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Calderaro A, Piccolo G, Chezzi C. The Laboratory Diagnosis of Malaria: A Focus on the Diagnostic Assays in Non-Endemic Areas. Int J Mol Sci 2024; 25:695. [PMID: 38255768 PMCID: PMC10815132 DOI: 10.3390/ijms25020695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 12/26/2023] [Accepted: 01/03/2024] [Indexed: 01/24/2024] Open
Abstract
Even if malaria is rare in Europe, it is a medical emergency and programs for its control should ensure both an early diagnosis and a prompt treatment within 24-48 h from the onset of the symptoms. The increasing number of imported malaria cases as well as the risk of the reintroduction of autochthonous cases encouraged laboratories in non-endemic countries to adopt diagnostic methods/algorithms. Microscopy remains the gold standard, but with limitations. Rapid diagnostic tests have greatly expanded the ability to diagnose malaria for rapid results due to simplicity and low cost, but they lack sensitivity and specificity. PCR-based assays provide more relevant information but need well-trained technicians. As reported in the World Health Organization Global Technical Strategy for Malaria 2016-2030, the development of point-of-care testing is important for the improvement of diagnosis with beneficial consequences for prompt/accurate treatment and for preventing the spread of the disease. Despite their limitations, diagnostic methods contribute to the decline of malaria mortality. Recently, evidence suggested that artificial intelligence could be utilized for assisting pathologists in malaria diagnosis.
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Affiliation(s)
- Adriana Calderaro
- Department of Medicine and Surgery, University of Parma, Viale A. Gramsci 14, 43126 Parma, Italy; (G.P.); (C.C.)
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Transfusion-Transmitted Malaria of Plasmodium malariae in Palermo, Sicily. Healthcare (Basel) 2021; 9:healthcare9111558. [PMID: 34828604 PMCID: PMC8618732 DOI: 10.3390/healthcare9111558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 11/08/2021] [Accepted: 11/11/2021] [Indexed: 11/17/2022] Open
Abstract
Transfusion-transmitted malaria (TTM) is a rare occurrence with serious consequences for the recipient. In non-endemic areas, the incidence of transmission of malaria by transfusion is very low. We report a clinical case of transfusion-transmitted malaria due to Plasmodium malariae, which happened in a patient with acute hemorrhagic gastropathy. Case presentation: In April 2019, a 70-year-old Italian man with recurrent spiking fever for four days was diagnosed with a P. malariae infection, as confirmed using microscopy and real-time PCR. The patient had never been abroad, but about two months before, he had received a red blood cell transfusion for anemia. Regarding the donor, we revealed that they were a missionary priest who often went to tropical regions. Plasmodium spp. PCR was also used on donor blood to confirm the causal link. Discussion and Conclusions: The donations of asymptomatic blood donors who are predominantly “semi-immune” with very low parasitic loads are an issue. The main problem is related to transfusion-transmitted malaria. Our case suggests that P. malariae infections in semi-immune asymptomatic donors are a threat to transfusion safety. Currently, microscopy is considered the gold standard for the diagnosis of malaria but has limited sensitivity to detect low levels of parasitemia. Screening using serological tests and molecular tests, combined with the donor’s questionnaire, should be used to reduce the cases of TTM.
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Calderaro A, Montecchini S, Buttrini M, Piccolo G, Rossi S, Arcangeletti MC, Farina B, De Conto F, Chezzi C. Malaria Diagnosis in Non-Endemic Settings: The European Experience in the Last 22 Years. Microorganisms 2021; 9:microorganisms9112265. [PMID: 34835391 PMCID: PMC8620059 DOI: 10.3390/microorganisms9112265] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 10/25/2021] [Accepted: 10/26/2021] [Indexed: 11/16/2022] Open
Abstract
Accurate, prompt, and reliable tools for the diagnosis of malaria are crucial for tracking the successes or drawbacks of control and elimination efforts, and for future programs aimed at global malaria eradication. Although microscopy remains the gold standard method, the number of imported malaria cases and the risk of reappearance of autochthonous cases stimulated several laboratories located in European countries to evaluate methods and algorithms suited to non-endemic settings, where skilled microscopists are not always available. In this review, an overview of the field evaluation and a comparison of the methods used for the diagnosis of malaria by European laboratories is reported, showing that the development of numerous innovations is continuous. In particular, the combination of rapid diagnostic tests and molecular assays with microscopy represents a reliable system for the early diagnosis of malaria in non-endemic settings.
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Affiliation(s)
- Adriana Calderaro
- Department of Medicine and Surgery, University of Parma, Viale A. Gramsci 14, 43126 Parma, Italy; (S.M.); (M.B.); (G.P.); (M.C.A.); (B.F.); (F.D.C.); (C.C.)
- Correspondence: ; Tel.: +39-0521-033499; Fax: +39-0521-993620
| | - Sara Montecchini
- Department of Medicine and Surgery, University of Parma, Viale A. Gramsci 14, 43126 Parma, Italy; (S.M.); (M.B.); (G.P.); (M.C.A.); (B.F.); (F.D.C.); (C.C.)
| | - Mirko Buttrini
- Department of Medicine and Surgery, University of Parma, Viale A. Gramsci 14, 43126 Parma, Italy; (S.M.); (M.B.); (G.P.); (M.C.A.); (B.F.); (F.D.C.); (C.C.)
| | - Giovanna Piccolo
- Department of Medicine and Surgery, University of Parma, Viale A. Gramsci 14, 43126 Parma, Italy; (S.M.); (M.B.); (G.P.); (M.C.A.); (B.F.); (F.D.C.); (C.C.)
| | - Sabina Rossi
- Unit of Clinical Microbiology, University Hospital of Parma, Viale A. Gramsci 14, 43126 Parma, Italy;
| | - Maria Cristina Arcangeletti
- Department of Medicine and Surgery, University of Parma, Viale A. Gramsci 14, 43126 Parma, Italy; (S.M.); (M.B.); (G.P.); (M.C.A.); (B.F.); (F.D.C.); (C.C.)
| | - Benedetta Farina
- Department of Medicine and Surgery, University of Parma, Viale A. Gramsci 14, 43126 Parma, Italy; (S.M.); (M.B.); (G.P.); (M.C.A.); (B.F.); (F.D.C.); (C.C.)
| | - Flora De Conto
- Department of Medicine and Surgery, University of Parma, Viale A. Gramsci 14, 43126 Parma, Italy; (S.M.); (M.B.); (G.P.); (M.C.A.); (B.F.); (F.D.C.); (C.C.)
| | - Carlo Chezzi
- Department of Medicine and Surgery, University of Parma, Viale A. Gramsci 14, 43126 Parma, Italy; (S.M.); (M.B.); (G.P.); (M.C.A.); (B.F.); (F.D.C.); (C.C.)
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Kotepui M, Kotepui KU, Milanez GD, Masangkay FR. Prevalence and proportion of Plasmodium spp. triple mixed infections compared with double mixed infections: a systematic review and meta-analysis. Malar J 2020; 19:224. [PMID: 32580721 PMCID: PMC7315477 DOI: 10.1186/s12936-020-03292-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 06/17/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Although mixed infection by two Plasmodium species has been recognized, mixed infection by three different Plasmodium species within one individual has not been clarified. This study sought to determine the pooled prevalence and proportion of triple mixed Plasmodium spp. infection compared with double mixed infection. METHODS Articles from PubMed, Scopus, and Web of Science were searched for cross-sectional studies of triple mixed infection by Plasmodium species and then were retrieved and extracted. The pooled proportion and prevalence of triple mixed infection by Plasmodium species were subjected to random-effects analysis. The secondary outcomes were differences in the pooled proportion between triple mixed infection and double mixed infection by Plasmodium species reported in the included studies. RESULTS Of 5621 identified studies, triple mixed infection data were available for 35 records, including 601 patients from 22 countries. The overall pooled prevalence of triple mixed infection was 4% (95% Confidence Interval (CI) 3-5%; I2 = 92.5%). The pooled proportion of triple mixed infection compared with double mixed infection was 12% (95% CI 9-18; I2 = 91%). Most of the included studies (29/35; 82.9%) presented a lower proportion of triple mixed infection than double mixed infection. Subgroup analysis demonstrated that the proportion of triple mixed infection was the highest in Oceania (23%; 95% CI 15-36%) and Europe (21%; 95% CI 5-86%), but the lowest in the USA (3%; 95% CI 2-4%). Moreover, the proportion of triple mixed infection was higher in residents (20%; 95% CI 14-29%) than in febrile patients (7%; 95% CI 4-13%), when compared with the proportion of double mixed infection. Subgroup analysis of the age groups demonstrated that, compared with the proportion of double mixed infection, triple mixed infection was lower in patients aged ≤ 5 years (OR = 0.27; 95% CI 0.13-0.56; I2 = 31%) and > 5 years (OR = 0.09; 95% CI 0.04-0.25, I2 = 78%). CONCLUSIONS The present study suggested that, in areas where triple mixed infection were endemic, PCR or molecular diagnosis for all residents in communities where malaria is submicroscopic can provide prevalence data and intervention measures, as well as prevent disease transmission and enhance malaria elimination efforts.
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Affiliation(s)
- Manas Kotepui
- Medical Technology, School of Allied Health Sciences, Walailak University, Tha Sala, Nakhon Si Thammarat, Thailand.
| | - Kwuntida Uthaisar Kotepui
- Medical Technology, School of Allied Health Sciences, Walailak University, Tha Sala, Nakhon Si Thammarat, Thailand
| | - Giovanni D Milanez
- Department of Medical Technology, Far Eastern University-Manila, Manila, Philippines
| | - Frederick R Masangkay
- Department of Medical Technology, Far Eastern University-Manila, Manila, Philippines
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Brashear AM, Roobsoong W, Siddiqui FA, Nguitragool W, Sattabongkot J, López-Uribe MM, Miao J, Cui L. A glance of the blood stage transcriptome of a Southeast Asian Plasmodium ovale isolate. PLoS Negl Trop Dis 2019; 13:e0007850. [PMID: 31730621 PMCID: PMC6881071 DOI: 10.1371/journal.pntd.0007850] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 11/27/2019] [Accepted: 10/16/2019] [Indexed: 11/24/2022] Open
Abstract
Plasmodium ovale accounts for a disproportionate number of travel-related malaria cases. This parasite is understudied since there is a reliance on clinical samples. We collected a P. ovale curtisi parasite isolate from a clinical case in western Thailand and performed RNA-seq analysis on the blood stage transcriptomes. Using both de novo assembly and alignment-based methods, we detected the transcripts for 6628 out of 7280 annotated genes. For those lacking evidence of expression, the vast majority belonged to the PIR and STP1 gene families. We identified new splicing patterns for over 2500 genes, and mapped at least one untranslated region for over half of all annotated genes. Our analysis also detected a notable presence of anti-sense transcripts for over 10% of P. ovale curtisi genes. This transcriptomic analysis provides new insights into the blood-stage biology of this neglected parasite.
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Affiliation(s)
- Awtum M. Brashear
- Department of Entomology, Pennsylvania State University, Department of Entomology, University Park, Pennsylvania, United States of America
- Department of Internal Medicine, University of South Florida, Tampa, Florida, United States of America
| | - Wanlapa Roobsoong
- Mahidol Vivax Research Unit, Faculty of Tropical Medicine, Mahidol University, Thailand
| | - Faiza A. Siddiqui
- Department of Internal Medicine, University of South Florida, Tampa, Florida, United States of America
| | - Wang Nguitragool
- Department of Molecular Tropical Medicine and Genetics, Faculty of Tropical Medicine, Mahidol University, Thailand
| | - Jetsumon Sattabongkot
- Mahidol Vivax Research Unit, Faculty of Tropical Medicine, Mahidol University, Thailand
| | - Margarita M. López-Uribe
- Department of Entomology, Pennsylvania State University, Department of Entomology, University Park, Pennsylvania, United States of America
| | - Jun Miao
- Department of Internal Medicine, University of South Florida, Tampa, Florida, United States of America
| | - Liwang Cui
- Department of Entomology, Pennsylvania State University, Department of Entomology, University Park, Pennsylvania, United States of America
- Department of Internal Medicine, University of South Florida, Tampa, Florida, United States of America
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Kamaliddin C, Le Bouar M, Berry A, Fenneteau O, Gillet P, Godineau N, Candolfi E, Houzé S. Assessment of diagnostic methods for imported malaria in mainland France. Med Mal Infect 2019; 50:141-160. [PMID: 31375372 DOI: 10.1016/j.medmal.2019.07.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 07/04/2019] [Indexed: 12/29/2022]
Affiliation(s)
- C Kamaliddin
- Centre national de référence du paludisme, hôpital Bichat, 75018 Paris, France
| | - M Le Bouar
- Service de parasitologie-mycologie, CHU de Toulouse, 31300 Toulouse, France
| | - A Berry
- Service de parasitologie-mycologie, CHU de Toulouse, 31300 Toulouse, France
| | - O Fenneteau
- Service d'hématologie biologique, CHU Robert-Debré, AP-HP, 75018 Paris, France
| | - P Gillet
- Department of clinical sciences, institute of tropical medicine, 2000 Anvers, Belgium
| | - N Godineau
- Service de parasitologie, centre hospitalier Delafontaine, 93200 Saint-Denis, France
| | - E Candolfi
- Laboratoire de parasitologie, institut de parasitologie et de pathologie tropicale, hôpitaux civils de Strasbourg, CHU, 67000 Strasbourg, France
| | - S Houzé
- Centre national de référence du paludisme, hôpital Bichat, 75018 Paris, France; Service de parasitologie, hôpital Bichat, AP-HP, 75018 Paris, France.
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7
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Calderaro A, Piccolo G, Montecchini S, Buttrini M, Rossi S, Dell'Anna ML, De Remigis V, Arcangeletti MC, Chezzi C, De Conto F. High prevalence of malaria in a non-endemic setting: comparison of diagnostic tools and patient outcome during a four-year survey (2013-2017). Malar J 2018; 17:63. [PMID: 29402283 PMCID: PMC5800101 DOI: 10.1186/s12936-018-2218-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Accepted: 01/30/2018] [Indexed: 11/18/2022] Open
Abstract
Background Malaria is no longer endemic in Italy since 1970 when the World Health Organization declared Italy malaria-free, but it is now the most commonly imported disease. The aim of the study was to analyse the trend of imported malaria cases in Parma, Italy, during January 2013–June 2017, reporting also the treatment and the outcome of cases, exploring the comparison of the three diagnostic tests used for malaria diagnosis: microscopy, immunochromatographic assay (ICT) (BinaxNOW®) and Real-time PCR assays detecting Plasmodium falciparum, Plasmodium vivax, Plasmodium malariae, Plasmodium ovale curtisi, Plasmodium ovale wallikeri, and Plasmodium knowlesi. Results Of the 288 patients with suspected malaria, 87 were positive by microscopy: 73 P. falciparum, 2 P. vivax, 8 P. ovale, 1 P. vivax/P. ovale, 1 P. malariae and 2 Plasmodium sp. All samples were positive by ICT except 6. Plasmodial DNA was revealed in the 87 cases and in 2 additional cases showing P. falciparum-specific bands by ICT, as follows: 75 P. falciparum, 2 P. vivax, 6 P. ovale curtisi, 3 P. ovale wallikeri, 1 P. malariae, and 2 mixed infections. 72 patients were foreigners and 17 Italians travelling for tourism or business. The majority of these patients presented with fever at blood collection and did not have chemoprophylaxis. No fatal cases were observed and the drug mostly used was quinine observing a negative blood smear or a parasitaemia < 0.001% after 48–72 h’ therapy. Conclusions The study shows an update and a thorough analysis of imported malaria cases in the area of Parma during 4.5 years from the point of view of the total case management, clinical and diagnostic. The prevalence of malaria in such area in the considered period was especially due to immigrants mostly from Africa. Molecular methods were more sensitive and specific than microscopy and ICT, both detecting additional cases of P. falciparum malaria missed by microscopy and correctly identifying the Plasmodium species of medical interest. The data reported in this study may stimulate the clinicians in non-endemic areas to suspect malaria also in cases, where the most typical symptoms are absent, and the parasitologists to confirm the results of microscopy, remaining the reference method, with molecular methods to avoid misdiagnosis.
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Affiliation(s)
- Adriana Calderaro
- Department of Medicine and Surgery, University of Parma, Viale A. Gramsci, 14, 43126, Parma, Italy.
| | - Giovanna Piccolo
- Department of Medicine and Surgery, University of Parma, Viale A. Gramsci, 14, 43126, Parma, Italy
| | - Sara Montecchini
- Department of Medicine and Surgery, University of Parma, Viale A. Gramsci, 14, 43126, Parma, Italy
| | - Mirko Buttrini
- Department of Medicine and Surgery, University of Parma, Viale A. Gramsci, 14, 43126, Parma, Italy
| | - Sabina Rossi
- Department of Medicine and Surgery, University of Parma, Viale A. Gramsci, 14, 43126, Parma, Italy
| | - Maria Loretana Dell'Anna
- Department of Medicine and Surgery, University of Parma, Viale A. Gramsci, 14, 43126, Parma, Italy
| | - Valeria De Remigis
- Department of Medicine and Surgery, University of Parma, Viale A. Gramsci, 14, 43126, Parma, Italy
| | | | - Carlo Chezzi
- Department of Medicine and Surgery, University of Parma, Viale A. Gramsci, 14, 43126, Parma, Italy
| | - Flora De Conto
- Department of Medicine and Surgery, University of Parma, Viale A. Gramsci, 14, 43126, Parma, Italy
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Akerele D, Ljolje D, Talundzic E, Udhayakumar V, Lucchi NW. Molecular diagnosis of Plasmodium ovale by photo-induced electron transfer fluorogenic primers: PET-PCR. PLoS One 2017. [PMID: 28640824 PMCID: PMC5480860 DOI: 10.1371/journal.pone.0179178] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Accurate diagnosis of malaria infections continues to be challenging and elusive, especially in the detection of submicroscopic infections. Developing new malaria diagnostic tools that are sensitive enough to detect low-level infections, user friendly, cost effective and capable of performing large scale diagnosis, remains critical. We have designed novel self-quenching photo-induced electron transfer (PET) fluorogenic primers for the detection of P. ovale by real-time PCR. In our study, a total of 173 clinical samples, consisting of different malaria species, were utilized to test this novel PET-PCR primer. The sensitivity and specificity were calculated using nested-PCR as the reference test. The novel primer set demonstrated a sensitivity of 97.5% and a specificity of 99.2% (95% CI 85.2–99.8% and 95.2–99.9% respectively). Furthermore, the limit of detection for P. ovale was found to be 1 parasite/μl. The PET-PCR assay is a new molecular diagnostic tool with comparable performance to other commonly used PCR methods. It is relatively easy to perform, and amiable to large scale malaria surveillance studies and malaria control and elimination programs. Further field validation of this novel primer will be helpful to ascertain the utility for large scale malaria screening programs.
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Affiliation(s)
- David Akerele
- Division of Pediatric Infectious Diseases, Emory Medical Center, Atlanta, Georgia, United States of America
| | - Dragan Ljolje
- Atlanta Research and Education Foundation, Decatur, Georgia, United States of America
| | - Eldin Talundzic
- Atlanta Research and Education Foundation, Decatur, Georgia, United States of America
| | - Venkatachalam Udhayakumar
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Naomi W. Lucchi
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- * E-mail:
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Rojo-Marcos G, Rubio-Muñoz JM, Ramírez-Olivencia G, García-Bujalance S, Elcuaz-Romano R, Díaz-Menéndez M, Calderón M, García-Bermejo I, Ruiz-Giardín JM, Merino-Fernández FJ, Torrús-Tendero D, Delgado-Iribarren A, Ribell-Bachs M, Arévalo-Serrano J, Cuadros-González J. Comparison of imported Plasmodium ovale curtisi and P. ovale wallikeri infections among patients in Spain, 2005-2011. Emerg Infect Dis 2015; 20:409-16. [PMID: 24572501 PMCID: PMC3944870 DOI: 10.3201/eid2003.130745] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Sequencing data from Plasmodium ovale genotypes co-circulating in multiple countries support the hypothesis that P. ovale curtisi and P. ovale wallikeri are 2 separate species. We conducted a multicenter, retrospective, comparative study in Spain of 21 patients who had imported P. ovale curtisi infections and 14 who had imported P. ovale wallikeri infections confirmed by PCR and gene sequencing during June 2005–December 2011. The only significant finding was more severe thrombocytopenia among patients with P. ovale wallikeri infection than among those with P. ovale curtisi infection (p = 0.031). However, we also found nonsignificant trends showing that patients with P. ovale wallikeri infection had shorter time from arrival in Spain to onset of symptoms, lower level of albumin, higher median maximum core temperature, and more markers of hemolysis than did those with P. ovale curtisi infection. Larger, prospective studies are needed to confirm these findings.
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Cheng Q, Cunningham J, Gatton ML. Systematic review of sub-microscopic P. vivax infections: prevalence and determining factors. PLoS Negl Trop Dis 2015; 9:e3413. [PMID: 25569135 PMCID: PMC4288718 DOI: 10.1371/journal.pntd.0003413] [Citation(s) in RCA: 104] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 11/12/2014] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Sub-microscopic (SM) Plasmodium infections represent transmission reservoirs that could jeopardise malaria elimination goals. A better understanding of the epidemiology of these infections and factors contributing to their occurrence will inform effective elimination strategies. While the epidemiology of SM P. falciparum infections has been documented, that of SM P. vivax infections has not been summarised. The objective of this study is to address this deficiency. METHODOLOGY/PRINCIPAL FINDINGS A systematic search of PubMed was conducted, and results of both light microscopy (LM) and polymerase chain reaction (PCR)-based diagnostic tests for P. vivax from 44 cross-sectional surveys or screening studies of clinical malaria suspects were analysed. Analysis revealed that SM P. vivax is prevalent across different geographic areas with varying transmission intensities. On average, the prevalence of SM P. vivax in cross-sectional surveys was 10.9%, constituting 67.0% of all P. vivax infections detected by PCR. The relative proportion of SM P. vivax is significantly higher than that of the sympatric P. falciparum in these settings. A positive relationship exists between PCR and LM P. vivax prevalence, while there is a negative relationship between the proportion of SM P. vivax and the LM prevalence for P. vivax. Amongst clinical malaria suspects, however, SM P. vivax was not identified. CONCLUSIONS/SIGNIFICANCE SM P. vivax is prevalent across different geographic areas, particularly areas with relatively low transmission intensity. Diagnostic tools with sensitivity greater than that of LM are required for detecting these infection reservoirs. In contrast, SM P. vivax is not prevalent in clinical malaria suspects, supporting the recommended use of quality LM and rapid diagnostic tests in clinical case management. These findings enable malaria control and elimination programs to estimate the prevalence and proportion of SM P. vivax infections in their settings, and develop appropriate elimination strategies to tackle SM P. vivax to interrupt transmission.
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Affiliation(s)
- Qin Cheng
- Drug Resistance and Diagnostics, Australian Army Malaria Institute, Enoggera, Brisbane, Australia
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
- * E-mail:
| | - Jane Cunningham
- Global Malaria Program, World Health Organization, Geneva, Switzerland
| | - Michelle L. Gatton
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
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Dakić Z, Ivović V, Pavlović M, Lavadinović L, Marković M, Djurković-Djaković O. Clinical significance of molecular methods in the diagnosis of imported malaria in returning travelers in Serbia. Int J Infect Dis 2014; 29:24-30. [PMID: 25312981 DOI: 10.1016/j.ijid.2014.08.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Revised: 08/18/2014] [Accepted: 08/20/2014] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES The goal of this study was to assess the clinical significance of conventional and PCR-based molecular diagnosis in patients with imported malaria in Serbia. METHODS Giemsa microscopy, the rapid diagnostic test, and quantitative real-time PCR (qPCR) were used to detect Plasmodium species in 109 whole-blood samples from patients after their return from malaria endemic areas, including those clinically suspected for malaria (n=97) and healthy travelers (n=12) examined as part of epidemiological surveillance. RESULTS A total of 45 patients were diagnosed with malaria: 42 (93.3%) by microscopy and three (6.7%) additional ones by qPCR. The agreement between the results of species-specific qPCR and microscopy was 73.3%; it was as high as 90.6% for Plasmodium falciparum infections. Follow-up analysis demonstrated persistence of Plasmodium sp DNA for a mean 6 days after the disappearance of parasitemia on microscopy. CONCLUSIONS Due to its sensitivity and specificity, qPCR is a helpful method complementary to microscopy, particularly in cases of low parasitemia. In addition, it is superior to microscopy for species identification.
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Affiliation(s)
- Zorica Dakić
- Department of Microbiology, Clinical Center of Serbia, Belgrade, Serbia
| | - Vladimir Ivović
- Center for Parasitic Zoonoses, Institute for Medical Research, University of Belgrade, Belgrade, Serbia
| | - Milorad Pavlović
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia; Clinic for Infectious and Tropical Diseases, Clinical Center of Serbia, Belgrade, Serbia
| | - Lidija Lavadinović
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia; Clinic for Infectious and Tropical Diseases, Clinical Center of Serbia, Belgrade, Serbia
| | - Marija Marković
- Center for Parasitic Zoonoses, Institute for Medical Research, University of Belgrade, Belgrade, Serbia
| | - Olgica Djurković-Djaković
- Center for Parasitic Zoonoses, Institute for Medical Research, University of Belgrade, Belgrade, Serbia.
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12
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Larréché S, Rapp C, Delacour H, Sanmartin N, Ficko C, Bigaillon C, Andriamanantena D, Pilo JE, Mérens A. Sensitivity of parasitological tests in imported Plasmodium vivax malaria in adults and impact of chemoprophylaxis and attack type. J Travel Med 2014; 21:195-200. [PMID: 24629014 DOI: 10.1111/jtm.12116] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Revised: 10/22/2013] [Accepted: 11/12/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Plasmodium vivax is the second most common species among cases of imported malaria diagnosed in Europe. The objective of this study is to describe the sensitivity of the parasitological tests in imported P. vivax malaria, and the impact of chemoprophylaxis and attack type (primary infection or relapse). METHODS A retrospective study included the imported vivax malaria cases admitted in a French military hospital between 2001 and 2013. The reference diagnosis method was microscopy corrected by polymerase chain reaction (PCR). Thin and thick blood films examination, quantitative buffy coat (QBC) test, and a rapid diagnostic test (RDT) had been systematically performed. PCR had been carried out for ambiguous profiles. RESULTS Eighty-nine cases recorded from 78 patients were included, 65 of them having recently traveled to French Guyana. Forty-two patients had properly followed chemoprophylaxis. Forty-six cases were primary infections while 43 were relapses. The sensitivity was 91% for the thin blood smear, 96% for the concentration techniques (Giemsa thick blood smear and QBC test), and 76% for the RDT. The combination of the three conventional tools has an imperfect sensitivity, both for the positive diagnosis of malaria (96%) and for the diagnosis of vivax species (80%). In 4% of the cases, the positive diagnosis was established only by the PCR. The species identification was established in 20% by the PCR. The sensibility of thin blood smear and of RDT decreased significantly with full compliance of chemoprophylaxis or primary infection, whereas the decrease of sensibility of concentration techniques was not significant. CONCLUSIONS This study illustrates the difficulties encountered in vivax malaria diagnosis, especially in patients who properly followed chemoprophylaxis or with primary infection due to a lower parasitemia. It underlines the lack of sensitivity of RDT for P. vivax and emphasizes the need for systematically combining various diagnosis methods.
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de Laval F, Simon F, Bogreau H, Rapp C, Wurtz N, Oliver M, Demaison X, Dia A, De Pina JJ, Merens A, Migliani R. Emergence of Plasmodium ovale malaria among the French Armed Forces in the Republic of Ivory Coast: 20 years of clinical and biological experience. Clin Infect Dis 2014; 58:e122-8. [PMID: 24429426 DOI: 10.1093/cid/ciu021] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND French military surveillance identified an increase in Plasmodium ovale attacks among soldiers in Ivory Coast. This emergence and the low sensitivity of biological tests raise the question of a possible role of P. ovale variant species. METHODS Epidemiological data about P. ovale attacks from 1993 to 2012 were studied; the species diagnosis was based on a thin blood smear and/or a quick diagnostic test. Clinical and biological features in soldiers hospitalized in 2 French military hospitals were also reviewed. Malaria polymerase chain reaction followed by genotyping was performed when available. RESULTS French military physicians declared 328 P. ovale attacks over the 20-year study. A peak of incidence occurred in 2005. Among patients with positive blood smears, the quick diagnostic test was positive in 33 of 101 tests performed. The hospital study showed that symptoms and biological changes were not specific, which made diagnosis challenging: fever, anemia, and thrombocytopenia were not present in 20%, 71%, and 23% of the 45 confirmed cases, respectively. It was possible to perform molecular investigations on 19 clinical isolates: 18 were classic haplotypes with additional polymorphism and 1 was variant. CONCLUSIONS This emergence of P. ovale malaria enabled a good description to be made in nonimmune patients. The lack of sensitivity of both clinical features and quick diagnostic tests suggests an underestimation. Reasons for this outbreak are especially intense exposure to the vectors and the insufficient efficacy of doxycycline against P. ovale. The polymorphism of classic haplotypes of P. ovale rather than variant forms could be involved.
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Affiliation(s)
- F de Laval
- French Army Center for Epidemiology and Public Health
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Calderaro A, Piccolo G, Gorrini C, Rossi S, Montecchini S, Dell'Anna ML, De Conto F, Medici MC, Chezzi C, Arcangeletti MC. Accurate identification of the six human Plasmodium spp. causing imported malaria, including Plasmodium ovale wallikeri and Plasmodium knowlesi. Malar J 2013; 12:321. [PMID: 24034175 PMCID: PMC3847200 DOI: 10.1186/1475-2875-12-321] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Accepted: 09/09/2013] [Indexed: 11/20/2022] Open
Abstract
Background Accurate identification of Plasmodium infections in non-endemic countries is of critical importance with regard to the administration of a targeted therapy having a positive impact on patient health and management and allowing the prevention of the risk of re-introduction of endemic malaria in such countries. Malaria is no longer endemic in Italy where it is the most commonly imported disease, with one of the highest rates of imported malaria among European non-endemic countries including France, the UK and Germany, and with a prevalence of 24.3% at the University Hospital of Parma. Molecular methods showed high sensitivity and specificity and changed the epidemiology of imported malaria in several non-endemic countries, highlighted a higher prevalence of Plasmodium ovale, Plasmodium vivax and Plasmodium malariae underestimated by microscopy and, not least, brought to light both the existence of two species of P. ovale (Plasmodium ovale curtisi and Plasmodium ovale wallikeri) and the infection in humans by Plasmodium knowlesi, otherwise not detectable by microscopy. Methods In this retrospective study an evaluation of two real-time PCR assays able to identify P. ovale wallikeri, distinguishing it from P. ovale curtisi, and to detect P. knowlesi, respectively, was performed applying them on a subset of 398 blood samples belonging to patients with the clinical suspicion of malaria. Results These assays revealed an excellent analytical sensitivity and no cross-reactivity versus other Plasmodium spp. infecting humans, suggesting their usefulness for an accurate and complete diagnosis of imported malaria. Among the 128 patients with malaria, eight P. ovale curtisi and four P. ovale wallikeri infections were detected, while no cases of P. knowlesi infection were observed. Discussion and conclusions Real-time PCR assays specific for P. ovale wallikeri and P. knowlesi were included in the panel currently used in the University Hospital of Parma for the diagnosis of imported malaria, accomplishing the goal of adhering to the recommendations of the World Health Organization to countries that are malaria-free to include the improvement of the early diagnosis of all cases of imported malaria.
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Affiliation(s)
- Adriana Calderaro
- Unit of Microbiology and Virology, Department of Clinical and Experimental Medicine, Faculty of Medicine and Surgery, University of Parma, Viale A, Gramsci 14, Parma, Italy.
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Afra K, Laupland K, Leal J, Lloyd T, Gregson D. Incidence, risk factors, and outcomes of Fusobacterium species bacteremia. BMC Infect Dis 2013; 14:264. [PMID: 24886502 PMCID: PMC4029911 DOI: 10.1186/1471-2334-14-264] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 05/07/2014] [Indexed: 01/06/2023] Open
Abstract
Background The aim of this study was to assess the epidemiology of intestinal parasitoses during a 5-year period in patients attending a tertiary-care hospital in a non-endemic setting. Methods In the period 2006–2010, 15,752 samples from 8,886 patients with clinically suspected parasitosis were subjected to macroscopic and microscopic examination, to parasitic antigen detection assays, and to cultures for protozoa and nematodes. Real-time PCR assays for the differentiation of Entamoeba histolytica and E. dispar and for the detection of Dientamoeba fragilis were also used. A statistical analysis evaluating the demographic data of the patients with intestinal parasitic infections was performed. Results Intestinal parasitic infections were diagnosed in 1,477 patients (16.6% prevalence), mainly adults and immigrants from endemic areas for faecal-oral infections; protozoa were detected in 93.4% and helminths in 6.6% of the cases, the latter especially in immigrants. Blastocystis hominis was the most common intestinal protozoan, and G. intestinalis was the most frequently detected among pathogenic protozoa, prevalent in immigrants, males, and pediatric patients. Both single (77.9%) and mixed (22.1%) parasitic infections were observed, the latter prevalent in immigrants. Conclusions Despite the importance of the knowledge about the epidemiology of intestinal parasitoses in order to adopt appropriate control measures and adequate patient care all over the world, data regarding industrialized countries are rarely reported in the literature. The data presented in this study indicate that intestinal parasitic infections are frequently diagnosed in our laboratory and could make a contribution to stimulate the attention by physicians working in non-endemic areas on the importance of suspecting intestinal parasitoses.
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Calderaro A, Piccolo G, Gorrini C, Montecchini S, Rossi S, Medici MC, Chezzi C, Snounou G. A new real-time PCR for the detection of Plasmodium ovale wallikeri. PLoS One 2012; 7:e48033. [PMID: 23110165 PMCID: PMC3480495 DOI: 10.1371/journal.pone.0048033] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Accepted: 09/20/2012] [Indexed: 12/01/2022] Open
Abstract
It has been proposed that ovale malaria in humans is caused by two closely related but distinct species of malaria parasites: P. ovale curtisi and P. ovale wallikeri. We have extended and optimized a Real-time PCR assay targeting the parasite’s small subunit ribosomal RNA (ssrRNA) gene to detect both these species. When the assay was applied to 31 archival blood samples from patients diagnosed with P. ovale, it was found that the infection in 20 was due to P. ovale curtisi and in the remaining 11 to P. ovale wallikeri. Thus, this assay provides a useful tool that can be applied to epidemiological investigations of the two newly recognized distinct P. ovale species, that might reveal if these species also differ in their clinical manifestation, drugs susceptibility and relapse periodicity. The results presented confirm that P. ovale wallikeri is not confined to Southeast Asia, since the majority of the patients analyzed in this study had acquired their P. ovale infection in African countries, mostly situated in West Africa.
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Affiliation(s)
- Adriana Calderaro
- Department of Pathology and Laboratory Medicine, Section of Microbiology, University of Parma, Parma, Italy.
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Neghina R, Neghina AM, Marincu I, Iacobiciu I. International travel increase and malaria importation in Romania, 2008-2009. Vector Borne Zoonotic Dis 2011; 11:1285-8. [PMID: 21548762 DOI: 10.1089/vbz.2010.0275] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES This report aims to assess the epidemiological characteristics of imported malaria in Romania in the context of international travel increase, and to compare them with the data reported by other European countries. METHODS Data on malaria cases were provided by the National Centre for Surveillance and Control of the Communicable Disease, whereas the data regarding international travels to and from Romania were retrieved from the Romanian Statistical Yearbook. RESULTS The number of Romanian citizens who traveled to Africa in 2007 increased by over 600% as compared to the previous year. During the years 2008-2009, 25 cases of imported malaria were registered in Romania, with no fatalities. All patients were male and most of them (84%) acquired the infection in Africa. Plasmodium falciparum was involved in 68% of cases. The majority of the affected patients (41%) were aged 31 to 40 years. Labor was the main reason for traveling (72%), and 92% of cases took either partial or no chemoprophylaxis. CONCLUSION The continuous growth of professional and leisure voyages to malaria-endemic regions may lead to a dramatic increase of imported cases, especially if prophylactic measures are not strictly followed.
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Affiliation(s)
- Raul Neghina
- Department of Parasitology, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania.
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Marangi M, Di Tullio R, Mens PF, Martinelli D, Fazio V, Angarano G, Schallig HD, Giangaspero A, Scotto G. Prevalence of Plasmodium spp. in malaria asymptomatic African migrants assessed by nucleic acid sequence based amplification. Malar J 2009; 8:12. [PMID: 19138412 PMCID: PMC2634767 DOI: 10.1186/1475-2875-8-12] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2008] [Accepted: 01/12/2009] [Indexed: 12/04/2022] Open
Abstract
Background Malaria is one of the most important infectious diseases in the world. Although most cases are found distributed in the tropical regions of Africa, Asia, Central and South Americas, there is in Europe a significant increase in the number of imported cases in non-endemic countries, in particular due to the higher mobility in today's society. Methods The prevalence of a possible asymptomatic infection with Plasmodium species was assessed using Nucleic Acid Sequence Based Amplification (NASBA) assays on clinical samples collected from 195 study cases with no clinical signs related to malaria and coming from sub-Saharan African regions to Southern Italy. In addition, base-line demographic, clinical and socio-economic information was collected from study participants who also underwent a full clinical examination. Results Sixty-two study subjects (31.8%) were found positive for Plasmodium using a pan Plasmodium specific NASBA which can detect all four Plasmodium species causing human disease, based on the small subunit 18S rRNA gene (18S NASBA). Twenty-four samples (38%) of the 62 18S NASBA positive study cases were found positive with a Pfs25 mRNA NASBA, which is specific for the detection of gametocytes of Plasmodium falciparum. A statistically significant association was observed between 18S NASBA positivity and splenomegaly, hepatomegaly and leukopaenia and country of origin. Conclusion This study showed that a substantial proportion of people originating from malaria endemic countries harbor malaria parasites in their blood. If transmission conditions are available, they could potentially be a reservoir. Thefore, health authorities should pay special attention to the health of this potential risk group and aim to improve their health conditions.
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