with key stakeholders from Cambodia, Ethiopia, Indonesia, Pakistan, Papua New Guinea (PNG), Sri Lanka and Vietnam. Documentation of policy processes provided by respondents was reviewed. Data analysis was guided by an analytic framework focused on three a priori defined domains: "context," "actors" and "processes". RESULTS The context of policy-making varied with available funding for malaria, population size, socio-economic status, and governance systems. There was limited documentation of the process itself or terms of reference for involved actors. In all countries, the NMP plays a critical role in initiating and informing policy change, but the involvement of other actors varied considerably. Available evidence was described as a key influencer of policy change; however, the importance of local evidence and the World Health Organization's endorsement of new treatments and diagnostics varied. The policy process itself and its complexity varied but was mostly semi-siloed from other disease specific policy processes in the wider Ministry of Health. Time taken to change and introduce a new policy guideline previously varied from 3 months to 3 years. CONCLUSIONS In the medium to long term, a better alignment of anti-malarial policy-making processes with the overall health policy-making would strengthen health governance. In the immediate term, shortening the timelines for policy change will be pivotal to meet proposed malaria elimination milestones.
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Affiliation(s)
- Varunika Ruwanpura
- Global Health Division, Menzies School of Health Research and Charles Darwin University, PO Box 41096, Casuarina, Darwin, NT, 0811, Australia
| | | | - Koen Peeters Grietens
- Institute of Tropical Medicine, Antwerp, Belgium
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Ric N Price
- Global Health Division, Menzies School of Health Research and Charles Darwin University, PO Box 41096, Casuarina, Darwin, NT, 0811, Australia
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Kamala Thriemer
- Global Health Division, Menzies School of Health Research and Charles Darwin University, PO Box 41096, Casuarina, Darwin, NT, 0811, Australia.
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Alves JRS, de Araújo FF, Pires CV, Teixeira-Carvalho A, Lima BAS, Torres LM, Ntumngia FB, Adams JH, Kano FS, Carvalho LH. Multiplexed Microsphere-Based Flow Cytometric Assay to Assess Strain Transcending Antibodies to Plasmodium vivax Duffy Binding Protein II Reveals an Efficient Tool to Identify Binding-Inhibitory Antibody Responders. Front Immunol 2021; 12:704653. [PMID: 34675915 PMCID: PMC8523986 DOI: 10.3389/fimmu.2021.704653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 09/13/2021] [Indexed: 11/24/2022] Open
Abstract
Malaria remains a major public health problem worldwide, and Plasmodium vivax is the most widely distributed malaria parasite. Naturally acquired binding inhibitory antibodies (BIAbs) to region II of the Duffy binding protein (DBPII), a P. vivax ligand that is critical for reticulocyte invasion, are associated with a reduced risk of clinical malaria. Owing to methodological issues in evaluating antibodies that inhibit the DBPII-DARC interaction, a limited number of studies have investigated DBPII BIAbs in P. vivax-exposed populations. Based on the assumption that individuals with a consistent BIAb response are characterized by strain-transcending immune responses, we hypothesized that detecting broadly reactive DBPII antibodies would indicate the presence of BIAb response. By taking advantage of an engineered DBPII immunogen targeting conserved DBPII neutralizing epitopes (DEKnull-2), we standardized a multiplex flow cytometry-based serological assay to detect broadly neutralizing IgG antibodies. For this study, a standard in vitro cytoadherence assay with COS-7 cells expressing DBPII was used to test for DBPII BIAb response in long-term P. vivax-exposed Amazonian individuals. Taken together, the results demonstrate that this DBPII-based multiplex assay facilitates identifying DBPII BIAb carriers. Of relevance, the ability of the multiplex assay to identify BIAb responders was highly accurate when the positivity for all antigens was considered. In conclusion, the standardized DBPII-based flow cytometric assay confirmed that DBPII-BIAb activity was associated with the breadth rather than the magnitude of anti-DBPII antibodies. Altogether, our results suggest that multiplex detection of broadly DBPII-reactive antibodies facilitates preliminary screening of BIAb responders.
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Affiliation(s)
- Jéssica R. S. Alves
- Molecular Biology and Malaria Immunology, René Rachou Institute, Oswaldo Cruz Foundation (FIOCRUZ), Belo Horizonte, Brazil
| | - Fernanda F. de Araújo
- Integrated Research Group in Biomarkers, René Rachou Institute, Oswaldo Cruz Foundation (FIOCRUZ), Belo Horizonte, Brazil
| | - Camilla V. Pires
- Center for Global Health and Infectious Diseases Research, Department of Global Health, College of Public Health, University of South Florida, Tampa, FL, United States
| | - Andréa Teixeira-Carvalho
- Integrated Research Group in Biomarkers, René Rachou Institute, Oswaldo Cruz Foundation (FIOCRUZ), Belo Horizonte, Brazil
| | - Barbara A. S. Lima
- Molecular Biology and Malaria Immunology, René Rachou Institute, Oswaldo Cruz Foundation (FIOCRUZ), Belo Horizonte, Brazil
| | - Letícia M. Torres
- Molecular Biology and Malaria Immunology, René Rachou Institute, Oswaldo Cruz Foundation (FIOCRUZ), Belo Horizonte, Brazil
| | - Francis B. Ntumngia
- Center for Global Health and Infectious Diseases Research, Department of Global Health, College of Public Health, University of South Florida, Tampa, FL, United States
| | - John H. Adams
- Center for Global Health and Infectious Diseases Research, Department of Global Health, College of Public Health, University of South Florida, Tampa, FL, United States
| | - Flora S. Kano
- Molecular Biology and Malaria Immunology, René Rachou Institute, Oswaldo Cruz Foundation (FIOCRUZ), Belo Horizonte, Brazil
| | - Luzia H. Carvalho
- Molecular Biology and Malaria Immunology, René Rachou Institute, Oswaldo Cruz Foundation (FIOCRUZ), Belo Horizonte, Brazil
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Cardona-Arias JA, Carmona-Fonseca J. Meta-analysis of the prevalence of malaria associated with pregnancy in Colombia 2000-2020. PLoS One 2021; 16:e0255028. [PMID: 34329329 PMCID: PMC8323879 DOI: 10.1371/journal.pone.0255028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 07/08/2021] [Indexed: 11/18/2022] Open
Abstract
Knowledge about malaria associated with pregnancy is scarce in Latin America, and in Colombia, little is known about the magnitude of this infection. A systematic review was conducted to determine the prevalence of malaria associated with pregnancy (MAP) and each of its three forms: gestational (GM), placental (PM), and congenital (CM) tested using thick blood smear (TBS) and PCR. Also to compare the proportion of cases due to Plasmodium falciparum and Plasmodium vivax in Colombia from the year 2000-2020. We searched in Pubmed, Science Direct, EMBASE, EMCare, Cochrane Library, Scielo, Lilacs, Google Scholar, libraries, and repositories of Colombian universities, to obtain data on prevalence of GM, PM and CM with their respective testing method. We performed a meta-analysis with a random-effects model to obtain pooled prevalence of MAP and its three forms categorized by testing methods (TBS and PCR). We used data from 14 studies (out of 258 screened) contributing 7932, 2506 women for GM and PM respectively, also data on 1143 umbilical cord blood samples, and 899 peripheral blood of neonates. We found prevalence by TBS as, MAP 4.5% (95%CI = 2.9-6.9), GM 5.8% (95%CI = 3.8-8.7), PM 3.4% (95%CI = 1.7-6.7) and CM 1.3% (95%CI = 0.6-3.0). With PCR the prevalence was, MAP 14.4% (95%CI = 7.6-25.5), GM 16.7% (95%CI = 9.0-28.8), PM 11.0% (95%CI = 4.1-26.3) and CM 16.2% (95%CI = 8.2-29.5). The prevalence of submicroscopic infection was 8.5% (95%CI = 3.4-19.7) in GM, 10.1% (95%CI = 3.5-25.5) in PM and 22.0% (95%CI = 13.2-34.3) in CM. Infections by P. vivax was dominant over P. falciparum when tested with TBS, the PCR test gave similar proportions of P. falciparum and P. vivax. This meta-analysis has demonstrated high prevalence of MAP in Colombia, and highlights the urgent need to increase attention of researchers, research funding institutions, government agencies, and health authorities to study and intervene MAP, that has currently been under investigated.
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MESH Headings
- Colombia
- Female
- Humans
- Malaria, Falciparum/blood
- Malaria, Falciparum/diagnosis
- Malaria, Falciparum/epidemiology
- Malaria, Falciparum/pathology
- Malaria, Vivax/blood
- Malaria, Vivax/diagnosis
- Malaria, Vivax/epidemiology
- Malaria, Vivax/pathology
- Plasmodium falciparum/metabolism
- Plasmodium vivax/metabolism
- Pregnancy
- Pregnancy Complications, Parasitic/blood
- Pregnancy Complications, Parasitic/diagnosis
- Pregnancy Complications, Parasitic/epidemiology
- Pregnancy Complications, Parasitic/pathology
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Affiliation(s)
| | - Jaime Carmona-Fonseca
- ”Grupo Salud y Comunidad César Uribe Pidrahíta”, University of Antioquia, Medellín, Colombia
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Arévalo-Herrera M, Miura K, Cespedes N, Echeverry C, Solano E, Castellanos A, Ramirez JS, Miranda A, Kajava AV, Long C, Corradin G, Herrera S. Immunoreactivity of Sera From Low to Moderate Malaria-Endemic Areas Against Plasmodium vivax r Pvs48/45 Proteins Produced in Escherichia coli and Chinese Hamster Ovary Systems. Front Immunol 2021; 12:634738. [PMID: 34248932 PMCID: PMC8264144 DOI: 10.3389/fimmu.2021.634738] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 05/25/2021] [Indexed: 11/13/2022] Open
Abstract
P48/45 is a conserved gametocyte antigen involved in Plasmodium parasite fertilization. A recombinant Plasmodium vivax P48/45 (Pvs48/45) protein expressed in Escherichia coli (E. coli) was highly antigenic and immunogenic in experimental animals and elicited specific transmission-blocking (TB) antibodies in a previous pilot study. Here, a similar Pvs48/45 gene was expressed in Chinese Hamster Ovary (CHO) cells and we compared its immunoreactivity with the E. coli product. Specific antibody titers were determined using plasma from Colombian individuals (n=227) living in endemic areas where both P. vivax and P. falciparum are prevalent and from Guatemala (n=54) where P. vivax is highly prevalent. In Colombia, plasma seroprevalence to CHO-rPvs48/45 protein was 46.3%, while for E. coli-rPvs48/45 protein was 36.1% (p<0.001). In Guatemala, the sero prevalence was 24.1% and 14.8% (p<0.001), respectively. Reactivity index (RI) against both proteins showed an age-dependent increase. IgG2 was the predominant subclass and the antibody avidity index evaluated by ELISA ranged between 4-6 mol/L. Ex vivo P. vivax mosquito direct membrane feeding assays (DMFA) performed in presence of study plasmas, displayed significant parasite transmission-blocking (TB), however, there was no direct correlation between antibody titers and oocysts transmission reduction activity (%TRA). Nevertheless, DMFA with CHO rPvs48/45 affinity purified IgG showed a dose response; 90.2% TRA at 100 μg/mL and 71.8% inhibition at 10 μg/mL. In conclusion, the CHO-rPvs48/45 protein was more immunoreactive in most of the malaria endemic places studied, and CHO-rPvs48/45 specific IgG showed functional activity, supporting further testing of the protein vaccine potential.
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Affiliation(s)
- Myriam Arévalo-Herrera
- Immunology Department, Malaria Vaccine and Drug Development Center, Cali, Colombia
- Immunology Department, Caucaseco Scientific Research Center, Cali, Colombia
| | - Kazutoyo Miura
- Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD, United States
| | - Nora Cespedes
- Immunology Department, Malaria Vaccine and Drug Development Center, Cali, Colombia
| | - Carlos Echeverry
- Immunology Department, Malaria Vaccine and Drug Development Center, Cali, Colombia
| | - Eduardo Solano
- Immunology Department, Caucaseco Scientific Research Center, Cali, Colombia
| | - Angélica Castellanos
- Immunology Department, Malaria Vaccine and Drug Development Center, Cali, Colombia
| | | | - Adolfo Miranda
- Parasitology Department, Centro Nacional de Epidemiología (CNE), Guatemala City, Guatemala
| | - Andrey V. Kajava
- Centre de Recherche en Biologie Cellulaire de Montpellier, Université Montpellier, Montpellier, France
| | - Carole Long
- Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD, United States
| | | | - Sócrates Herrera
- Immunology Department, Malaria Vaccine and Drug Development Center, Cali, Colombia
- Immunology Department, Caucaseco Scientific Research Center, Cali, Colombia
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40
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Putaporntip C, Kuamsab N, Pattanawong U, Yanmanee S, Seethamchai S, Jongwutiwes S. Plasmodium cynomolgi Co-infections among Symptomatic Malaria Patients, Thailand. Emerg Infect Dis 2021; 27:590-593. [PMID: 33496236 PMCID: PMC7853550 DOI: 10.3201/eid2702.191660] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Among 1,180 symptomatic malaria patients, 9 (0.76%) infected with Plasmodium cynomolgi were co-infected with P. vivax (n = 7), P. falciparum (n = 1), or P. vivax and P. knowlesi (n = 1). Patients were from Tak, Chanthaburi, Ubon Ratchathani, Yala, and Narathiwat Provinces, suggesting P. cynomolgi is widespread in this country.
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41
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Engel N, Ghergu C, Matin MA, Kibria MG, Thriemer K, Price RN, Ding XC, Howes RE, Ley B, Incardona S, Alam MS. Implementing radical cure diagnostics for malaria: user perspectives on G6PD testing in Bangladesh. Malar J 2021; 20:217. [PMID: 33980257 PMCID: PMC8114691 DOI: 10.1186/s12936-021-03743-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 04/20/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND The radical cure of Plasmodium vivax requires treatment with an 8-aminoquinoline drug, such as primaquine and tafenoquine, to eradicate liver hypnozoite stages, which can reactivate to cause relapsing infections. Safe treatment regimens require prior screening of patients for glucose-6-phosphate dehydrogenase (G6PD) deficiency to avoid potential life-threatening drug induced haemolysis. Testing is rarely available in malaria endemic countries, but will be needed to support routine use of radical cure. This study investigates end-user perspectives in Bangladesh on the introduction of a quantitative G6PD test (SD Biosensor STANDARD™ G6PD analyser) to support malaria elimination. METHODS The perspectives of users on the SD Biosensor test were analysed using semi-structured interviews and focus group discussions with health care providers and malaria programme officers in Bangladesh. Key emerging themes regarding the feasibility of introducing this test into routine practice, including perceived barriers, were analysed. RESULTS In total 63 participants were interviewed. Participants emphasized the life-saving potential of the biosensor, but raised concerns including the impact of limited staff time, high workload and some technical aspects of the device. Participants highlighted that there are both too few and too many P. vivax patients to implement G6PD testing owing to challenges of funding, workload and complex testing infrastructure. Implementing the biosensor would require flexibility and improvisation to deal with remote sites, overcoming a low index of suspicion and mutual interplay of declining patient numbers and reluctance to test. This approach would generate new forms of evidence to justify introduction in policy and carefully consider questions of deployment given declining patient numbers. CONCLUSIONS The results of the study show that, in an elimination context, the importance of malaria needs to be maintained for both policy makers and the affected communities, in this case by ensuring P. vivax, PQ treatment, and G6PD deficiency remain visible. Availability of new technologies, such as the biosensor, will fuel ongoing debates about priorities for allocating resources that must be adapted to a constantly evolving target. Technical and logistical concerns regarding the biosensor should be addressed by future product designs, adequate training, strengthened supply chains, and careful planning of communication, advocacy and staff interactions at all health system levels.
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Affiliation(s)
- Nora Engel
- Department of Health, Ethics & Society, Research School for Public Health and Primary Care (CAPHRI), Faculty of Health, Medicine & Life Sciences, Maastricht University, Maastricht, Netherlands.
| | - Cristian Ghergu
- Department of Health, Ethics & Society, Research School for Public Health and Primary Care (CAPHRI), Faculty of Health, Medicine & Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Mohammad Abdul Matin
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mohammad Golam Kibria
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Kamala Thriemer
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Ric N Price
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Xavier C Ding
- Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland
| | - Rosalind E Howes
- Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland
| | - Benedikt Ley
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Sandra Incardona
- Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland
| | - Mohammad Shafiul Alam
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
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Dombrowski JG, Barateiro A, Peixoto EPM, Barros ABCDS, de Souza RM, Clark TG, Campino S, Wrenger C, Wunderlich G, Palmisano G, Epiphanio S, Gonçalves LA, Marinho CRF. Adverse pregnancy outcomes are associated with Plasmodium vivax malaria in a prospective cohort of women from the Brazilian Amazon. PLoS Negl Trop Dis 2021; 15:e0009390. [PMID: 33914739 PMCID: PMC8112668 DOI: 10.1371/journal.pntd.0009390] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 05/11/2021] [Accepted: 04/15/2021] [Indexed: 11/29/2022] Open
Abstract
Background Malaria in Brazil represents one of the highest percentages of Latin America cases, where approximately 84% of infections are attributed to Plasmodium (P.) vivax. Despite the high incidence, many aspects of gestational malaria resulting from P. vivax infections remain poorly studied. As such, we aimed to evaluate the consequences of P. vivax infections during gestation on the health of mothers and their neonates in an endemic area of the Amazon. Methods and findings We have conducted an observational cohort study in Brazilian Amazon between January 2013 and April 2015. 600 pregnant women were enrolled and followed until delivery. After applying exclusion criteria, 329 mother-child pairs were included in the analysis. Clinical data regarding maternal infection, newborn’s anthropometric measures, placental histopathological characteristics, and angiogenic and inflammatory factors were evaluated. The presence of plasma IgG against the P. vivax (Pv) MSP119 protein was used as marker of exposure and possible associations with pregnancy outcomes were analyzed. Multivariate logistic regression analysis revealed that P. vivax infections during the first trimester of pregnancy are associated with adverse gestational outcomes such as premature birth (adjusted odds ratio [aOR] 8.12, 95% confidence interval [95%CI] 2.69–24.54, p < 0.0001) and reduced head circumference (aOR 3.58, 95%CI 1.29–9.97, p = 0.01). Histopathology analysis showed marked differences between placentas from P. vivax-infected and non-infected pregnant women, especially regarding placental monocytes infiltrate. Placental levels of vasomodulatory factors such as angiopoietin-2 (ANG-2) and complement proteins such as C5a were also altered at delivery. Plasma levels of anti-PvMSP119 IgG in infected pregnant women were shown to be a reliable exposure marker; yet, with no association with improved pregnancy outcomes. Conclusions This study indicates that P. vivax malaria during the first trimester of pregnancy represents a higher likelihood of subsequent poor pregnancy outcomes associated with marked placental histologic modification and angiogenic/inflammatory imbalance. Additionally, our findings support the idea that antibodies against PvMSP119 are not protective against poor pregnancy outcomes induced by P. vivax infections. Malaria during pregnancy is associated with adverse effects on the fetus and the newborn. As far as we know, no study has previously investigated in a single work, the link between Plasmodium vivax malaria in pregnancy and poor gestational outcomes, alteration of the newborn’s anthropometric profile, placental lesions, angiogenic and inflammatory factors, and humoral immunity against the parasite. For this purpose, we investigated the association between P. vivax malaria during pregnancy and newborn’s anthropometric profile, placental pathology, gestational outcomes, and the presence of IgG against P. vivax MSP119 that may confer protection against infection during pregnancy. We performed a large cohort study of malaria during pregnancy that analyzed data from mother-child pairs delivered between 2013 and 2015 in the Southwestern Brazilian Amazonian region. By evaluating data from 329 pregnancies, we found that P. vivax malaria during the first pregnancy trimester is significantly associated with the occurrence of preterm birth, low birth weight, and reduced newborn head circumference and body length. We also noted that P. vivax malaria in pregnancy promoted placental lesions and homeostasis imbalance, characterized by increased syncytial nuclear aggregates, fibrin deposition, and monocytes/leukocytes infiltrate, as well as imbalanced angiogenic factors, leptin, and cytokines. We observed that pregnant women with IgG against P. vivax MSP119 are not protected against poor pregnancy outcomes caused by P. vivax infections during pregnancy. Our observations improve our understanding of the disease and P. vivax burden during pregnancy, changing the current paradigm of the outcome of P. vivax malaria in pregnancy. That may represent a long-term severe consequence for the affected populations living in P. vivax-endemic regions. Our results also indicate that IgG against P. vivax MSP119 is not associated with protection from poor pregnancy outcomes, excluding this protein as a possible vaccination target that can prevent adverse outcomes caused by P. vivax infections during pregnancy.
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Affiliation(s)
| | - André Barateiro
- Department of Parasitology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | | | | | | | - Taane Gregory Clark
- Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Susana Campino
- Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Carsten Wrenger
- Department of Parasitology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Gerhard Wunderlich
- Department of Parasitology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Giuseppe Palmisano
- Department of Parasitology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Sabrina Epiphanio
- Department of Clinical and Toxicological Analyses, Faculty of Pharmaceutical Sciences, University of São Paulo, São Paulo, Brazil
| | - Lígia Antunes Gonçalves
- Department of Parasitology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
- * E-mail: (LAG); (CRFM)
| | - Claudio Romero Farias Marinho
- Department of Parasitology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
- * E-mail: (LAG); (CRFM)
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Wangmaung N, Chomean S, Ittarat W. Differential diagnosis of Plasmodium falciparum and Plasmodium vivax in mixed infection by colorimetric nanogold probes. Anal Biochem 2021; 624:114173. [PMID: 33757758 DOI: 10.1016/j.ab.2021.114173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 03/12/2021] [Accepted: 03/16/2021] [Indexed: 11/18/2022]
Abstract
Malaria is an infectious disease reported mostly in the tropical region. The most severe human malaria is Plasmodium falciparum since it can cause cerebral malaria. Therefore, the presence of P. falciparum either in single or mixed infection needs accurate diagnosis. In some mixed infections, the presence of P. falciparum may be cryptic which cannot be detected by microscopic examination. The molecular diagnosis is required in these cases. Many methods based on amplification of malaria parasite genes have been developed but most of them need sophisticated instruments. Here, we created a colorimetric method using probe immobilized gold nanoparticles (AuNPs) to detect the malaria parasite gene. Color changes rely on salt-induced aggregation of AuNPs in the presence or absence of DNA hybridization. Color changes could be observed either by a naked eye or UV-vis spectrophotometer. By this approach, single infection by the most common malaria parasite, P. falciparum or P. vivax could be differentially identified. Mixed infection of these two malaria species could also be clearly diagnosed including cases of cryptic P. falciparum. The novel nanogold based molecular malaria diagnosis is sensitive, specific, rapid and cheap ($0.94). The prepared nanogold malaria probes are stable for up to 3 months indicating their filed application in remote areas.
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Affiliation(s)
- Nantawan Wangmaung
- Medical Technology, Schools of Allied Health Science, Walailak University, Thailand.
| | - Sirinart Chomean
- Medical Technology, Faculty of Allied Health Science, Thammasat University, Thailand
| | - Wanida Ittarat
- Clinical Microscopy, Faculty of Medical Technology, Mahidol University, Thailand
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Holm AE, Gomes LC, Marinho CRF, Silvestre OM, Vestergaard LS, Biering-Sørensen T, Brainin P. Prevalence of Cardiovascular Complications in Malaria: A Systematic Review and Meta-Analysis. Am J Trop Med Hyg 2021; 104:1643-1650. [PMID: 33724926 PMCID: PMC8103436 DOI: 10.4269/ajtmh.20-1414] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 01/02/2021] [Indexed: 12/13/2022] Open
Abstract
Recent studies have suggested that malaria may affect the cardiovascular system. The aim of this systematic review and meta-analysis was to determine the prevalence of cardiovascular complications in symptomatic malaria patients. We searched databases such as Pubmed, Embase, Cochrane, and Web of Science (January 1950-April 2020) for studies reporting on cardiovascular complications in adults and children with malaria. Cardiovascular complications were defined as abnormalities in electrocardiogram (ECG), cardiac biomarkers, and echocardiography on admission or during outpatient examination. Studies of patients with known heart disease or cardiovascular evaluation performed after the start of intravenous antimalarial medication were excluded. The study was registered in International Prospective Register of Systematic Reviews (PROSPERO) (No.: CRD42020167672). The literature search yielded 1,243 studies, and a total of 43 studies with symptomatic malaria patients were included. Clinical studies (n = 12 adults; n = 5 children) comprised 3,117 patients, of which a majority had Plasmodium falciparum (n = 15) and were diagnosed with severe malaria (n = 13). In random-effects models of adults, the pooled prevalence estimate for any cardiovascular complication was 7% (95% CI: 5-9). No meta-analysis was conducted in children, but the range of abnormal ECG was 0-8%, cardiac biomarkers 0-57%, and echocardiography 4-9%. We analyzed 33 cases (n = 10 postmortem), in which the most common cardiovascular pathologies were myocarditis and acute coronary syndrome. All histopathological studies found evidence of parasitized red blood cells in the myocardium. Cardiovascular complications are not uncommon in symptomatic adults and children with malaria. Additional studies investigating malaria and cardiovascular disease are encouraged.
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Affiliation(s)
- Anna Engell Holm
- Federal University of Acre, Campus Floresta, Cruzeiro do Sul, Acre, Brazil
- Department of Cardiology, Herlev-Gentofte Hospital, Hellerup, Denmark
| | - Laura C. Gomes
- Federal University of Acre, Campus Floresta, Cruzeiro do Sul, Acre, Brazil
| | | | | | - Lasse S. Vestergaard
- National Malaria Reference Laboratory, Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark
| | - Tor Biering-Sørensen
- Department of Cardiology, Herlev-Gentofte Hospital, Hellerup, Denmark
- Faculty of Biomedical Sciences, Copenhagen University, Copenhagen, Denmark
| | - Philip Brainin
- Federal University of Acre, Campus Floresta, Cruzeiro do Sul, Acre, Brazil
- Department of Cardiology, Herlev-Gentofte Hospital, Hellerup, Denmark
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Rosado J, White MT, Longley RJ, Lacerda M, Monteiro W, Brewster J, Sattabongkot J, Guzman-Guzman M, Llanos-Cuentas A, Vinetz JM, Gamboa D, Mueller I. Heterogeneity in response to serological exposure markers of recent Plasmodium vivax infections in contrasting epidemiological contexts. PLoS Negl Trop Dis 2021; 15:e0009165. [PMID: 33591976 PMCID: PMC7909627 DOI: 10.1371/journal.pntd.0009165] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 02/26/2021] [Accepted: 01/21/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Antibody responses as serological markers of Plasmodium vivax infection have been shown to correlate with exposure, but little is known about the other factors that affect antibody responses in naturally infected people from endemic settings. To address this question, we studied IgG responses to novel serological exposure markers (SEMs) of P. vivax in three settings with different transmission intensity. METHODOLOGY We validated a panel of 34 SEMs in a Peruvian cohort with up to three years' longitudinal follow-up using a multiplex platform and compared results to data from cohorts in Thailand and Brazil. Linear regression models were used to characterize the association between antibody responses and age, the number of detected blood-stage infections during follow-up, and time since previous infection. Receiver Operating Characteristic (ROC) analysis was used to test the performance of SEMs to identify P. vivax infections in the previous 9 months. PRINCIPAL FINDINGS Antibody titers were associated with age, the number of blood-stage infections, and time since previous P. vivax infection in all three study sites. The association between antibody titers and time since previous P. vivax infection was stronger in the low transmission settings of Thailand and Brazil compared to the higher transmission setting in Peru. Of the SEMs tested, antibody responses to RBP2b had the highest performance for classifying recent exposure in all sites, with area under the ROC curve (AUC) = 0.83 in Thailand, AUC = 0.79 in Brazil, and AUC = 0.68 in Peru. CONCLUSIONS In low transmission settings, P. vivax SEMs can accurately identify individuals with recent blood-stage infections. In higher transmission settings, the accuracy of this approach diminishes substantially. We recommend using P. vivax SEMs in low transmission settings pursuing malaria elimination, but they are likely to be less effective in high transmission settings focused on malaria control.
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Affiliation(s)
- Jason Rosado
- Unit of Malaria: Parasites and hosts, Institut Pasteur, Paris, France
- Sorbonne Université, ED 393, Paris, France
| | - Michael T. White
- Unit of Malaria: Parasites and hosts, Institut Pasteur, Paris, France
| | - Rhea J. Longley
- Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
- Department of Medical Biology, University of Melbourne, Australia
| | - Marcus Lacerda
- Instituto Leônidas & Maria Deane (Fiocruz), Manaus, Brazil
- Tropical Medicine Foundation Dr Heitor Vieira Dourado, Manaus, Amazonas, Brazil
| | - Wuelton Monteiro
- Tropical Medicine Foundation Dr Heitor Vieira Dourado, Manaus, Amazonas, Brazil
| | - Jessica Brewster
- Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
| | - Jetsumon Sattabongkot
- Vivax Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Mitchel Guzman-Guzman
- Laboratorio ICEMR-Amazonia, Laboratorios de Investigación y Desarrollo, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Alejandro Llanos-Cuentas
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Joseph M. Vinetz
- Laboratorio ICEMR-Amazonia, Laboratorios de Investigación y Desarrollo, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
- Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America
- Departamento de Ciencias Celulares y Moleculares, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Dionicia Gamboa
- Laboratorio ICEMR-Amazonia, Laboratorios de Investigación y Desarrollo, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru
- Departamento de Ciencias Celulares y Moleculares, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Ivo Mueller
- Unit of Malaria: Parasites and hosts, Institut Pasteur, Paris, France
- Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
- Department of Medical Biology, University of Melbourne, Australia
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Hailemeskel E, Tebeje SK, Behaksra SW, Shumie G, Shitaye G, Keffale M, Chali W, Gashaw A, Ashine T, Drakeley C, Bousema T, Gadisa E, Tadesse FG. The epidemiology and detectability of asymptomatic plasmodium vivax and plasmodium falciparum infections in low, moderate and high transmission settings in Ethiopia. Malar J 2021; 20:59. [PMID: 33482841 PMCID: PMC7821398 DOI: 10.1186/s12936-021-03587-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 01/05/2021] [Accepted: 01/07/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND As countries move to malaria elimination, detecting and targeting asymptomatic malaria infections might be needed. Here, the epidemiology and detectability of asymptomatic Plasmodium falciparum and Plasmodium vivax infections were investigated in different transmission settings in Ethiopia. METHOD A total of 1093 dried blood spot (DBS) samples were collected from afebrile and apparently healthy individuals across ten study sites in Ethiopia from 2016 to 2020. Of these, 862 were from community and 231 from school based cross-sectional surveys. Malaria infection status was determined by microscopy or rapid diagnostics tests (RDT) and 18S rRNA-based nested PCR (nPCR). The annual parasite index (API) was used to classify endemicity as low (API > 0 and < 5), moderate (API ≥ 5 and < 100) and high transmission (API ≥ 100) and detectability of infections was assessed in these settings. RESULTS In community surveys, the overall prevalence of asymptomatic Plasmodium infections by microscopy/RDT, nPCR and all methods combined was 12.2% (105/860), 21.6% (183/846) and 24.1% (208/862), respectively. The proportion of nPCR positive infections that was detectable by microscopy/RDT was 48.7% (73/150) for P. falciparum and 4.6% (2/44) for P. vivax. Compared to low transmission settings, the likelihood of detecting infections by microscopy/RDT was increased in moderate (Adjusted odds ratio [AOR]: 3.4; 95% confidence interval [95% CI] 1.6-7.2, P = 0.002) and high endemic settings (AOR = 5.1; 95% CI 2.6-9.9, P < 0.001). After adjustment for site and correlation between observations from the same survey, the likelihood of detecting asymptomatic infections by microscopy/RDT (AOR per year increase = 0.95, 95% CI 0.9-1.0, P = 0.013) declined with age. CONCLUSIONS Conventional diagnostics missed nearly half of the asymptomatic Plasmodium reservoir detected by nPCR. The detectability of infections was particularly low in older age groups and low transmission settings. These findings highlight the need for sensitive diagnostic tools to detect the entire parasite reservoir and potential infection transmitters.
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Affiliation(s)
- Elifaged Hailemeskel
- Malaria and Neglected Tropical Diseases Directorate, Armauer Hansen Research Institute, PO Box 1005, Addis Ababa, Ethiopia
- Department of Biomedical Sciences, College of Natural and Computational Sciences, Addis Ababa University, PO Box 1176, Addis Ababa, Ethiopia
- Department of Biology, College of Natural and Computational Sciences, Wollo University, PO Box, 1145, Dessie, Ethiopia
- Department of Medical Microbiology, Radboud University Medical Center, 6525 GA, Nijmegen, The Netherlands
| | - Surafel K Tebeje
- Malaria and Neglected Tropical Diseases Directorate, Armauer Hansen Research Institute, PO Box 1005, Addis Ababa, Ethiopia
- Department of Medical Microbiology, Radboud University Medical Center, 6525 GA, Nijmegen, The Netherlands
| | - Sinknesh W Behaksra
- Malaria and Neglected Tropical Diseases Directorate, Armauer Hansen Research Institute, PO Box 1005, Addis Ababa, Ethiopia
| | - Girma Shumie
- Malaria and Neglected Tropical Diseases Directorate, Armauer Hansen Research Institute, PO Box 1005, Addis Ababa, Ethiopia
| | - Getasew Shitaye
- Department of Biomedical Sciences, School of Medical Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Migbaru Keffale
- Malaria and Neglected Tropical Diseases Directorate, Armauer Hansen Research Institute, PO Box 1005, Addis Ababa, Ethiopia
| | - Wakweya Chali
- Malaria and Neglected Tropical Diseases Directorate, Armauer Hansen Research Institute, PO Box 1005, Addis Ababa, Ethiopia
| | - Abrham Gashaw
- Malaria and Neglected Tropical Diseases Directorate, Armauer Hansen Research Institute, PO Box 1005, Addis Ababa, Ethiopia
| | - Temesgen Ashine
- Malaria and Neglected Tropical Diseases Directorate, Armauer Hansen Research Institute, PO Box 1005, Addis Ababa, Ethiopia
| | - Chris Drakeley
- Department of Immunology and Infection, London School of Hygiene & Tropical Medicine, WC1E 7HT, London, UK
| | - Teun Bousema
- Department of Medical Microbiology, Radboud University Medical Center, 6525 GA, Nijmegen, The Netherlands
- Department of Immunology and Infection, London School of Hygiene & Tropical Medicine, WC1E 7HT, London, UK
| | - Endalamaw Gadisa
- Malaria and Neglected Tropical Diseases Directorate, Armauer Hansen Research Institute, PO Box 1005, Addis Ababa, Ethiopia
| | - Fitsum G Tadesse
- Malaria and Neglected Tropical Diseases Directorate, Armauer Hansen Research Institute, PO Box 1005, Addis Ababa, Ethiopia.
- Department of Medical Microbiology, Radboud University Medical Center, 6525 GA, Nijmegen, The Netherlands.
- Institute of Biotechnology, Addis Ababa University, PO Box, 1176, Addis Ababa, Ethiopia.
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Dalimi A, Mosawi SH. The Comparison of Real-time-PCR-HRM and Microscopy Methods for Detection of Mixed Plasmodium spp. Infections in Laghman Province, Afghanistan. Infect Disord Drug Targets 2021; 21:399-404. [PMID: 32614757 DOI: 10.2174/1871526520666200702134555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 06/01/2020] [Accepted: 06/01/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Laghman province, in the east of Afghanistan, is one of the most malaria endemic regions with prominence of Plasmodium vivax and Plasmodium falciparum. So far, no study has been conducted to investigate the extent of mixed infections in this area. OBJECTIVE In this study, we aimed to evaluate the prevalence of mixed infections of malaria in Laghman province by using a new and highly sensitive molecular method (real-time polymerase chain reaction high resolution melting analysis) and compare its results with microscopically confirmed cases of malaria. METHODS In general, 347 infected individuals have been referred to Khalwati laboratory that is located in the center of Laghman province from May to November of 2018. Microscopic analysis was performed on prepared thick and thin blood films under ×100 lens with oil immersion. The real- time-PCR-HRM assay was performed using an ABI 7500 Fast Real-time PCR system. RESULTS In a microscopic examination, out of 347 patients referred to the Center, 267 (76.94%) cases were detected to be Plasmodium vivax, 79 (22.76%) Plasmodium falciparum and 1 (0.28%) case of mixed of two species. However, by using Real-time PCR-HRM technique, 249 (71.75%) were detected Plasmodium vivax, 79 (22.76%) were Plasmodium falciparum and 19 (5.47%) were mixed of two species. CONCLUSION Our result indicated that the Real-time PCR-HRM method is more accurate and more reliable than microscopic method in the diagnosis of malaria mixed infections.
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Affiliation(s)
- Abdolhossein Dalimi
- Department of Medical Parasitology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Sayed Hussain Mosawi
- Department of Medical Parasitology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
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Padhy SK, Sahu S, Govindahari V. Retinopathy Secondary to Uncomplicated Plasmodium vivax Malaria. Ophthalmic Surg Lasers Imaging Retina 2021; 52:50-51. [PMID: 33471916 DOI: 10.3928/23258160-20201223-10] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 11/20/2020] [Indexed: 11/20/2022]
Abstract
To report a case of bilateral malarial retinopathy secondary to uncomplicated Plasmodium vivax malaria. A 45-year-old male patient presented with sudden onset of diminution of vision both eyes and was treated for P. vivax malaria 1 week before the ocular symptoms. Dilated fundus examination revealed multiple intraretinal (dot-blot, flame shaped) hemorrhages, cotton-wool spots, and areas of retinal whitening predominantly involving the posterior pole both eyes, with features being more severe in left eye. Optical coherence tomography revealed bilateral subfoveal neurosensory detachments. Retinopathy is typically rare in the settings of P. vivax malaria, albeit commonly seen in patients with cerebral malaria (Plasmodium falciparum). [Ophthalmic Surg Lasers Imaging Retina. 2021;52:50-51.].
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Tokmalaev AK, Baranova AM, Maleev VV. [Epidemiological and clinical aspects of diagnosis, treatment and prophylaxis of imported malaria cases in Russian Federation]. TERAPEVT ARKH 2020; 92:77-81. [PMID: 33720609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 12/26/2020] [Indexed: 06/12/2023]
Abstract
Actually one of the main tasks of health workers in the field of the tropical diseases prevention (malaria) is early detection of malaria imported cases and efficacious treatment. In order to prevent the re-establishment of local malaria transmission by Anopheles mosquitoes from imported malaria cases, and fatal cases of disease there is develop and implement the Case Management Protocol of malaria diagnosis and treatment (2014, 2019) based on long-term experience of epidemiologists and clinicians, taking into account recommendations of WHO (2013, 2015). In this article the main principles of diagnosis and treatment of different malaria species Plasmodium falciparumand Plasmodium vivax-malaria, prophylaxis measures of autochthonous cases from imported cases of the word endemic region are discussed.
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Affiliation(s)
| | - A M Baranova
- Sechenov First Moscow State Medical University (Sechenov University)
| | - V V Maleev
- Central Research Institute of Epidemiology
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Iqbal J, Al-Awadhi M, Ahmad S. Decreasing trend of imported malaria cases but increasing influx of mixed P. falciparum and P. vivax infections in malaria-free Kuwait. PLoS One 2020; 15:e0243617. [PMID: 33306727 PMCID: PMC7732060 DOI: 10.1371/journal.pone.0243617] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 11/20/2020] [Indexed: 01/22/2023] Open
Abstract
Malaria still continues to be the most important parasitic disease worldwide, affecting 228 million people and causing 405,000 deaths each year. In this retrospective study during 2013 to 2018, we documented the incidence of imported malaria infection and evaluated the impact of malaria preventive measures in Kuwait, a non-endemic country. The epidemiologic and demographic data of all malaria cases was collected from the Infectious Diseases Hospital, Kuwait where all suspected cases of malaria are referred for confirmation and therapeutic intervention. The diagnosis of malaria infection was done by microscopy of Giemsa stained blood films. Selected samples were retested with BinaxNOW® Malaria rapid test and molecular assay to reconfirm the Plasmodium spp. or mixed infection. Overall, 1913 (25.9%) malaria cases were detected, 81.5% of which were among male subjects. Male subjects had higher incidence of P. vivax malaria (113; 91.1%) and mixed infection with P. falciparum and P. vivax (1245; 90.0%) compared to females who had higher rate of P. falciparum infection (52.4%). An overwhelming majority of malaria cases (1895; 99.1%) were detected among expatriates from malaria-endemic countries; India (1012; 52.9%), Pakistan (390; 20.4%), Afghanistan (94; 4.9%) and African countries (313; 16.3%). Only 18 cases involved Kuwaiti nationals, all with a history of travel to African countries. The majority of malaria cases were detected during the summer and fall months (May-October). Our data showed that the incidence rate of imported malaria cases was stable during 2013 to 2018, however, the incidence of total malaria cases showed a declining trend over the years. This study confirms that the preventive program has been successful in reducing the incidence of imported malaria infections in Kuwait. The most striking finding of this study was high incidence of mixed infection with P. falciparum and P. vivax, with almost all (97%) cases among workers from India.
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Affiliation(s)
- Jamshaid Iqbal
- Department of Microbiology, Faculty of Medicine, Kuwait University, Kuwait, Kuwait
- * E-mail:
| | - Mohammad Al-Awadhi
- Department of Microbiology, Faculty of Medicine, Kuwait University, Kuwait, Kuwait
| | - Suhail Ahmad
- Department of Microbiology, Faculty of Medicine, Kuwait University, Kuwait, Kuwait
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