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Velavan TP, Fleischmann WA, Kremsner PG. A severe case of Plasmodium falciparum malaria in a traveler returning from Kazakhstan, a malaria-free country. Int J Infect Dis 2024; 143:107026. [PMID: 38583823 DOI: 10.1016/j.ijid.2024.107026] [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: 02/22/2024] [Revised: 03/20/2024] [Accepted: 03/25/2024] [Indexed: 04/09/2024] Open
Abstract
Following a 2-week trip to Kazakhstan, a 42-year-old woman presented at the emergency department in Germany with fever, headache, nausea, and neurological symptoms. An infection with Plasmodium falciparum was rapidly diagnosed. The patient was immediately treated with intravenous artesunate and transferred to an intensive care unit. The initial parasite density was as high as 30% infected erythrocytes with 845,880 parasites/µL. Since Kazakhstan was declared malaria-free in 2012, molecular testing for Plasmodium has been initiated to identify a possible origin. Genotyping of the msp-1 gene and microsatellite markers showed that the parasites are of African origin, with two different alleles indicating a polyclonal infection. After a hospitalization of 10 days, the patient was discharged in good health. Overall, our results emphasize that malaria must be on the list of differential diagnoses for patients with fever of unknown origin, even if they come from countries where malaria does not commonly occur.
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Affiliation(s)
- Thirumalaisamy P Velavan
- Institute for Tropical Medicine, University of Tübingen, Tübingen, Germany; Vietnamese-German Center for Medical Research, VG-CARE, Hanoi, Vietnam; Faculty of Medicine, Duy Tan University, Da Nang, Vietnam.
| | - Wim A Fleischmann
- Institute for Tropical Medicine, University of Tübingen, Tübingen, Germany
| | - Peter G Kremsner
- Institute for Tropical Medicine, University of Tübingen, Tübingen, Germany; Centre de Recherches Médicales de Lambaréné, Lambarene, Gabon
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2
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Küpper-Tetzel CP, Idris R, Kessel J, Schüttfort G, Hoehl S, Kohmer N, Graf C, Hogardt M, Besier S, Wichelhaus TA, Vehreschild MJGT, Stephan C, Wetzstein N. Coinfections and antimicrobial treatment in a cohort of falciparum malaria in a non-endemic country: a 10-year experience. Infection 2024; 52:461-469. [PMID: 37889376 PMCID: PMC10954839 DOI: 10.1007/s15010-023-02103-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 09/27/2023] [Indexed: 10/28/2023]
Abstract
INTRODUCTION Falciparum malaria remains one of the deadliest infectious diseases worldwide. In Germany, it is mainly an imported infection among travellers. Rates of coinfection are often unknown, and a clinical rationale for the beneficial use of calculated antibiotic therapy in patients with malaria and suspected coinfection is lacking. METHODS We conducted an analysis of all in-patients treated with falciparum malaria at a German infectious diseases centre in vicinity to one of Europe's major airports for 2010-2019. Logistic regression and time-to-event analysis were used to evaluate predictors for bacterial coinfection, the use of antibacterial substances, as well as their influence on clinical course. RESULTS In total, 264 patients were included. Of those, 64% received an additional antibacterial therapy (n = 169). Twenty-nine patients (11.0%) were found to have suffered from a relevant bacterial coinfection, while only a small fraction had relevant bacteremia (n = 3, 1.4%). However, patients with severe malaria did not suffer from coinfections more frequently (p = 0.283). CRP levels were not a reliable predictor for a bacterial coinfection (OR 0.99, 95% CI 0.94-1.06, p = 0.850), while another clinical focus of infection was positively associated (OR 3.86, 95% CI 1.45-11.55, p = 0.010). CONCLUSION Although bacterial coinfections were rare in patients with malaria at our centre, the risk does not seem negligible. These data point rather towards individual risk assessment in respective patients than to general empiric antibiotic use.
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Affiliation(s)
- Claus P Küpper-Tetzel
- Department of Internal Medicine, Infectious Diseases, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Raja Idris
- Department of Internal Medicine, Infectious Diseases, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Johanna Kessel
- Department of Internal Medicine, Infectious Diseases, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Gundolf Schüttfort
- Department of Internal Medicine, Infectious Diseases, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Sebastian Hoehl
- Institute of Medical Virology, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Niko Kohmer
- Institute of Medical Virology, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Christiana Graf
- Institute of Medical Virology, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
- Department of Internal Medicine, Gastroenterology and Hepatology, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Michael Hogardt
- Institute of Medical Microbiology and Infection Control, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Silke Besier
- Institute of Medical Microbiology and Infection Control, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Thomas A Wichelhaus
- Institute of Medical Microbiology and Infection Control, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Maria J G T Vehreschild
- Department of Internal Medicine, Infectious Diseases, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Christoph Stephan
- Department of Internal Medicine, Infectious Diseases, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Nils Wetzstein
- Department of Internal Medicine, Infectious Diseases, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany.
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T R, C D, A R, Jc Y. Nine years of imported malaria in a teaching hospital in Belgium: Demographics, clinical characteristics, and outcomes. Diagn Microbiol Infect Dis 2024; 108:116206. [PMID: 38335879 DOI: 10.1016/j.diagmicrobio.2024.116206] [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: 07/27/2023] [Revised: 10/06/2023] [Accepted: 01/30/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND Imported malaria is often misdiagnosed due to the aspecific symptoms and lack of familiarity among clinicians. This study aims to evaluate a decade-long trend of imported malaria cases in a Belgian teaching hospital by analyzing demographics, clinical characteristics, and outcomes. METHODS Medical records of 223 patients with confirmed malaria diagnoses between 2010 and 2019 were analyzed. RESULTS Most patients were male (63.2%), aged 18-65 years (77.1%), and visiting friends or relatives (40.8%). Central Africa was the most common travel destination (54.3%), and 63.7% did not take prophylaxis. Symptoms were flu-like, with fever (91.9%) being most prevalent. P. falciparum was identified in 88.3% of cases. A high proportion of severe cases (41.7%) and a low mortality rate (0.9%) were recorded. A severe form of the disease is associated with a more extended hospital stay than uncomplicated form (median of 5 vs. 4 days, p < 0.001). Thirty-five-point five percent [33/93] of patients with severe malaria have had a previous malaria infection compared to 50.8% [66/130] of uncomplicated patients (p= 0.013) wich was statistically significant. CONCLUSION Malaria disproportionately affects VFRs traveling to Central Africa, and flu-like symptoms should raise suspicion. Prophylaxis is essential to prevent the disease, and early diagnosis is critical for effective management. A severe form of the disease is associated with a more extended hospital stay than uncomplicated form and people with a previous history of malaria have a less severe disease.
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Affiliation(s)
- Ratovonjanahary T
- Epidemiology and Biostatistics Unit, Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels, Belgium
| | - Danwang C
- Clinton Health Access Initiative, Inc., Boston, MA, USA
| | - Robert A
- Epidemiology and Biostatistics Unit, Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels, Belgium
| | - Yombi Jc
- Department of Internal Medicine and Infectious Diseases, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium; Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels, Belgium.
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González Martínez MÁ, Castaño Suero MJ, Guerrero Muñoz M, Francisco Rossetti A, Sequeira Aymar E, Roca Saumell C. [Initial assessment of immigrant patients in primary care]. Aten Primaria 2024; 56:102896. [PMID: 38417201 PMCID: PMC10909696 DOI: 10.1016/j.aprim.2024.102896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 01/19/2024] [Indexed: 03/01/2024] Open
Abstract
The clinical interview of immigrant patients requires cultural competence to ensure good understanding and correct communication, in addition to collecting specific information that differs from that of native patients, such as origin and migratory route or cultural identity. Screening for latent tuberculosis infection is recommended in certain cases and screening for other infections, both cosmopolitan with a higher prevalence in migrants (HIV, syphilis, hepatitis B and C) and imported (Chagas, intestinal parasites, strongyloidiasis, schistosomiasis), depending on origin. It is essential to check the vaccination status and complete the vaccination schedule, adapting it to the current calendar, prioritizing vaccines such as measles, rubella and poliomyelitis. We propose preventive activities to be carried out when traveling to countries of origin, due to their special characteristics and risks: general advice, exploring the risk of malaria, assessing specific vaccinations, advice regarding sexually transmitted infections and special considerations if they have chronic diseases; and addressing, if appropriate, the risks of female genital mutilation.
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Affiliation(s)
- María Ángeles González Martínez
- Equip d'Atenció Primària Trinitat Vella, Institut Català de la Salut, Barcelona, España; Grupo de trabajo COCOOPSI de la CAMFIC, Barcelona, España.
| | - María Jesús Castaño Suero
- Grupo de trabajo COCOOPSI de la CAMFIC, Barcelona, España; Equipo de Atención Primaria Amadeu Torner, Institut Català de Salut, L'Hospitalet de Llobregat, Barcelona, España
| | - Marta Guerrero Muñoz
- Grupo de trabajo COCOOPSI de la CAMFIC, Barcelona, España; Equipo de Atención Primaria Universitat, Institut Català de la Salut, Barcelona, España; Unidad de Salud Internacional y Medicina Tropical, Hospital del Mar, Barcelona, España
| | - Agustín Francisco Rossetti
- Grupo de trabajo COCOOPSI de la CAMFIC, Barcelona, España; Equipo de Atención Primaria Centre, Institut Català de Salut, L'Hospitalet de Llobregat, Barcelona, España
| | - Ethel Sequeira Aymar
- Grupo de trabajo COCOOPSI de la CAMFIC, Barcelona, España; Consorci d'Atenció Primària de Salut Barcelona Esquerra, IsGlobal, Barcelona, IDIBAPS, Barcelona, España
| | - Carme Roca Saumell
- Grupo de trabajo COCOOPSI de la CAMFIC, Barcelona, España; Equip d'Atenció Primària El Clot, Institut Català de la Salut, Barcelona, España; Facultat de Medicina, Universitat de Barcelona, Barcelona, España
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5
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Kamau E, Olivo Freites C, Sakona AN. Case Report: Challenges of Diagnosing Malaria in Returning Travelers at the Height of COVID-19 Pandemic. Am J Trop Med Hyg 2024; 110:64-68. [PMID: 38011732 DOI: 10.4269/ajtmh.23-0467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 09/17/2023] [Indexed: 11/29/2023] Open
Abstract
In 2021, we treated three patients in Southern California who contracted malaria while traveling in Uganda. Two patients visited the Nile River in Uganda in the months of July and August 2021, and upon returning to the United States, diagnosis was delayed due to limited access to care during the COVID-19 pandemic. One of the patients developed severe malaria, and the second developed parasitemia after he stopped taking malaria prophylaxis. The third patient, who traveled to Kampala, Uganda, in December 2021 returned home and was admitted for chronic medical conditions. Later in the clinical course, he developed symptoms consistent with malaria, but due to SARS-CoV-2 diagnosis, there was no suspicion of malaria infection until it was incidentally discovered while performing a blood manual differential. All patients were treated for malaria and recovered uneventfully.
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Affiliation(s)
- Edwin Kamau
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, California
- Department of Pathology and Area Laboratory Services, Tripler Army Medical Center, Honolulu, Hawaii
| | - Christian Olivo Freites
- Division of Infectious Diseases, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Ashlyn N Sakona
- Division of Infectious Diseases, David Geffen School of Medicine, University of California, Los Angeles, California
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Grossman T, Vainer J, Paran Y, Studentsky L, Manor U, Dzikowski R, Schwartz E. Emergence of artemisinin-based combination treatment failure in patients returning from sub-Saharan Africa with P. falciparum malaria. J Travel Med 2023; 30:taad114. [PMID: 37606241 DOI: 10.1093/jtm/taad114] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 08/15/2023] [Accepted: 08/18/2023] [Indexed: 08/23/2023]
Abstract
BACKGROUND Artemisinin-based combination therapies (ACTs) are recommended as first-line treatment against uncomplicated Plasmodium falciparum infection. Mutations in the PfKelch13 (PF3D7_1343700) gene led to resistance to artemisinin in Southeast Asia. Mutations in the Pfcoronin (PF3D7_1251200) gene confer reduced artemisinin susceptibility in vitro to an African Plasmodium strain, but their role in clinical resistance has not been established. METHODS We conducted a retrospective observational study of Israeli travellers returning from sub-Saharan Africa with P. falciparum malaria, including patients with artemether-lumefantrine (AL) failure. Blood samples from all malaria-positive patients are delivered to the national Parasitology Reference Laboratory along with personal information. Confirmation of malaria, species identification and comparative parasite load analysis were performed using real-time PCR. DNA extractions from stored leftover samples were analysed for the presence of mutations in Pfkelch13 and Pfcoronin. Age, weight, initial parasitaemia level and Pfcoronin status were compared in patients who failed treatment vs responders. RESULTS During 2009-2020, 338 patients had P. falciparum malaria acquired in Africa. Of those, 15 (24-69 years old, 14 males) failed treatment with AL. Four were still parasitemic at the end of treatment, and 11 had malaria recrudescence. Treatment failure rates were 0% during 2009-2012, 9.1% during 2013-2016 and 17.4% during 2017-2020. In all patients, the Pfkelch13 propeller domain had a wild-type sequence. We did find the P76S mutation in the propeller domain of Pfcoronin in 4/15 (28.6%) of the treatment-failure cases compared to only 3/56 (5.5%) in the successfully treated patients (P = 0.027). CONCLUSION AL treatment failure emergence was not associated with mutations in Pfkelch13. However, P76S mutation in the Pfcoronin gene was more frequently present in the treatment-failure group and merits further investigation. The increase of malaria incidence in sub-Saharan-Africa partly attributed to the COVID-19 pandemic might also reflect a wider spread of ACT resistance.
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Affiliation(s)
- Tamar Grossman
- Parasitology Reference Laboratory, Public Health Laboratories-Jerusalem (PHL-J), Public Health Services (PHS), Ministry of Health (MOH), Jerusalem 9134302, Israel
| | - Julia Vainer
- Parasitology Reference Laboratory, Public Health Laboratories-Jerusalem (PHL-J), Public Health Services (PHS), Ministry of Health (MOH), Jerusalem 9134302, Israel
| | - Yael Paran
- Infectious Disease Department, Tel Aviv Sourasky Medical Center, Tel Aviv 64239, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Liora Studentsky
- Parasitology Reference Laboratory, Public Health Laboratories-Jerusalem (PHL-J), Public Health Services (PHS), Ministry of Health (MOH), Jerusalem 9134302, Israel
| | - Uri Manor
- Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- The Center for Geographic Medicine, Sheba Medical Center, Tel HaShomer 5262000, Israel
| | - Ron Dzikowski
- Department of Microbiology & Molecular Genetics, The Kuvin Center for the Study of Infectious and Tropical Diseases, IMRIC, The Hebrew University-Hadassah Medical School, Jerusalem 91120, Israel
| | - Eli Schwartz
- Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- The Center for Geographic Medicine, Sheba Medical Center, Tel HaShomer 5262000, Israel
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7
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Good MF, Yanow SK. Hiding in plain sight: an epitope-based strategy for a subunit malaria vaccine. Trends Parasitol 2023; 39:929-935. [PMID: 37684152 PMCID: PMC10592166 DOI: 10.1016/j.pt.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 08/13/2023] [Accepted: 08/14/2023] [Indexed: 09/10/2023]
Abstract
Recent data suggest that approaches to developing a subunit blood-stage malaria vaccine may be misdirected. While antigenic polymorphism is recognized as a challenge, efforts to counter this have primarily involved enhancing the quantity and quality of antibody with potent adjuvants, identifying conserved target proteins, or combining multiple antigens to broaden the immune response. However, paradoxically, evidence has emerged that narrowing, rather than broadening, the immune response may be required to obtain an immune response protective against multiple Plasmodium strains. Non-immunodominant, conserved epitopes are crucial. The evidence comes from studying the immune response to red cell surface-expressed antigens but should also be applicable to merozoite surface antigens. Strategies to define the targets of these highly focused immune responses are provided.
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Affiliation(s)
- Michael F Good
- Institute for Glycomics, Griffith University, Gold Coast, Australia.
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Naserrudin NA, Jiee SF, Habil B, Jantim A, Mohamed AFB, Dony JJF, Ibrahim SSA, Fornace KM, Hassan MR, Jeffree MS, Hod R, Culleton R, Ahmed K. The public health response to a Plasmodium malariae outbreak in Penampang district, Sabah during a COVID-19 movement control order. Malar J 2023; 22:292. [PMID: 37789320 PMCID: PMC10546630 DOI: 10.1186/s12936-023-04693-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 08/29/2023] [Indexed: 10/05/2023] Open
Abstract
BACKGROUND Since 2018, no indigenous human malaria cases has been reported in Malaysia. However, during the recent COVID-19 pandemic the World Health Organization is concerned that the pandemic might erode the success of malaria control as there are reports of increase malaria cases in resource limited countries. Little is known how the COVID-19 pandemic has impacted malaria in middle-income countries like Malaysia. Here the public health response to a Plasmodium malariae outbreak occurred in a village in Sabah state, Malaysia, during a COVID-19 movement control order is reported. METHODS An outbreak was declared following the detection of P. malariae in July 2020 and active case detection for malaria was performed by collecting blood samples from residents residing within 2 km radius of Moyog village. Vector prevalence and the efficacy of residual insecticides were determined. Health awareness programmes were implemented to prevent future outbreaks. A survey was conducted among villagers to understand risk behaviour and beliefs concerning malaria. RESULTS A total of 5254 blood samples collected from 19 villages. Among them, 19 P. malariae cases were identified, including the index case, which originated from a man who returned from Indonesia. His return from Indonesia and healthcare facilities visit coincided with the movement control order during COVID-19 pandemic when the healthcare facilities stretched its capacity and only serious cases were given priority. Despite the index case being a returnee from a malaria endemic area presenting with mild fever, no malaria test was performed at local healthcare facilities. All cases were symptomatic and uncomplicated except for a pregnant woman with severe malaria. There were no deaths; all patients recovered following treatment with artemether-lumefantrine combination therapy. Anopheles balabacensis and Anopheles barbirostris were detected in ponds, puddles and riverbeds. The survey revealed that fishing and hunting during night, and self-treatment for mild symptoms contributed to the outbreak. Despite the index case being a returnee from a malaria-endemic area presenting with mild fever, no malaria test was performed at local healthcare facilities. CONCLUSION The outbreak occurred during a COVID-19 movement control order, which strained healthcare facilities, prioritizing only serious cases. Healthcare workers need to be more aware of the risk of malaria from individuals who return from malaria endemic areas. To achieve malaria elimination and prevention of disease reintroduction, new strategies that include multisectoral agencies and active community participation are essential for a more sustainable malaria control programme.
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Affiliation(s)
- Nurul Athirah Naserrudin
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Bangi, Malaysia
- Sabah State Health Department, Ministry of Health, Kota Kinabalu, Malaysia
| | - Sam Froze Jiee
- Department of Community Medicine and Public Health, Faculty of Medicine and Health Sciences, Universiti Malaysia Sarawak, Kota Samarahan, Malaysia
| | - Bobby Habil
- Penampang District Health Office, Ministry of Health, Kota Kinabalu, Malaysia
| | - Anisah Jantim
- Penampang District Health Office, Ministry of Health, Kota Kinabalu, Malaysia
| | | | | | | | - Kimberly M Fornace
- School of Biodiversity, One Health and Veterinary Medicine, University of Glasgow, Glasgow, UK
- Faculty of Infectious and Tropical Diseases and Centre for Climate Change and Planetary Health, London School of Hygiene and Tropical Medicine, London, UK
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Mohd Rohaizat Hassan
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Bangi, Malaysia
| | - Mohammad Saffree Jeffree
- Department of Public Health Medicine, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Malaysia
| | - Rozita Hod
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Bangi, Malaysia
| | | | - Kamruddin Ahmed
- Borneo Medical Health and Research Centre,, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Malaysia.
- Department of Pathology and Microbiology, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Malaysia.
- Research Center for Global and Local Infectious Diseases, Oita University, Oita, Japan.
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Pundir H, Pant M, Joshi T, Bhat S, Pathak R, Bajpai AB, Chandra S, Tamta S. Identification of essential oil phytocompounds as natural inhibitors of Odorant-binding protein to prevent malaria through in silico approach. J Biomol Struct Dyn 2023; 41:8323-8333. [PMID: 36214706 DOI: 10.1080/07391102.2022.2132419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 09/28/2022] [Indexed: 10/17/2022]
Abstract
Malaria predominantly affects millions annually in the African and Asian tropical and subtropical countries. With no effective vaccine, malaria prevention is exclusively dependent on preventing human-vector interaction. Anopheles gambiae, the main vector of the malaria parasite Plasmodium falciparum contains Odorant Binding proteins (OBPs) which are considered an attractive drug target for anti-malarial therapy. To identify a potential anti-malarial compound, we performed a structure-based screening of 876 phytocompounds derived from essential oils against the OBP4 by molecular docking. The compounds having better docking scores were assessed for drug-likeness, toxicity, and molecular interaction analysis. As per the results, strong affinities and high stability were demonstrated by two phytocompounds viz. Alpha-cyperone (-8.1 kcal mol-1) and Humulene oxide (-8.1 kcal mol-1) with OBP4. The hydrophobic interactions involve Phe123, Ala106, Thr57, Ala52, Thr69, and Ile64 within the binding cavities, which may block the OBP4 receptor resulting in disorientation. After that, the potential compounds were subjected to molecular dynamics (MD) simulation to evaluate their structural stability and dynamics at the active site of OBP4. The MM-PBSA result revealed that Alpha-cyperone and Humulene oxide had binding free energy of -92.44 kJ mol-1 and -113.25 kJ mol-1, respectively. Simulation outcomes demonstrate that these phytocompounds displayed considerable significant structural and pharmacological properties. The LD50 value of Alpha-cyperone and Humulene oxide also suggested that both are safe and suitable for use in natural repellent development. We suggest that the use of these compounds can minimize the treatment period and the various side effects associated with the currently available anti-malarial drugs.Communicated by Ramaswamy H. Sarma.
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Affiliation(s)
- Hemlata Pundir
- Department of Botany, D.S.B Campus, Kumaun University, Nainital, Uttarakhand, India
| | - Manish Pant
- Department of Post-Harvest Process and Food Engineering, Govind Ballabh Pant University of Agriculture and Technology, Pantnagar, Uttarakhand, India
| | - Tanuja Joshi
- Computational Biology & Biotechnology Laboratory, Department of Botany, Soban Singh Jeena University, Almora, Uttarakhand, India
| | - Sunaullah Bhat
- Insect Biosystematics & Insect-Pest Management Laboratory, Department of Zoology, Kumaun University-SSJ Campus, Almora, Uttarakhand, India
| | - Ramanand Pathak
- Department of Botany, M.L.K. College, Balrampur, Uttar Pradesh, India
| | | | - Subhash Chandra
- Computational Biology & Biotechnology Laboratory, Department of Botany, Soban Singh Jeena University, Almora, Uttarakhand, India
| | - Sushma Tamta
- Department of Botany, D.S.B Campus, Kumaun University, Nainital, Uttarakhand, India
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Siłka W, Wieczorek M, Siłka J, Woźniak M. Malaria Detection Using Advanced Deep Learning Architecture. SENSORS (BASEL, SWITZERLAND) 2023; 23:1501. [PMID: 36772541 PMCID: PMC9921611 DOI: 10.3390/s23031501] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 01/22/2023] [Accepted: 01/25/2023] [Indexed: 06/18/2023]
Abstract
Malaria is a life-threatening disease caused by parasites that are transmitted to humans through the bites of infected mosquitoes. The early diagnosis and treatment of malaria are crucial for reducing morbidity and mortality rates, particularly in developing countries where the disease is prevalent. In this article, we present a novel convolutional neural network (CNN) architecture for detecting malaria from blood samples with a 99.68% accuracy. Our method outperforms the existing approaches in terms of both accuracy and speed, making it a promising tool for malaria diagnosis in resource-limited settings. The CNN was trained on a large dataset of blood smears and was able to accurately classify infected and uninfected samples with high sensitivity and specificity. Additionally, we present an analysis of model performance on different subtypes of malaria and discuss the implications of our findings for the use of deep learning in infectious disease diagnosis.
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Affiliation(s)
- Wojciech Siłka
- Faculty of Medicine, Jagiellonian University Medical College, 31-008 Kraków, Poland
| | - Michał Wieczorek
- Faculty of Applied Mathematics, Silesian University of Technology, 44-100 Gliwice, Poland
- Geosolution Sp. z o.o., 02-672 Warsaw, Poland
| | - Jakub Siłka
- Faculty of Applied Mathematics, Silesian University of Technology, 44-100 Gliwice, Poland
- Geosolution Sp. z o.o., 02-672 Warsaw, Poland
| | - Marcin Woźniak
- Faculty of Applied Mathematics, Silesian University of Technology, 44-100 Gliwice, Poland
- Geosolution Sp. z o.o., 02-672 Warsaw, Poland
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11
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Choy B, Bristowe H, Khozoee B, Lampejo T. Increased imported severe Plasmodium falciparum malaria involving hyperparasitaemia (>10%) in a UK hospital following relaxation of COVID-19 restrictions compared to the pre-pandemic period. J Travel Med 2022; 29:6754372. [PMID: 36209409 PMCID: PMC9619718 DOI: 10.1093/jtm/taac116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 09/29/2022] [Accepted: 09/30/2022] [Indexed: 12/29/2022]
Abstract
We identified and compared patients diagnosed with Plasmodium falciparum malaria at a large hospital in London, UK prior to the COVID-19 pandemic versus following relaxation of COVID-19-associated restrictions. We found that parasitaemias, rates of hyperpasitaemia and severe malaria were significantly higher in the period post-relaxation of COVID-19 restrictions.
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Affiliation(s)
- Bennett Choy
- Department of Infection Sciences, King s College Hospital, London SE5 9RS, UK
| | - Henrietta Bristowe
- Department of Infection Sciences, King s College Hospital, London SE5 9RS, UK
| | - Baktash Khozoee
- Department of Infection Sciences, King s College Hospital, London SE5 9RS, UK
| | - Temi Lampejo
- Department of Infection Sciences, King s College Hospital, London SE5 9RS, UK
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Valle A, Yu NC, Giannakakos V, Maini R, Shaines M. A Case of Latent Plasmodium Falciparum Malaria in a Patient With Coexisting Systemic Lupus Erythematosus (SLE) and Neuromyelitis Optica Spectrum Disorder (NMOSD). Cureus 2022; 14:e30436. [DOI: 10.7759/cureus.30436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2022] [Indexed: 11/07/2022] Open
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Norman FF, Treviño-Maruri B, Ruiz Giardín JM, Gullón-Peña B, Salvador F, Serre N, Díaz-Menéndez M, Calabuig E, Rodriguez-Guardado A, Lombide I, Pérez-Ayala A, Torrús D, Goikoetxea J, García-Rodriguez M, Pérez-Molina JA. Trends in imported malaria during the COVID-19 pandemic, Spain (+Redivi Collaborative Network). J Travel Med 2022; 29:6649393. [PMID: 35876259 DOI: 10.1093/jtm/taac083] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 07/08/2022] [Accepted: 07/13/2022] [Indexed: 11/13/2022]
Abstract
INTRODUCTION The COVID-19 pandemic has caused disruptions in prevention and management strategies for malaria globally. Currently, data analysing trends in travel-related infections during the pandemic years are scarce. The objective of this analysis was to describe the epidemiological and clinical characteristics of patients with imported malaria within the +Redivi network in Spain, focusing on yearly trends from pre-pandemic years to date. METHODS Cases recorded in +Redivi from October 2009 to December 2021 were analysed and patients with a diagnosis of malaria (standard diagnostic methods using thick/thin peripheral blood smears, with/without a malaria rapid diagnostic test and/or Plasmodium spp. polymerase chain reaction) were identified. The total number of malaria cases, cases according to type of patient and severe cases, per year, were analysed. RESULTS In total, 1751 cases of malaria (1751/26 601, 6.6%) were identified. The majority occurred in males (1041, 59.5%), median age was 36.3 (interquartile range: 27-44.7) years and most occurred in visiting friends and relatives (VFR)-immigrants (872, 49.8%). Most infections were acquired in sub-Saharan Africa (1.660, 94.8%) and were due to Plasmodium falciparum (81.3%). There were 64 cases of severe malaria (3.7%) and 4 patients died (0.2% mortality, all in pre-pandemic years). A significant increase in cases of severe malaria was observed during the study period (P < 0.001) (attributable to the increase in 2021). There were 16/93 severe cases in 2021 (17.2%), all due to Plasmodium falciparum, (compared with ≤ 5% in previous years), which mainly occurred in travellers and VFR-immigrants (10/16, 62.5% and 5/16, 31.3%, respectively). CONCLUSIONS After an initial decline associated with travel restrictions due to the ongoing COVID-19 pandemic, an increase in imported malaria and a significant increase in cases of severe malaria was observed. Patients with imported malaria may present and/or be diagnosed late during this public health crisis and health care professionals should be alerted to the recent increase in severe cases.
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Affiliation(s)
- Francesca F Norman
- National Referral Unit for Tropical Diseases, Infectious Diseases Department. Ramón y Cajal University Hospital, IRYCIS, Madrid, Spain, Universidad de Alcalá, CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
| | - Begoña Treviño-Maruri
- Unitat de Medicina Tropical y Salut Internacional Vall d'Hebron-Drassanes, Vall d'Hebron University Hospital, PROSICS Barcelona, Spain, CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
| | | | - Beatriz Gullón-Peña
- National Referral Unit for Tropical Diseases, Infectious Diseases Department. Ramón y Cajal University Hospital, IRYCIS, Madrid, Spain, Universidad de Alcalá, CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
| | - Fernando Salvador
- Infectious Diseases Department, Vall d'Hebron University Hospital, PROSICS Barcelona, Spain, CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
| | - Nuria Serre
- Unitat de Medicina Tropical y Salut Internacional Vall d'Hebron-Drassanes, Vall d'Hebron University Hospital, PROSICS Barcelona, Spain, CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
| | - Marta Díaz-Menéndez
- National Referral Centre for Imported Tropical Diseases, Hospital Universitario La Paz-Carlos III, Madrid, Spain
| | - Eva Calabuig
- La Fe University and Polytechnic Hospital, University of Valencia, Valencia, Spain
| | | | | | | | - Diego Torrús
- Alicante General University Hospital, Alicante, Spain
| | | | | | - Jose A Pérez-Molina
- National Referral Unit for Tropical Diseases, Infectious Diseases Department. Ramón y Cajal University Hospital, IRYCIS, Madrid, Spain, Universidad de Alcalá, CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
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Mace KE, Lucchi NW, Tan KR. Malaria Surveillance — United States, 2018. MMWR. SURVEILLANCE SUMMARIES 2022; 71:1-35. [PMID: 36048717 PMCID: PMC9470224 DOI: 10.15585/mmwr.ss7108a1] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Problem/Condition Malaria in humans is caused by intraerythrocytic protozoa of the genus Plasmodium. These parasites are transmitted by the bite of an infective female Anopheles species mosquito. Most malaria infections in the United States and its territories occur among persons who have traveled to regions with ongoing malaria transmission. However, among persons who have not traveled out of the country, malaria is occasionally acquired through exposure to infected blood or tissues, congenital transmission, nosocomial exposure, or local mosquitoborne transmission. Malaria surveillance in the United States and its territories provides information on its occurrence (e.g., temporal, geographic, and demographic), guides prevention and treatment recommendations for travelers and patients, and facilitates rapid transmission control measures if locally acquired cases are identified. Period Covered This report summarizes confirmed malaria cases in persons with onset of illness in 2018 and trends in previous years. Description of System Malaria cases diagnosed by blood smear microscopy, polymerase chain reaction, or rapid diagnostic tests are reported to local and state health departments through electronic laboratory reports or by health care providers or laboratory staff members directly reporting to CDC or health departments. Case investigations are conducted by local and state health departments, and reports are transmitted to CDC through the National Malaria Surveillance System (NMSS), the National Notifiable Diseases Surveillance System (NNDSS), or direct CDC clinical consultations. CDC reference laboratories provide diagnostic assistance and conduct antimalarial drug resistance marker testing on blood specimens submitted by health care providers or local or state health departments. This report summarizes data from the integration of all cases from NMSS and NNDSS, CDC clinical consultations, and CDC reference laboratory reports. Results CDC received reports of 1,823 confirmed malaria cases with onset of symptoms in 2018, including one cryptic case and one case acquired through a bone marrow transplant. The number of cases reported in 2018 is 15.6% fewer than in 2017. The number of cases diagnosed in the United States and its territories has been increasing since the mid-1970s; the number of cases reported in 2017 was the highest since 1972. Of the cases in 2018, a total of 1,519 (85.0%) were imported cases that originated from Africa; 1,061 (69.9%) of the cases from Africa were from West Africa, a similar proportion to what was observed in 2017. Among all cases, P. falciparum accounted for most infections (1,273 [69.8%]), followed by P. vivax (173 [9.5%]), P. ovale (95 [5.2%]), and P. malariae (48 [2.6%]). For the first time since 2008, an imported case of P. knowlesi was identified in the United States and its territories. Infections by two or more species accounted for 17 cases (<1.0%). The infecting species was not reported or was undetermined in 216 cases (11.9%). Most patients (92.6%) had symptom onset <90 days after returning to the United States or its territories from a country with malaria transmission. Of the U.S. civilian patients who reported reason for travel, 77.0% were visiting friends and relatives. Chemoprophylaxis with antimalarial medications are recommended for U.S. residents to prevent malaria while traveling in countries where it is endemic. Fewer U.S. residents with imported malaria reported taking any malaria chemoprophylaxis in 2018 (24.5%) than in 2017 (28.4%), and adherence was poor among those who took chemoprophylaxis. Among the 864 U.S. residents with malaria for whom information on chemoprophylaxis use and travel region were known, 95.0% did not adhere to or did not take a CDC-recommended chemoprophylaxis regimen. Among 683 women with malaria, 19 reported being pregnant. Of these, 11 pregnant women were U.S. residents, and one of whom reported taking chemoprophylaxis to prevent malaria but her adherence to chemoprophylaxis was not reported. Thirty-eight (2.1%) malaria cases occurred among U.S. military personnel in 2018, more than in 2017 (26 [1.2%]). Among all reported malaria cases in 2018, a total of 251 (13.8%) were classified as severe malaria illness, and seven persons died from malaria. In 2018, CDC analyzed 106 P. falciparum-positive and four P. falciparum mixed species specimens for antimalarial resistance markers (although certain loci were untestable in some specimens); identification of genetic polymorphisms associated with resistance to pyrimethamine were found in 99 (98.0%), to sulfadoxine in 49 (49.6%), to chloroquine in 50 (45.5%), and to mefloquine in two (2.0%); no specimens tested contained a marker for atovaquone or artemisinin resistance. Interpretation The importation of malaria reflects the overall trends in global travel to and from areas where malaria is endemic, and 15.6% fewer cases were imported in 2018 compared with 2017. Of imported cases, 59.3% were among persons who had traveled from West Africa. Among U.S. civilians, visiting friends and relatives was the most common reason for travel (77.1%). Public Health Actions The best way for U.S. residents to prevent malaria is to take chemoprophylaxis medication before, during, and after travel to a country where malaria is endemic. Adherence to recommended malaria prevention strategies among U.S. travelers would reduce the number of imported cases. Reported reasons for nonadherence include prematurely stopping after leaving the area where malaria was endemic, forgetting to take the medication, and experiencing a side effect. Health care providers can make travelers aware of the risks posed by malaria and incorporate education to motivate them to be adherent to chemoprophylaxis. Malaria infections can be fatal if not diagnosed and treated promptly with antimalarial medications appropriate for the patient’s age, pregnancy status, medical history, the likely country of malaria acquisition, and previous use of antimalarial chemoprophylaxis. Antimalarial use for chemoprophylaxis and treatment should be determined by the CDC guidelines, which are frequently updated. In April 2019, intravenous (IV) artesunate became the first-line medication for treatment of severe malaria in the United States and its territories. Artesunate was approved by the Food and Drug Administration (FDA) in 2020 and is commercially available (Artesunate for Injection) from major U.S. drug distributors (https://amivas.com). Stocking IV artesunate locally allows for immediate treatment of severe malaria once diagnosed and provides patients with the best chance of a complete recovery and no sequelae. With commercial IV artesunate now available, CDC will discontinue distribution of non–FDA-approved IV artesunate under an investigational new drug protocol on September 30, 2022. Detailed recommendations for preventing malaria are online at https://www.cdc.gov/malaria/travelers/drugs.html. Malaria diagnosis and treatment recommendations are also available online at https://www.cdc.gov/malaria/diagnosis_treatment. Health care providers who have sought urgent infectious disease consultation and require additional assistance on diagnosis and treatment of malaria can call the Malaria Hotline 9:00 a.m.–5:00 p.m. Eastern Time, Monday–Friday, at 770-488-7788 or 855-856-4713 or after hours for urgent inquiries at 770-488-7100. Persons submitting malaria case reports (care providers, laboratories, and state and local public health officials) should provide complete information because incomplete reporting compromises case investigations and public health efforts to prevent future infections and examine trends in malaria cases. Molecular surveillance of antimalarial drug resistance markers enables CDC to track, guide treatment, and manage drug resistance in malaria parasites both domestically and globally. A greater proportion of specimens from domestic malaria cases are needed to improve the completeness of antimalarial drug resistance analysis; therefore, CDC requests that blood specimens be submitted for any case of malaria diagnosed in the United States and its territories.
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Affiliation(s)
- Kimberly E. Mace
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, CDC
| | - Naomi W. Lucchi
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, CDC
| | - Kathrine R. Tan
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, CDC
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Mischlinger J, Jochum J, Ramharter M, Kurth F. [Malaria and its importance in travel medicine]. Dtsch Med Wochenschr 2022; 147:745-755. [PMID: 35672022 DOI: 10.1055/a-1661-3783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Malaria remains one of the most important infectious diseases worldwide. The annual number of cases is currently estimated at around 240 million globally, of which more than 500,000 cases are fatal. The majority of malaria cases in Europe are imported from the African continent. Plasmodium falciparum, the causative agent of malaria tropica, causes 75-90 % of all infections imported to Germany. Artemisinin-based combination therapies are the standard treatment for uncomplicated malaria worldwide. In addition to uncomplicated malaria infections, Plasmodium falciparum can cause severe malaria, characterized by vital organ dysfunction and hyperparasitaemia. The treatment of choice for severe malaria is parenteral artesunate. For all patients presenting with febrile illness after a stay in a malaria-endemic area malaria must be ruled out immediately. Microscopy of the thick drop remains the gold standard for diagnosis in clinical routine.
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Ben Abderrahim S, Gharsallaoui S, Ben Daly A, Mosbahi A, Chaieb S, Nfikha Z, Ismaïl S, Makni C, Mokni M, Fathallah-Mili A, Jedidi M, Ben Dhiab M. Imported malaria in adults: about a case of cerebral malaria. EGYPTIAN JOURNAL OF FORENSIC SCIENCES 2022; 12:19. [PMID: 35382261 PMCID: PMC8972756 DOI: 10.1186/s41935-022-00279-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 03/27/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Malaria is the first parasitic infection endemic in the world caused by parasites species of Plasmodium. Cerebral malaria (CM) is a rapidly progressive and severe form of Plasmodium falciparum infection, characterized by a greater accumulation of red blood cells parasitized by Plasmodium falciparum in the brain. The diagnosis of malaria is usually made in living patients from a blood sample taken in the course of a fever on return from an endemic country, whereas CM, often associated with fatal outcomes even in treated subjects, is usually diagnosed at autopsy.
Case presentation
We present the case of a 36-year-old man who died a few days after returning from a business trip to the Ivory Coast. As a result of an unclear cause of death, a medicolegal autopsy was ordered. Autopsy findings revealed massive congestion and edema of the brain with no other macroscopic abnormalities at organ gross examination. Histology and laboratory tests were conducted revealing a Plasmodium falciparum infection, with numerous parasitized erythrocytes containing dots of hemozoin pigment (malaria pigment) in all examined brain sections and all other organs. Death was attributed to cerebral malaria with multiple organ failure.
Conclusions
This report summarizes several features for the diagnosis of malaria and how postmortem investigations, as well as histology and laboratory diagnosis, may lead to a retrospective diagnosis of a fatal complicated form with cerebral involvement.
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A Model to Estimate the Effect of International Traffic on Malaria Cases: The Case of Japan from 1999 to 2021. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19020880. [PMID: 35055702 PMCID: PMC8775555 DOI: 10.3390/ijerph19020880] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/08/2022] [Accepted: 01/10/2022] [Indexed: 01/10/2023]
Abstract
Aiming to identify the potentially reduced malaria cases by stagnation of international traffic after the COVID-19 pandemic, a longitudinal analysis of malaria cases as well as entries of Japanese and foreigners was conducted using data from 5 April 1999 to 30 September 2021 in Japan. Multivariable risk ratios were calculated with the Poison regression model as a predictive model of malaria cases by the number of entries for Japanese and foreigners. A generalized regression model was used to examine an association of time trend with entries for Japanese and foreigners using data before 2019, to estimate the potentially reduced number of entries after 2020. The potentially reduced number of malaria cases was estimated by the potentially reduced number of entries for Japanese and foreigners after 2020 using a multivariable Poison regression model. The multivariable risk ratio (95% confidence intervals) of malaria case numbers per 100,000 persons increment of entries per day was 3.41 (1.50–7.77) for Japanese and 1.47 (0.92–2.35) for foreigners. During 2020, a potential reduction of 28 (95% confidence limit: 22–34) malaria cases was estimated, which accounted for 58% (52–63%) of malaria cases in Japan. These finding suggest that the stagnation of international traffic during the COVID-19 pandemic reduced the number of malaria cases in Japan. This model may be helpful for countries without indigenous malaria to predict future trends of imported malaria cases.
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Sikka R, Bharti PK, Gupta H. microRNAs: An opportunity to overcome significant challenges in malaria detection and control. CURRENT RESEARCH IN PHARMACOLOGY AND DRUG DISCOVERY 2022; 3:100115. [PMID: 35801230 PMCID: PMC9253159 DOI: 10.1016/j.crphar.2022.100115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 06/14/2022] [Accepted: 06/20/2022] [Indexed: 11/27/2022] Open
Abstract
Organ damage and pathological disease states lead to the rapid release of microRNAs (miRNAs), a class of endogenous small non-coding RNAs, into the blood circulation. Because secreted miRNAs can be detected in biologic fluids such as plasma, they are currently being explored as promising non-invasive biomarkers of infectious and non-infectious diseases. Malaria remains a major global health challenge but still the potential of miRNAs has not been explored extensively in the context of malaria compared to other diseases. Here, we highlight important miRNAs found during different phases of the malaria life cycle in the anopheline vector and the human host. We have also put forward our opinion on how malaria parasite-stage-specific miRNAs can be incorporated into new diagnostic and prognostic tools to detect carrier mosquitoes and infected patients. In addition, we have emphasised the potential of miRNAs to be used as new therapeutics to treat severe malaria patients, an unresearched area of malaria control.
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19
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Giannone B, Hedrich N, Schlagenhauf P. Imported malaria in Switzerland, (1990-2019): A retrospective analysis. Travel Med Infect Dis 2021; 45:102251. [PMID: 34973453 DOI: 10.1016/j.tmaid.2021.102251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 12/23/2021] [Accepted: 12/26/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Malaria is a life-threatening, mosquito-borne parasitic disease, caused by Plasmodium spp. It is a major public health issue. Malaria in Switzerland is primarily "imported" by infected international travellers, migrants, and asylum-seekers. METHOD We investigated the epidemiology and characteristics of imported malaria in Switzerland in the period between 1990 and 2019 using data from the Swiss Federal Office of Public Health (BAG). We also obtained traveller statistics from the World Tourism Organization (UNWTO). RESULTS During the last thirty years a total of 8'439 malaria cases and 52 deaths were reported in Switzerland. The main origin of infection was West Africa, followed by Central Africa and East Africa. The profile of malaria in migrants in Switzerland has changed, reflecting variation in migrant flows. The estimated risk of malaria in travellers sank significantly over the time frame of the study (p < 0.001, 95% CI -0.076 to -0.043). CONCLUSIONS Travel medicine should focus on West Africa, the main source of malaria in Switzerland. Despite most cases and all but one death being caused by Plasmodium falciparum, Plasmodium vivax remains a threat for travellers and is associated with complex prevention and therapy regimens. Public health authorities need to pre-empt the need for malaria screening, prevention and treatment based on the profile of migrant waves from malaria endemic areas including Eritrea and Afghanistan arriving in Europe.
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Affiliation(s)
- Bodo Giannone
- Kantonsspital St.Gallen, Emergency Department, Switzerland
| | - Nadja Hedrich
- University of Zürich, Epidemiology, Biostatistics and Prevention Institute, Switzerland
| | - Patricia Schlagenhauf
- University of Zürich, Epidemiology, Biostatistics and Prevention Institute, WHO Collaborating Centre for Travellers' Health, Department of Global and Public Health, MilMedBiol Competence Centre, Hirschengraben 84, 8001, Zürich, Switzerland.
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Usui M, Williamson KC. Stressed Out About Plasmodium falciparum Gametocytogenesis. Front Cell Infect Microbiol 2021; 11:790067. [PMID: 34926328 PMCID: PMC8674873 DOI: 10.3389/fcimb.2021.790067] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 11/08/2021] [Indexed: 11/21/2022] Open
Abstract
Blocking malaria transmission is critical to malaria control programs but remains a major challenge especially in endemic regions with high levels of asymptomatic infections. New strategies targeting the transmissible sexual stages of the parasite, called gametocytes, are needed. This review focuses on P. falciparum gametocytogenesis in vivo and in vitro. Highlighting advances made elucidating genes required for gametocyte production and identifying key questions that remain unanswered such as the factors and regulatory mechanisms that contribute to gametocyte induction, and the mechanism of sequestration. Tools available to begin to address these issues are also described to facilitate advances in our understanding of this important stage of the life cycle.
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Affiliation(s)
- Miho Usui
- Department of Microbiology and Immunology, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Kim C Williamson
- Department of Microbiology and Immunology, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
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Gupta H, Wassmer SC. Harnessing the Potential of miRNAs in Malaria Diagnostic and Prevention. Front Cell Infect Microbiol 2021; 11:793954. [PMID: 34976869 PMCID: PMC8716737 DOI: 10.3389/fcimb.2021.793954] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 11/09/2021] [Indexed: 12/14/2022] Open
Abstract
Despite encouraging progress over the past decade, malaria remains a major global health challenge. Its severe form accounts for the majority of malaria-related deaths, and early diagnosis is key for a positive outcome. However, this is hindered by the non-specific symptoms caused by malaria, which often overlap with those of other viral, bacterial and parasitic infections. In addition, current tools are unable to detect the nature and degree of vital organ dysfunction associated with severe malaria, as complications develop silently until the effective treatment window is closed. It is therefore crucial to identify cheap and reliable early biomarkers of this wide-spectrum disease. microRNAs (miRNAs), a class of small non-coding RNAs, are rapidly released into the blood circulation upon physiological changes, including infection and organ damage. The present review details our current knowledge of miRNAs as biomarkers of specific organ dysfunction in patients with malaria, and both promising candidates identified by pre-clinical models and important knowledge gaps are highlighted for future evaluation in humans. miRNAs associated with infected vectors are also described, with a view to expandind this rapidly growing field of research to malaria transmission and surveillance.
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Affiliation(s)
- Himanshu Gupta
- Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Samuel C. Wassmer
- Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Garcia-Ruiz de Morales A, Morcate C, Isaba-Ares E, Perez-Tanoira R, Perez-Molina JA. High prevalence of malaria in a non-endemic setting among febrile episodes in travellers and migrants coming from endemic areas: a retrospective analysis of a 2013-2018 cohort. Malar J 2021; 20:449. [PMID: 34838010 PMCID: PMC8627073 DOI: 10.1186/s12936-021-03984-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 11/13/2021] [Indexed: 11/10/2022] Open
Abstract
Background The study aimed to analyse the likelihood of imported malaria in people with a suggestive clinical picture and its distinctive characteristics in a hospital in the south of Madrid, Spain. Methods Observational retrospective study that consisted of a review of all medical files of patients with any malaria test registered at Móstoles University Hospital between April 2013 and April 2018. All suspected malaria cases were confirmed by Plasmodium spp. polymerase chain reaction (PCR). Results Of the 328 patients with suspected malaria (53.7% migrant-travellers; 38.7% visitors; 7.6% travellers), 108 cases were confirmed (101 by Plasmodium falciparum), accounting for a 33% positive sample rate. Sixteen cases were diagnosed only by PCR. Patients with malaria, compared to those without, presented predominantly with fever (84% vs. 65%), were older (34 vs. 24 years), sought medical attention earlier (17d vs. 32d), had a greater number of previous malaria episodes (74% vs. 60%), lower levels of platelets (110,500µL vs. 250,000µL), and higher of bilirubin (0.6 mg/dL vs. 0.5 mg/dL). Severe malaria was present in 13 cases; no deaths were recorded. Malaria diagnosis showed a bimodal distribution with two peaks: June to September and November to January. Conclusions Malaria is still a common diagnosis among febrile patients coming from the tropics specially among migrant travellers. Fever, thrombocytopenia, and/or high bilirubin levels should raise suspicion for this parasitic infection. Prompt diagnosis is crucial to avoid severe cases and deaths. Supplementary Information The online version contains supplementary material available at 10.1186/s12936-021-03984-9.
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Affiliation(s)
- Alejandro Garcia-Ruiz de Morales
- Infectious Diseases Department, National Referral Centre for Tropical Diseases, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), CIBER de Enfermedades Infecciosas, 28034, Madrid, Spain.,Internal Medicine Department, Móstoles University Hospital, Móstoles, Spain
| | - Covadonga Morcate
- Internal Medicine Department, Móstoles University Hospital, Móstoles, Spain
| | - Elena Isaba-Ares
- Internal Medicine Department, Móstoles University Hospital, Móstoles, Spain
| | - Ramon Perez-Tanoira
- Clinical Microbiology Department, Príncipe de Asturias University Hospital, Madrid, Spain.,Biomedicine and Biotechnology Department, Faculty of Medicine, Alcalá de Henares University, Alcalá de Henares, Spain
| | - Jose A Perez-Molina
- Infectious Diseases Department, National Referral Centre for Tropical Diseases, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), CIBER de Enfermedades Infecciosas, 28034, Madrid, Spain.
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Ferra Murcia S, Hernández Sierra B, Vogt Sánchez EA, Collado Romacho AR. Febrile syndrome upon return from the tropics during the COVID-19 pandemic. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2021; 39:477-478. [PMID: 34446398 PMCID: PMC8382604 DOI: 10.1016/j.eimce.2021.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 10/25/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Sergio Ferra Murcia
- Unidad de Enfermedades Infecciosas, Servicio Medicina Interna, Hospital Universitario Torrecárdenas, Almería, Spain.
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Serrano D, Santos-Reis A, Silva C, Dias A, Dias B, Toscano C, Conceição C, Baptista-Fernandes T, Nogueira F. Imported Malaria in Portugal: Prevalence of Polymorphisms in the Anti-Malarial Drug Resistance Genes pfmdr1 and pfk13. Microorganisms 2021; 9:microorganisms9102045. [PMID: 34683365 PMCID: PMC8538333 DOI: 10.3390/microorganisms9102045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 09/18/2021] [Accepted: 09/21/2021] [Indexed: 02/04/2023] Open
Abstract
Malaria is one of the ‘big three’ killer infectious diseases, alongside tuberculosis and HIV. In non-endemic areas, malaria may occur in travelers who have recently been to or visited endemic regions. The number of imported malaria cases in Portugal has increased in recent years, mostly due to the close relationship with the community of Portuguese language countries. Samples were collected from malaria-infected patients attending Centro Hospitalar Lisboa Ocidental (CHLO) or the outpatient clinic of Instituto de Higiene e Medicina Tropical (IHMT-NOVA) between March 2014 and May 2021. Molecular characterization of Plasmodium falciparum pfk13 and pfmdr1 genes was performed. We analyzed 232 imported malaria cases. The majority (68.53%) of the patients came from Angola and only three patients travelled to a non-African country; one to Brazil and two to Indonesia. P. falciparum was diagnosed in 81.47% of the cases, P. malariae in 7.33%, P. ovale 6.47% and 1.72% carried P. vivax. No mutations were detected in pfk13. Regarding pfmdr1, the wild-type haplotype (N86/Y184/D1246) was also the most prevalent (64.71%) and N86/184F/D1246 was detected in 26.47% of the cases. The typical imported malaria case was middle-aged male, traveling from Angola, infected with P. falciparum carrying wild type pfmdr1 and pfk13. Our study highlights the need for constant surveillance of malaria parasites imported into Portugal as an important pillar of public health.
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Affiliation(s)
- Debora Serrano
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade NOVA de Lisboa (IHMT-NOVA), Rua da Junqueira 100, 1349-008 Lisboa, Portugal; (D.S.); (A.S.-R.); (C.S.); (B.D.); (C.C.)
| | - Ana Santos-Reis
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade NOVA de Lisboa (IHMT-NOVA), Rua da Junqueira 100, 1349-008 Lisboa, Portugal; (D.S.); (A.S.-R.); (C.S.); (B.D.); (C.C.)
| | - Clemente Silva
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade NOVA de Lisboa (IHMT-NOVA), Rua da Junqueira 100, 1349-008 Lisboa, Portugal; (D.S.); (A.S.-R.); (C.S.); (B.D.); (C.C.)
| | - Ana Dias
- Laboratório de Microbiologia Clínica e Biologia Molecular, Serviço de Patologia Clínica, Centro Hospitalar Lisboa Ocidental (CHLO), Rua da Junqueira 126, 1349-019 Lisboa, Portugal; (A.D.); (C.T.); (T.B.-F.)
| | - Brigite Dias
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade NOVA de Lisboa (IHMT-NOVA), Rua da Junqueira 100, 1349-008 Lisboa, Portugal; (D.S.); (A.S.-R.); (C.S.); (B.D.); (C.C.)
| | - Cristina Toscano
- Laboratório de Microbiologia Clínica e Biologia Molecular, Serviço de Patologia Clínica, Centro Hospitalar Lisboa Ocidental (CHLO), Rua da Junqueira 126, 1349-019 Lisboa, Portugal; (A.D.); (C.T.); (T.B.-F.)
| | - Cláudia Conceição
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade NOVA de Lisboa (IHMT-NOVA), Rua da Junqueira 100, 1349-008 Lisboa, Portugal; (D.S.); (A.S.-R.); (C.S.); (B.D.); (C.C.)
| | - Teresa Baptista-Fernandes
- Laboratório de Microbiologia Clínica e Biologia Molecular, Serviço de Patologia Clínica, Centro Hospitalar Lisboa Ocidental (CHLO), Rua da Junqueira 126, 1349-019 Lisboa, Portugal; (A.D.); (C.T.); (T.B.-F.)
| | - Fatima Nogueira
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade NOVA de Lisboa (IHMT-NOVA), Rua da Junqueira 100, 1349-008 Lisboa, Portugal; (D.S.); (A.S.-R.); (C.S.); (B.D.); (C.C.)
- Correspondence: ; Tel.: +351-213652600
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Robben PM, Dunbar CR, Akin EH, Pichugin A, Regules JA. Late-presenting Plasmodium falciparum Malaria in a Non-Endemic Setting During COVID-19 Travel Restrictions. Mil Med 2021; 188:e1335-e1337. [PMID: 34557926 PMCID: PMC8500131 DOI: 10.1093/milmed/usab393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 09/01/2021] [Accepted: 09/13/2021] [Indexed: 11/23/2022] Open
Abstract
We report a case of febrile Plasmodium falciparum malaria in a 36-year-old male patient occurring 14 years after immigration from and more than 12 months since a return visit to the endemic area. The critical need for awareness regarding late presentations of P. falciparum is discussed.
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Affiliation(s)
- Paul M Robben
- Malaria Biologics Branch, Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA
| | - Christopher R Dunbar
- Infectious Disease Service, Dwight D. Eisenhower Army Medical Center, Fort Gordon, GA 30905, USA
| | - Elgin H Akin
- Malaria Biologics Branch, Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA
| | - Alexander Pichugin
- Malaria Biologics Branch, Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA
| | - Jason A Regules
- Malaria Biologics Branch, Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA
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26
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Mischlinger J, Dudek V, Ramharter M. Predictive Performance of Rapid Diagnostic Tests for Falciparum Malaria and Its Modeled Impact on Integrated Community Case Management of Malaria in Sub-Saharan African Febrile Children. Clin Infect Dis 2021; 73:e1158-e1167. [PMID: 33506270 PMCID: PMC8423504 DOI: 10.1093/cid/ciaa1942] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 01/04/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Integrated community case management (iCCM) of malaria complements public health services to improve access to timely diagnosis and treatment of malaria. ICCM relies on standardized test-and-treat algorithms implemented by community health workers using malaria rapid diagnostic tests (RDTs). However, due to a changing epidemiology of fever causes in Africa, positive RDT results might not correctly reflect malaria. In this study, we modeled diagnostic predictive values for all malaria-endemic African regions as an indicator of the programmatic usefulness of RDTs in iCCM campaigns on malaria. METHODS Positive predictive values (PPVs) and negative predictive values (NPVs) of RDTs for clinical malaria were modeled. Assay-specific performance characteristics stem from the Cochrane Library and data on the proportion of malaria-attributable fevers among African febrile children aged <5 years were used as prevalence matrix. RESULTS Average country-level PPVs vary considerably. Ethiopia had the lowest PPVs (histidine-rich protein II [HRP2] assay, 17.35%; parasite lactate dehydrogenase [pLDH] assay, 39.73%), and Guinea had the highest PPVs (HRP2 assay, 95.32%; pLDH assay, 98.46%). On the contrary, NPVs were above 90% in all countries (HRP2 assay, ≥94.87%; pLDH assay, ≥93.36%). CONCLUSIONS PPVs differed considerably within Africa when used to screen febrile children, indicating unfavorable performance of RDT-based test-and-treat algorithms in low-PPV settings. This suggests that the administration of antimalarials alone may not constitute causal treatment in the presence of a positive RDT result for a substantial proportion of patients, particularly in low-PPV settings. Therefore, current iCCM algorithms should be complemented by information on other setting-specific major causes of fever.
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Affiliation(s)
- Johannes Mischlinger
- Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine and I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,German Centre for Infection Research, Partner Site Hamburg-Luebeck-Borstel, Hamburg, Germany
| | - Veronika Dudek
- Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine and I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,German Centre for Infection Research, Partner Site Hamburg-Luebeck-Borstel, Hamburg, Germany
| | - Michael Ramharter
- Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine and I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,German Centre for Infection Research, Partner Site Hamburg-Luebeck-Borstel, Hamburg, Germany
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27
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Wilairatana P, Kuraeiad S, Rattaprasert P, Kotepui M. Prevalence of malaria and scrub typhus co-infection in febrile patients: a systematic review and meta-analysis. Parasit Vectors 2021; 14:471. [PMID: 34521454 PMCID: PMC8442375 DOI: 10.1186/s13071-021-04969-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 08/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Little information is available about malaria and scrub typhus co-infection. This study aimed to investigate the pooled prevalence of malaria and scrub typhus co-infection in febrile patients. Further, it aimed to estimate the prevalence of scrub typhus infection among patients with malaria and the odds of co-infection. This will aid the diagnosis and management of co-infected patients in endemic areas. METHODS We searched for relevant studies in three databases: PubMed, Scopus, and Web of Science. We assessed the quality of the included studies using the Joanna Briggs Institute checklist for analytical cross-sectional studies. We estimated (1) the pooled prevalence of malaria and scrub typhus co-infection, (2) the pooled prevalence of scrub typhus infection in malaria-positive patients, and (3) the pooled odds of co-infection using the DerSimonian-Laird method for random-effects models. The study results and summary estimates were visualized on a forest plot as point estimates (effect size, prevalence) and 95% confidence intervals (CI). We assessed the heterogeneity of the studies by Cochrane Q or I2 statistics. We performed subgroup analyses of countries and scrub typhus diagnostic tests to explore the sources of heterogeneity of the included studies. We assessed publication bias if more than 10 studies were used to estimate the outcome. All data analyses were conducted using Stata version 14 (StataCorp, College Station, TX, USA). RESULTS Of the 542 studies retrieved from three databases, we included 14 meeting the inclusion criteria in the systematic review and meta-analysis. The pooled prevalence of malaria and scrub typhus co-infection (56 cases) among febrile patients (7920 cases) was 1% (95% CI: 0-1%, I2: 78.28%), while the pooled prevalence of scrub typhus infection (321 cases) in patients with malaria (1418 cases) was 21% (95% CI: 12-30%, I2: 98.15%). Subgroup analysis showed that the pooled prevalence of scrub typhus infection among patients with malaria in India was 8% (95% CI: 4-13%, I2: 85.87%, nine studies with 59/794 cases), while the pooled prevalence of scrub typhus infection among patients with malaria in Thailand was 35% (95% CI: 7-64%, I2: 98.9%, four studies with 262/624 cases). The co-infections did not occur by chance (P = 0.013, odds: 0.43, 95% CI: 0.22-0.84%, I2: 60.9%). In the sensitivity analysis, the pooled prevalence of malaria and scrub typhus co-infection among febrile patients was 0% (95% CI: 0-1%, I2: 59.91%). CONCLUSIONS The present study showed the pooled prevalence and a significant association between malaria and scrub typhus. The results show the status of co-infection. Further research into co-infection in endemic areas is needed, in particular, to determine whether co-infection can accelerate disease progression or protect against severe disease.
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Affiliation(s)
- Polrat Wilairatana
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400, Thailand
| | - Saruda Kuraeiad
- Department of Medical Technology, School of Allied Health Sciences, Walailak University, Tha Sala, Nakhon Si Thammarat, 80160, Thailand
| | - Pongruj Rattaprasert
- Department of Protozoology, Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400, Thailand
| | - Manas Kotepui
- Department of Medical Technology, School of Allied Health Sciences, Walailak University, Tha Sala, Nakhon Si Thammarat, 80160, Thailand.
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28
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Islam N, Wright S, Lau CL, Doi SAR, Mills DJ, Clark J, Clements ACA, Furuya-Kanamori L. Efficacy of a 3-day pretravel schedule of tafenoquine for malaria chemoprophylaxis: a network meta-analysis. J Travel Med 2021; 28:6217513. [PMID: 33834208 DOI: 10.1093/jtm/taab057] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 03/30/2021] [Accepted: 04/01/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Chemoprophylaxis with weekly doses of tafenoquine (200 mg/day for 3 days before departure [loading dose], 200 mg/week during travel and 1-week post-travel [maintenance doses]) is effective in preventing malaria. Effectiveness of malaria chemoprophylaxis drugs in travellers is often compromised by poor compliance. Shorter schedules that can be completed before travel, allowing 'drug-free holidays', could increase compliance and thus reduce travel-related malaria. In this meta-analysis, we examined if a loading dose of tafenoquine alone is effective in preventing malaria in short-term travellers. METHODS Four databases were searched in November 2020 for randomized controlled trials (RCTs) that assessed efficacy and/or safety of tafenoquine for chemoprophylaxis. Network meta-analysis using the generalized pair-wise modelling framework was utilized to estimate the odds ratio (OR) of malaria infection in long-term (>28 days) and short-term (≤28 days) travellers, as well as adverse events (AEs) associated with receiving loading dose of tafenoquine alone, loading dose of tafenoquine followed by maintenance doses, loading dose of mefloquine followed by maintenance doses, or placebo. RESULTS Nine RCTs (1714 participants) were included. In long-term travellers, compared to mefloquine, tafenoquine with maintenance doses (OR = 1.05; 95% confidence interval [CI]: 0.44-2.46) was equally effective in preventing malaria, while there was an increased risk of infection with the loading dose of tafenoquine alone (OR = 2.89; 95% CI: 0.78-10.68) and placebo (OR = 62.91; 95% CI: 8.53-463.88). In short-term travellers, loading dose of tafenoquine alone (OR = 0.98; 95% CI: 0.04-22.42) and tafenoquine with maintenance doses (OR = 1.00; 95% CI: 0.06-16.10) were as effective as mefloquine. The risk of AEs with tafenoquine with maintenance doses (OR = 1.03; 95% CI: 0.67-1.60) was similar to mefloquine, while loading dose of tafenoquine alone (OR = 0.58; 95% CI: 0.20-1.66) was associated with lower risk of AEs, although the difference was not statistically significant. CONCLUSIONS For short-term travellers, loading dose of tafenoquine alone was equally effective, had possibly lower rate of AEs, and likely better compliance than standard tafenoquine or mefloquine chemoprophylaxis schedules with maintenance doses. Studies are needed to confirm if short-term travellers remain free of infection after long-term follow-up. REGISTRATION The meta-analysis was registered in PROSPERO (CRD42021223756). HIGHLIGHT Tafenoquine is the latest approved drug for malaria chemoprophylaxis. A loading dose of tafenoquine (200 mg/day for 3 days before departure) is as effective in preventing malaria in short-term (≤28 days) travellers as chemoprophylaxis schedules of tafenoquine or mefloquine with maintenance doses, allowing travellers to have a 'drug-free holiday'.
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Affiliation(s)
- Nazmul Islam
- Department of Public Health, College of Health Sciences, QU Health, Qatar University, Doha, PO BOX 2713, Qatar
| | - Sophie Wright
- ANU Medical School, Australian National University, Canberra, ACT 2601, Australia
| | - Colleen L Lau
- School of Public Health, Faculty of Medicine, The University of Queensland, Herston, QLD 4006, Australia
- Dr Deb The Travel Doctor, Travel Medicine Alliance, Brisbane, QLD 4000, Australia
| | - Suhail A R Doi
- Department of Population Medicine, College of Medicine, QU Health, Qatar University, Doha, PO BOX 2713, Qatar
| | - Deborah J Mills
- Dr Deb The Travel Doctor, Travel Medicine Alliance, Brisbane, QLD 4000, Australia
- Research School of Population Health, Australian National University, Canberra, ACT 2601, Australia
| | - Justin Clark
- Institute for Evidence-Based Healthcare, Bond University, Robina, QLD 4226, Australia
| | | | - Luis Furuya-Kanamori
- Research School of Population Health, Australian National University, Canberra, ACT 2601, Australia
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, QLD 4029, Australia
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29
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Current Epidemiological Characteristics of Imported Malaria, Vector Control Status and Malaria Elimination Prospects in the Gulf Cooperation Council (GCC) Countries. Microorganisms 2021; 9:microorganisms9071431. [PMID: 34361867 PMCID: PMC8307262 DOI: 10.3390/microorganisms9071431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 06/22/2021] [Accepted: 06/25/2021] [Indexed: 11/23/2022] Open
Abstract
Malaria is the most common vector-borne parasitic infection causing significant human morbidity and mortality in nearly 90 tropical/sub-tropical countries worldwide. Significant differences exist in the incidence of malaria cases, dominant Plasmodium species, drug-resistant strains and mortality rates in different countries. Six Gulf Cooperation Council (GCC) countries (Bahrain, Kuwait, Qatar, Oman, Saudi Arabia and United Arab Emirates, UAE) in the Middle East region with similar climates, population demographics and economic prosperity are aiming to achieve malaria elimination. In this narrative review, all studies indexed in PubMed describing epidemiological characteristics of indigenous and imported malaria cases, vector control status and how malaria infections can be controlled to achieve malaria elimination in GCC countries were reviewed and discussed. These studies have shown that indigenous malaria cases are absent in Bahrain, Kuwait, Qatar and UAE and have progressively declined in Oman and Saudi Arabia. However, imported malaria cases continue to occur as GCC countries have large expatriate populations originating from malaria-endemic countries. Various malaria control and prevention strategies adopted by GCC countries including more stringent measures to reduce the likelihood of importing malaria cases by prior screening of newly arriving expatriates and vector elimination programs are likely to lead to malaria elimination in this region.
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Characterization of an outbreak of malaria in a non-endemic zone on the coastal region of Ecuador. ACTA ACUST UNITED AC 2021; 41:100-112. [PMID: 34111343 PMCID: PMC8320780 DOI: 10.7705/biomedica.5816] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Indexed: 11/21/2022]
Abstract
Introduction: Malar¡a ¡s a vector-borne d¡sease w¡dely d¡str¡buted ¡n the Amazon reg¡on and the coastal area of northern Ecuador. Its ep¡dem¡ology ¡nvolves related factors such as human settlements, vector reproduct¡on s¡tes, mob¡l¡ty, product¡ve act¡v¡ty, and the response capac¡ty of health systems, among others. Objective: To describe malaria transm¡ss¡on by Plasmodium vivax ¡n a non-endem¡c area of Ecuador by analyz¡ng the ep¡dem¡olog¡cal and entomolog¡cal factors ¡nvolved. Materials and methods: We conducted the epidemiological study of the cases reported ¡n the Sal¡nas canton and the character¡zat¡on of vector breed¡ng s¡tes through captures of larvae and adult mosqu¡toes by human capture of rest¡ng mosqu¡toes. Results: We detected 21 cases of malar¡a w¡th local transm¡ss¡on related to the presence of ¡n¡t¡al cases ¡n Venezuelan rrrigrant pat¡ents and ¡dentified Anopheles albimanus as the predom¡nant vector ¡n natural breed¡ng s¡tes such as estuar¡es, wells, and water channels. Conclusions: We detected an outbreak of malar¡a tr¡ggered by ¡mported cases from Venezuela. Cl¡mat¡c, soc¡al, env¡ronmental, and ecolog¡cal cond¡t¡ons have favored the development of the vector maintaining the transm¡ss¡on cycle. Strateg¡es to control ¡mported malar¡a should be mult¡ple ¡nclud¡ng early case detect¡on and control of product¡ve breed¡ng s¡tes to avo¡d local transm¡ss¡on.
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Pousibet-Puerto J, Lozano-Serrano AB, Soriano-Pérez MJ, Vázquez-Villegas J, Giménez-López MJ, Cabeza-Barrera MI, Cuenca-Gómez JÁ, Palanca-Giménez M, Luzón-García MP, Castillo-Fernández N, Cabezas-Fernández MT, Salas-Coronas J. Migration-associated malaria from Africa in southern Spain. Parasit Vectors 2021; 14:240. [PMID: 33962647 PMCID: PMC8103587 DOI: 10.1186/s13071-021-04727-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 04/16/2021] [Indexed: 11/23/2022] Open
Abstract
Background The western area of the province of Almeria, sited in southern Spain, has one of the highest immigrant population rates in Spain, mainly dedicated to agricultural work. In recent years, there has been a significant increase in the number of cases of imported malaria associated with migrants from countries belonging to sub-Saharan Africa. The objective of our study is to describe the epidemiological, clinical and analytical characteristics of malaria patients treated in a specialized tropical unit, paying special attention to the differences between VFR and non-VFR migrants and also to the peculiarities of microscopic malaria cases compared to submicroscopic ones. Methods Retrospective observational study of migrants over 14 years of age with imported malaria treated from October 2004 to May 2019. Characteristics of VFR and non-VFR migrants were compared. Malaria cases were divided into microscopic malaria (MM) and submicroscopic malaria (SMM). SMM was defined as the presence of a positive malaria PCR test together with a negative direct microscopic examination and a negative rapid diagnostic test (RDT). Microscopic malaria was defined as the presence of a positive RDT and/or a positive smear examination. Results Three hundred thirty-six cases of malaria were diagnosed, 329 in sub-Saharan immigrants. Of these, 78.1% were VFR migrants, in whom MM predominated (85.2% of cases). In non-VFR migrants, SMM represented 72.2% of the cases. Overall, 239 (72.6%) patients presented MM and 90 (27.4%) SMM. Fever was the most frequent clinical manifestation (64.4%), mainly in the MM group (MM: 81.1% vs SMM: 20.0%; p < 0.01). The most frequent species was P. falciparum. Patients with SMM presented fewer cytopenias and a greater number of coinfections due to soil-transmitted helminths, filarial and intestinal protozoa compared to patients with MM. Conclusions Imported malaria in our area is closely related to sub-Saharan migration. VFR migrants are the main risk group, highlighting the need for actions aimed at improving disease prevention measures. On the other hand, almost a third of the cases are due to SMM. This fact could justify its systematic screening, at least for those travelers at greater risk. Graphic Abstract ![]()
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Joaquín Salas-Coronas
- Tropical Medicine Unit. Hospital de Poniente, El Ejido, Almería, Spain. .,CEMyRI (Center for the Study of Migration and Intercultural Relations) of the University of Almeria, Almería, Spain.
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Current Status and the Epidemiology of Malaria in the Middle East Region and Beyond. Microorganisms 2021; 9:microorganisms9020338. [PMID: 33572053 PMCID: PMC7915327 DOI: 10.3390/microorganisms9020338] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 01/12/2021] [Accepted: 01/14/2021] [Indexed: 12/22/2022] Open
Abstract
Vector-borne parasitic infectious diseases are important causes of morbidity and mortality globally. Malaria is one of the most common vector-borne parasitic infection and is caused by five Plasmodium species, namely P. falciparum, P. vivax, P. ovale, P. malariae, and P. knowlesi. Epidemiologically, differences in the patterns of malaria cases, causative agent, disease severity, antimicrobial resistance, and mortality exist across diverse geographical regions. The world witnessed 229 million malaria cases which resulted in 409,000 deaths in 2019 alone. Although malaria cases are reported from 87 countries globally, Africa bears the brunt of these infections and deaths as nearly 94% of total malaria cases and deaths occur in this continent, particularly in sub-Saharan Africa. Most of the Middle East Region countries are malaria-free as no indigenous cases of infection have been described in recent years. However, imported cases of malaria continue to occur as some of these countries. Indeed, the six Gulf Cooperation Council (GCC) countries have large expatriate population originating from malaria endemic countries. In this review, the current status and epidemiology of malaria in the Middle East Region countries and other malaria-endemic countries that are home to a large migrant workforce being employed in Middle East Region countries are discussed.
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Sato S. Plasmodium-a brief introduction to the parasites causing human malaria and their basic biology. J Physiol Anthropol 2021; 40:1. [PMID: 33413683 PMCID: PMC7792015 DOI: 10.1186/s40101-020-00251-9] [Citation(s) in RCA: 92] [Impact Index Per Article: 30.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 12/21/2020] [Indexed: 02/07/2023] Open
Abstract
Malaria is one of the most devastating infectious diseases of humans. It is problematic clinically and economically as it prevails in poorer countries and regions, strongly hindering socioeconomic development. The causative agents of malaria are unicellular protozoan parasites belonging to the genus Plasmodium. These parasites infect not only humans but also other vertebrates, from reptiles and birds to mammals. To date, over 200 species of Plasmodium have been formally described, and each species infects a certain range of hosts. Plasmodium species that naturally infect humans and cause malaria in large areas of the world are limited to five—P. falciparum, P. vivax, P. malariae, P. ovale and P. knowlesi. The first four are specific for humans, while P. knowlesi is naturally maintained in macaque monkeys and causes zoonotic malaria widely in South East Asia. Transmission of Plasmodium species between vertebrate hosts depends on an insect vector, which is usually the mosquito. The vector is not just a carrier but the definitive host, where sexual reproduction of Plasmodium species occurs, and the parasite’s development in the insect is essential for transmission to the next vertebrate host. The range of insect species that can support the critical development of Plasmodium depends on the individual parasite species, but all five Plasmodium species causing malaria in humans are transmitted exclusively by anopheline mosquitoes. Plasmodium species have remarkable genetic flexibility which lets them adapt to alterations in the environment, giving them the potential to quickly develop resistance to therapeutics such as antimalarials and to change host specificity. In this article, selected topics involving the Plasmodium species that cause malaria in humans are reviewed.
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Affiliation(s)
- Shigeharu Sato
- Borneo Medical and Health Research Centre, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Jalan UMS, 88400 Kota Kinabalu, Sabah, Malaysia. .,Department of Pathobiology and Medical Diagnostics, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Jalan UMS, 88400, Kota Kinabalu, Sabah, Malaysia.
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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] [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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Ferra Murcia S, Hernández Sierra B, Vogt Sánchez EA, Collado Romacho AR. Febrile syndrome upon return from the tropics during the COVID-19 pandemic. Enferm Infecc Microbiol Clin 2020; 39:S0213-005X(20)30331-1. [PMID: 33279273 PMCID: PMC7832141 DOI: 10.1016/j.eimc.2020.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/20/2020] [Accepted: 10/25/2020] [Indexed: 11/10/2022]
Affiliation(s)
- Sergio Ferra Murcia
- Unidad de Enfermedades Infecciosas, Servicio Medicina Interna, Hospital Universitario Torrecárdenas, Almería, España.
| | | | | | - Antonio Ramón Collado Romacho
- Unidad de Enfermedades Infecciosas, Servicio Medicina Interna, Hospital Universitario Torrecárdenas, Almería, España
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36
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Abstract
The global spread of parasites is unquestionably linked with human activities. Migration in all its different forms played a major role in the introduction of parasites into new areas. In ancient times, mass migrations were the main causes for the spread of parasites while in the recent past and present, emigration, immigration, displacement, external and internal migration, and labor migration were the reasons for the dispersal of parasites. With the advent of seagoing ships, long-distance trading became another important mode of spreading parasites. This review summarizes the spread of parasites using notable examples. In addition, the different hypotheses explaining the arrival of Plasmodium vivax and soil-transmitted helminths in pre-Columbian America are also discussed.
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Affiliation(s)
- Dietmar Steverding
- Bob Champion Research and Education Building, Norwich Medical School, University of East Anglia , Norwich, UK
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37
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Osier F, Uzonna JE. Editorial: Regulation of Immunity to Parasitic Infections Endemic to Africa. Front Immunol 2020; 11:1159. [PMID: 32595637 PMCID: PMC7304307 DOI: 10.3389/fimmu.2020.01159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 05/12/2020] [Indexed: 12/03/2022] Open
Affiliation(s)
- Faith Osier
- Centre for Infectious Diseases, Heidelberg University Hospital, Heidelberg, Germany.,KEMRI Wellcome Trust Research Programme, Centre for Geographical Medicine Research, Kilifi, Kenya
| | - Jude E Uzonna
- Department of Immunology, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
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