1
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Rocha D, de Melo GC, Carneiro JMH, Ribeiro M, Ribeiro S, de Godoy DT, Costa E, de Almeida ACG, de Andrade EF, Abrahim CMDM, Fraiji NA, Ferreira AGP, Monteiro WM, Brindeiro R, Tanuri A, de Lacerda MVG, Alvarez P. Use of a NAT-based assay to improve the surveillance system and prevent transfusion-transmitted malaria in blood banks. Malar J 2020; 19:275. [PMID: 32736625 PMCID: PMC7395345 DOI: 10.1186/s12936-020-03345-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 07/23/2020] [Indexed: 02/04/2023] Open
Abstract
Background Malaria can be transmitted by blood transfusion through donations collected from asymptomatic donors. Transfusion-transmitted malaria (TTM) poses a great risk to blood services worldwide. A good screening tool for Plasmodium spp. detection in blood banks must have a high sensitivity for prevention of TTM. However, in Brazilian blood banks, screening for malaria still relies on microscopy. Methods In Brazil, screening for human immunodeficiency virus type 1 (HIV), RNA/DNA for hepatitis C (HCV) and hepatitis B (HBV) viruses is mandatory for every blood donation and uses nucleic acid amplification testing (NAT). The aim of this study was to evaluate the inclusion of an assay for malaria to identify Plasmodium sp. from total nucleic acid (TNA; DNA/RNA) by targeting the 18S rRNA gene of the parasite. Results Considering the limitations of microscopy and the wide availability of the Brazilian NAT platform in the screening of blood units for HIV, HCV, and HBV, a molecular diagnostic tool was validated for detection of Plasmodium sp. in blood banks; a pilot study showed that using this novel NAT assay could reduce the risk of TTM. Conclusion The prototype HIV/HCV/HBV/malaria NAT assay was effective in detecting infected candidate donors and has good prospects to be applied in routine screening for preventing TTM.
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Affiliation(s)
- Daniele Rocha
- Institute of Technology in Immunobiology Bio-Manguinhos, Oswaldo Cruz Foundation/Fiocruz, Avenida Brasil 4365, Rio de Janeiro, Brazil.,Departamento de Genética, Universidade Federal do Rio de Janeiro-UFRJ, Rio de Janeiro, Brazil
| | - Gisely Cardoso de Melo
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Heitor Vieira Dourado, Manaus, Amazonas, Brazil.,Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil
| | | | - Marisa Ribeiro
- Institute of Technology in Immunobiology Bio-Manguinhos, Oswaldo Cruz Foundation/Fiocruz, Avenida Brasil 4365, Rio de Janeiro, Brazil.,Departamento de Genética, Universidade Federal do Rio de Janeiro-UFRJ, Rio de Janeiro, Brazil
| | - Sthefanie Ribeiro
- Institute of Technology in Immunobiology Bio-Manguinhos, Oswaldo Cruz Foundation/Fiocruz, Avenida Brasil 4365, Rio de Janeiro, Brazil
| | - Daniela Tupy de Godoy
- Institute of Technology in Immunobiology Bio-Manguinhos, Oswaldo Cruz Foundation/Fiocruz, Avenida Brasil 4365, Rio de Janeiro, Brazil
| | - Elaine Costa
- Institute of Technology in Immunobiology Bio-Manguinhos, Oswaldo Cruz Foundation/Fiocruz, Avenida Brasil 4365, Rio de Janeiro, Brazil
| | - Anne Cristine Gomes de Almeida
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Heitor Vieira Dourado, Manaus, Amazonas, Brazil
| | - Elisabete Ferreira de Andrade
- Institute of Technology in Immunobiology Bio-Manguinhos, Oswaldo Cruz Foundation/Fiocruz, Avenida Brasil 4365, Rio de Janeiro, Brazil.,Departamento de Genética, Universidade Federal do Rio de Janeiro-UFRJ, Rio de Janeiro, Brazil
| | | | - Nelson Abrahim Fraiji
- HEMOAM-Fundação Hospitalar de Hematologia e Hemoterapia do Amazonas, Manaus, Amazonas, Brazil
| | - Antonio Gomes Pinto Ferreira
- Institute of Technology in Immunobiology Bio-Manguinhos, Oswaldo Cruz Foundation/Fiocruz, Avenida Brasil 4365, Rio de Janeiro, Brazil
| | - Wuelton Marcelo Monteiro
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Heitor Vieira Dourado, Manaus, Amazonas, Brazil.,Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil
| | - Rodrigo Brindeiro
- Departamento de Genética, Universidade Federal do Rio de Janeiro-UFRJ, Rio de Janeiro, Brazil
| | - Amilcar Tanuri
- Departamento de Genética, Universidade Federal do Rio de Janeiro-UFRJ, Rio de Janeiro, Brazil
| | - Marcus Vinicius Guimarães de Lacerda
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Heitor Vieira Dourado, Manaus, Amazonas, Brazil.,Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil.,Instituto de Pesquisas Leônidas e Maria Deane, Fiocruz, Manaus, Amazonas, Brazil
| | - Patrícia Alvarez
- Institute of Technology in Immunobiology Bio-Manguinhos, Oswaldo Cruz Foundation/Fiocruz, Avenida Brasil 4365, Rio de Janeiro, Brazil.
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2
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Mardani A. Prevention strategies of transfusion-transmitted parasitic infections (TTPIs): Strengths and challenges of current approaches, and evaluation of the strategies implemented in Iran. Parasite Epidemiol Control 2020; 9:e00141. [PMID: 32149193 PMCID: PMC7052507 DOI: 10.1016/j.parepi.2020.e00141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 01/27/2020] [Accepted: 02/16/2020] [Indexed: 11/30/2022] Open
Abstract
Background Several strategies are being implemented in blood transfusion centers of the world to prevent the transfusion-transmitted parasitic infections (TTPIs). The objective of this study was to determine and describe the strategies to minimize the transmission risk of parasitic agents via blood transfusion in Iran. Methods This study was conducted in the Iranian blood transfusion organization (IBTO). The data were extracted from the latest version of the “medical interview” standard operating procedure (SOP). Results The donor selection is the first and only step to reduce the risk of TTPIs in endemic and non-endemic areas of Iran. In all blood transfusion centers of the IBTO, the blood donation volunteers with a previous history of malaria, Chagas disease, visceral leishmaniasis (VL), muco-cutaneous leishmaniasis and babesiosis, as well as those with clinical toxoplasmosis, cutaneous leishmaniasis (CL) and with a history of residence in, or travel to, malaria-endemic areas are permanently or temporarily deferred from the blood donation. Conclusions Since malaria, toxoplasmosis and VL are endemic in parts of Iran, as well as the increasing travels to endemic areas and immigrations from endemic to non-endemic areas of parasitic infections, the extensive use of blood and blood components and the asymptomatic occurrence of most parasitic infections in blood donors, the donor selection strategy is not sufficient to prevent the TTPIs. Therefore, the changing of donor selection process and the use of other common preventive strategies are recommended to reduce the risk of TTPIs, especially for high-risk groups of toxoplasmosis and VL.
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Affiliation(s)
- Ahmad Mardani
- Department of Microbiology, Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran
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3
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Batista-Dos-Santos SA, Freitas DRC, Raiol M, Cabral GF, Feio AC, Póvoa MM, Cunha MG, Ribeiro-Dos-Santos Â. Strategy to improve malaria surveillance system preventing transfusion-transmitted malaria in blood banks using molecular diagnostic. Malar J 2018; 17:344. [PMID: 30285750 PMCID: PMC6167815 DOI: 10.1186/s12936-018-2486-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 09/19/2018] [Indexed: 11/10/2022] Open
Abstract
Background Malaria can be transmitted by blood transfusion through donations collected from asymptomatic or parasitic donors. The parasites are released into the bloodstream during its life cycle and will therefore be present in donated blood by infected individuals. All cases of transfusion-transmitted malaria (TTM) notified since 2005 in Brazil were fatal. A good screening tool for Plasmodium spp. detection in blood units must have a high detection threshold, and the prevention of TTM relies entirely on the exclusion of potentially infected donors. However, in Brazilian blood banks, the screening test relies on blood thick smears examination. Methods The molecular diagnostic based on mitochondrial DNA (mtDNA) using real time PCR (mt-qPCR) was improved to detect Plasmodium falciparum, Plasmodium vivax, and standardized for use in Plasmodium malariae. The analytic sensitivity of this mt-qPCR methodology was performed using a sample of P. vivax. Results The mt-qPCR was highly efficient, and the analytic sensitivity for P. vivax was determined (0.000006 parasites/µL). This method was tested to detect P. vivax and P. falciparum in individuals from two malaria-endemic areas in Brazil, Amazon region (Pará and Rondônia states), the samples were collected in 10 reference units of two blood banks (Pará/nine cities and Rondônia/Porto Velho), and parasites mtDNA were detected in 10 of 2224 potential blood donors (0.45%). In all 10 positive samples, only P. vivax was detected. Conclusion Molecular diagnostic using mt-qPCR was effective in revealing infected potential donors with good perspectives to be applied as screening routine of asymptomatic carriers for preventing transfusion-transmitted malaria in blood banks.
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Affiliation(s)
- Sérgio Antônio Batista-Dos-Santos
- Laboratório de Genética Humana e Médica, Universidade Federal do Pará, Belém, Pará, CEP: 66075-110, Brazil.,Fundação Centro de Hemoterapia e Hematologia do Pará, Belém, Pará, CEP: 660033-000, Brazil
| | | | - Milene Raiol
- Laboratório de Genética Humana e Médica, Universidade Federal do Pará, Belém, Pará, CEP: 66075-110, Brazil
| | - Gleyce F Cabral
- Laboratório de Genética Humana e Médica, Universidade Federal do Pará, Belém, Pará, CEP: 66075-110, Brazil
| | - Ana Cecília Feio
- Instituto Evandro Chagas, Ananindeua, Pará, CEP: 66087-082, Brazil
| | - Marinete M Póvoa
- Instituto Evandro Chagas, Ananindeua, Pará, CEP: 66087-082, Brazil
| | - Maristela G Cunha
- Laboratório de Microbiologia e Imunologia, Universidade Federal do Pará, Belém, Pará, CEP: 66075-110, Brazil.
| | - Ândrea Ribeiro-Dos-Santos
- Laboratório de Genética Humana e Médica, Universidade Federal do Pará, Belém, Pará, CEP: 66075-110, Brazil
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4
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Lin H, Zhu S, Zhu S, Shao L, Zhu N, Huang C, Sun J. Selective malaria antibody screening among eligible blood donors in Jiangsu, China. Rev Inst Med Trop Sao Paulo 2017; 59:e43. [PMID: 28793014 PMCID: PMC5553941 DOI: 10.1590/s1678-9946201759043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 02/22/2017] [Indexed: 01/30/2023] Open
Abstract
The risk of transfusion-transmitted malaria is a major concern in many countries.
This study investigated the prevalence of malaria antibodies and parasitemia in
eligible blood donors in Jiangsu, in Eastern China. Malaria antibodies were detected
in 2.13% of the 704 plasma samples studied. We found that the prevalence of malaria
antibodies was not significantly correlated with gender, occupation and frequency of
donation, but it increased with age. No Plasmodium was observed in
red blood cells and no Plasmodium DNA was detected in any of the
antibody-positive samples. The prevalence of malaria antibodies was not higher than
expected in Eastern China.
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Affiliation(s)
- Hong Lin
- Jiangsu Province Blood Center, Nanjing, China
| | - Shaowen Zhu
- Jiangsu Province Blood Center, Nanjing, China
| | | | - Lei Shao
- Jiangsu Province Blood Center, Nanjing, China
| | - Nan Zhu
- Jiangsu Province Blood Center, Nanjing, China
| | | | - Jun Sun
- Jiangsu Province Blood Center, Nanjing, China
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5
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Alho RM, Machado KVA, Val FFA, Fraiji NA, Alexandre MAA, Melo GC, Recht J, Siqueira AM, Monteiro WM, Lacerda MVG. Alternative transmission routes in the malaria elimination era: an overview of transfusion-transmitted malaria in the Americas. Malar J 2017; 16:78. [PMID: 28202065 PMCID: PMC5312538 DOI: 10.1186/s12936-017-1726-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 02/06/2017] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Transfusion-transmitted (TT) malaria is an alternative infection route that has gained little attention from authorities, despite representing a life-threatening condition. There has been no systematic review of this health problem in American countries. The aim of this study was to describe the clinical and epidemiological characteristics of TT malaria in the Americas and identify factors associated with lethality based on the studies published in the literature. METHODS Potentially relevant papers in all languages were retrieved from MEDLINE and LILACS. Additional articles were obtained from reviews and original papers. Publications on screening of candidate blood donors and on surveillance of TT malaria cases were included. Odds ratios with respective 95% confidence intervals (95% CI) were calculated. Epidemiological characteristics of blood donors of TT malaria cases, including a pooled positivity of different tests for malaria diagnosis, were retrieved. RESULTS A total of 63 publications regarding TT malaria from seven countries were included, from 1971 to 2016. A total of 422 cases of TT malaria were recorded. Most TT malaria cases were in females (62.0%) and 39.5% were in the ≥61 years-old age group. About half of all cases were from Mexico (50.7%), 40.3% from the United States of America (USA) and 6.6% from Brazil. Gyneco-obstetrical conditions (67.3%), surgical procedures (20.6%) and complications from neoplasias (6.1%) were the most common indications of transfusion. Packed red blood cells (RBCs) (50.7%) and whole blood (43.3%) were the blood products mostly associated with TT malaria. Cases were mostly caused by Plasmodium malariae (58.4%), followed by Plasmodium vivax (20.7%) and Plasmodium falciparum (17.9%). A total of 66.6% of cases were diagnosed by microscopy. Incubation period of 2-3 weeks was the most commonly observed (28.6%). Lethality was seen in 5.3% of cases and was associated with living in non-endemic countries, P. falciparum infection and concomitant neoplastic diseases. CONCLUSION There is an important research and knowledge gap regarding the TT malaria burden in Latin American countries where malaria remains endemic. No screening method that is practical, affordable and suitably sensitive is available at blood banks in Latin American countries, where infections with low parasitaemia contribute greatly to transmission. Lethality from TT malaria was not negligible. TT malaria needs to be acknowledged and addressed in areas moving toward elimination.
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Affiliation(s)
- Regina M Alho
- Universidade do Estado do Amazonas, Av. Pedro Teixeira, 25, Dom Pedro, Manaus, AM, 69040-000, Brazil.,Fundação de Hematologia e Hemoterapia do Amazonas, Av. Constantino Nery, 4397, Chapada, Manaus, AM, 69050-002, Brazil
| | - Kim Vinícius Amaral Machado
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Av. Pedro Teixeira, 25, Dom Pedro, Manaus, AM, 69040-000, Brazil
| | - Fernando F A Val
- Universidade do Estado do Amazonas, Av. Pedro Teixeira, 25, Dom Pedro, Manaus, AM, 69040-000, Brazil.,Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Av. Pedro Teixeira, 25, Dom Pedro, Manaus, AM, 69040-000, Brazil
| | - Nelson A Fraiji
- Fundação de Hematologia e Hemoterapia do Amazonas, Av. Constantino Nery, 4397, Chapada, Manaus, AM, 69050-002, Brazil
| | - Marcia A A Alexandre
- Universidade do Estado do Amazonas, Av. Pedro Teixeira, 25, Dom Pedro, Manaus, AM, 69040-000, Brazil
| | - Gisely C Melo
- Universidade do Estado do Amazonas, Av. Pedro Teixeira, 25, Dom Pedro, Manaus, AM, 69040-000, Brazil.,Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Av. Pedro Teixeira, 25, Dom Pedro, Manaus, AM, 69040-000, Brazil
| | | | - André M Siqueira
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Av. Brasil, 4365, Manguinhos, Rio de Janeiro, RJ, 21040-360, Brazil
| | - Wuelton M Monteiro
- Universidade do Estado do Amazonas, Av. Pedro Teixeira, 25, Dom Pedro, Manaus, AM, 69040-000, Brazil. .,Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Av. Pedro Teixeira, 25, Dom Pedro, Manaus, AM, 69040-000, Brazil.
| | - Marcus V G Lacerda
- Universidade do Estado do Amazonas, Av. Pedro Teixeira, 25, Dom Pedro, Manaus, AM, 69040-000, Brazil.,Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Av. Pedro Teixeira, 25, Dom Pedro, Manaus, AM, 69040-000, Brazil.,Instituto de Pesquisas Leônidas & Maria Deane, Fundação Oswaldo Cruz, Rua Terezina, 476, Adrianópolis, Manaus, AM, 69057-070, Brazil
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6
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Mendonça VRD, Barral-Netto M. Immunoregulation in human malaria: the challenge of understanding asymptomatic infection. Mem Inst Oswaldo Cruz 2015; 110:945-55. [PMID: 26676319 PMCID: PMC4708013 DOI: 10.1590/0074-02760150241] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 10/23/2015] [Indexed: 12/21/2022] Open
Abstract
Asymptomatic Plasmodium infection carriers represent a major threat
to malaria control worldwide as they are silent natural reservoirs and do not seek
medical care. There are no standard criteria for
asymptomaticPlasmodium infection; therefore, its diagnosis relies
on the presence of the parasite during a specific period of symptomless infection.
The antiparasitic immune response can result in reducedPlasmodium
sp. load with control of disease manifestations, which leads to asymptomatic
infection. Both the innate and adaptive immune responses seem to play major roles in
asymptomatic Plasmodiuminfection; T regulatory cell activity
(through the production of interleukin-10 and transforming growth factor-β) and
B-cells (with a broad antibody response) both play prominent roles. Furthermore,
molecules involved in the haem detoxification pathway (such as haptoglobin and haeme
oxygenase-1) and iron metabolism (ferritin and activated c-Jun N-terminal kinase)
have emerged in recent years as potential biomarkers and thus are helping to unravel
the immune response underlying asymptomatic Plasmodium infection.
The acquisition of large data sets and the use of robust statistical tools, including
network analysis, associated with well-designed malaria studies will likely help
elucidate the immune mechanisms responsible for asymptomatic infection.
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Affiliation(s)
- Vitor R de Mendonça
- Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, BA, Brasil
| | - Manoel Barral-Netto
- Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, BA, Brasil
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7
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Das NG, Dhiman S, Talukdar PK, Goswami D, Rabha B, Baruah I, Veer V. Role of asymptomatic carriers and weather variables in persistent transmission of malaria in an endemic district of Assam, India. Infect Ecol Epidemiol 2015; 5:25442. [PMID: 25595688 PMCID: PMC4297276 DOI: 10.3402/iee.v5.25442] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Revised: 11/24/2014] [Accepted: 11/28/2014] [Indexed: 11/16/2022] Open
Abstract
Background Malaria transmission is perennial in the Assam–Arunachal Pradesh interstate border areas in the Sonitpur district of Assam, India. A yearlong study was carried out on the incidence of symptomatic and asymptomatic malaria and the role of asymptomatic malaria carriers in persistent transmission of the disease. The relationships between malaria incidence and weather parameters were also investigated. Methods Active and mass blood surveys were conducted on a monthly basis in Bengenajuli, Sapairaumari Pathar, and Nigam villages near the Assam–Arunachal Pradesh border. Epidemiological indices were estimated for malaria-positive cases. Multiple linear regression between monthly malaria incidence and monthly average temperature, and relative humidity along with monthly total rainfall was carried out. The known malaria vectors collected in CDC light traps were identified and recorded. Results Slide positivity rate (SPR) and Plasmodium falciparum percent (Pf%) for symptomatic malaria were 26.1 and 79.8, respectively. Prevalence of malaria vectors was observed throughout the year with varying density. Anopheles philippinensis/nivipes and A. annularis were predominant among the seven known vector species recorded currently. Asymptomatic parasitemia was detected throughout the year with SPR ranging from 4.8 to 5.3. Monthly rainfall with 1-month lag had the highest correlation (r=0.92) with SPR. The relationship between SPR and weather factors was established as SPR=−114.22+0.58 Tmin+1.38 RH+0.03 RF (R2=0.89; p=0.00). Conclusion Low and relatively constant levels of asymptomatic parasitemia was present in the study area. High malaria vector density and presence of asymptomatic malaria parasite carriers were responsible for persistent malaria transmission in the region. This study concludes that passive detection and prompt treatment of asymptomatic carriers is essential for preventing persistent disease transmission. Rainfall along with some other weather variables may be used for predicting the malaria epidemics in the region. The predictive information could be useful to target resources more effectively.
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Affiliation(s)
| | - Sunil Dhiman
- Defence Research Laboratory, Tezpur, Assam, India
| | | | | | - Bipul Rabha
- Defence Research Laboratory, Tezpur, Assam, India
| | - Indra Baruah
- Defence Research Laboratory, Tezpur, Assam, India
| | - Vijay Veer
- Defence Research Laboratory, Tezpur, Assam, India
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8
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Freitas DRC, Duarte EC. Normative evaluation of blood banks in the Brazilian Amazon region in respect to the prevention of transfusion-transmitted malaria. Rev Bras Hematol Hemoter 2014; 36:394-402. [PMID: 25453648 PMCID: PMC4318476 DOI: 10.1016/j.bjhh.2014.09.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Accepted: 06/25/2014] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To evaluate blood banks in the Brazilian Amazon region with regard to structure and procedures directed toward the prevention of transfusion-transmitted malaria (TTM). METHODS This was a normative evaluation based on the Brazilian National Health Surveillance Agency (ANVISA) Resolution RDC No. 153/2004. Ten blood banks were included in the study and classified as 'adequate' (≥80 points), 'partially adequate' (from 50 to 80 points), or 'inadequate' (<50 points). The following components were evaluated: 'donor education' (5 points), 'clinical screening' (40 points), 'laboratory screening' (40 points) and 'hemovigilance' (15 points). RESULTS The overall median score was 49.8 (minimum=16; maximum=78). Five blood banks were classified as 'inadequate' and five as 'partially adequate'. The median clinical screening score was 26 (minimum=16; maximum=32). The median laboratory screening score was 20 (minimum=0; maximum=32). Eight blood banks performed laboratory tests for malaria; six tested all donations. Seven used thick smears, but only one performed this procedure in accordance with Ministry of Health requirements. One service had a Program of External Quality Evaluation for malaria testing. With regard to hemovigilance, two institutions reported having procedures to detect cases of transfusion-transmitted malaria. CONCLUSION Malaria is neglected as a blood-borne disease in the blood banks of the Brazilian Amazon region. None of the institutions were classified as 'adequate' in the overall classification or with regard to clinical screening and laboratory screening. Blood bank professionals, the Ministry of Health and Health Surveillance service managers need to pay more attention to this matter so that the safety procedures required by law are complied with.
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Affiliation(s)
- Daniel Roberto Coradi Freitas
- Universidade de Brasília (UnB), Brasília, DF, Brazil; Agência Nacional de Vigilância Sanitária (ANVISA), Brasília, DF, Brazil.
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9
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Mendrone A, Cerutti C, Levi JE, Boulos M, Sanchez MCA, Malafronte RDS, Di Santi SM, Odone V. Unexpected detection of Plasmodium vivax and Plasmodium falciparum DNA in asymptomatic blood donors: fact or artifact? Malar J 2014; 13:336. [PMID: 25168246 PMCID: PMC4158092 DOI: 10.1186/1475-2875-13-336] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Accepted: 08/08/2014] [Indexed: 11/23/2022] Open
Abstract
A study searching for Plasmodium vivax and Plasmodium falciparum DNA among blood donors from the non-endemic area in Brazil reported a rate of 7.41%. This number is at least three times higher than what has been observed in blood donors from the Amazon, an endemic area concentrating >99% of all malaria cases in Brazil. Moreover, the majority of the donors were supposedly infected by P. falciparum, a rare finding both in men and anophelines from the Atlantic forest. These findings shall be taken with caution since they disagree with several publications in the literature and possibly overestimate the actual risk of malaria transmission by blood transfusion in São Paulo city.
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Affiliation(s)
- Alfredo Mendrone
- />Fundação Pró-Sangue, Hemocentro de São Paulo, São Paulo, Brazil
| | - Crispim Cerutti
- />Unidade de Medicina Tropical, Universidade Federal do Espírito Santo, Vitoria, Brazil
| | - José Eduardo Levi
- />Fundação Pró-Sangue, Hemocentro de São Paulo, São Paulo, Brazil
- />Instituto de Medicina Tropical, Universidade de São Paulo, São Paulo, Brazil
| | - Marcos Boulos
- />Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | | | - Silvia Maria Di Santi
- />Instituto de Medicina Tropical, Universidade de São Paulo, São Paulo, Brazil
- />Superintendência de Controle de Endemias, Secretaria de Estado da Saúde de São Paulo, São Paulo, Brazil
| | - Vicente Odone
- />Fundação Pró-Sangue, Hemocentro de São Paulo, São Paulo, Brazil
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10
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Maselli LMF, Levy D, Laporta GZ, Monteiro AM, Fukuya LA, Ferreira-da-Cruz MF, Daniel-Ribeiro CT, Dorlhiac-Llacer PE, Sallum MAM, Bydlowski SP. Detection of Plasmodium falciparum and Plasmodium vivax subclinical infection in non-endemic region: implications for blood transfusion and malaria epidemiology. Malar J 2014; 13:224. [PMID: 24906577 PMCID: PMC4059091 DOI: 10.1186/1475-2875-13-224] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 06/03/2014] [Indexed: 11/22/2022] Open
Abstract
Background In Brazil, malaria is endemic in the Amazon River basin and non-endemic in the extra-Amazon region, which includes areas of São Paulo state. In this state, a number of autochthonous cases of malaria occur annually, and the prevalence of subclinical infection is unknown. Asymptomatic infections may remain undetected, maintaining transmission of the pathogen, including by blood transfusion. In these report it has been described subclinical Plasmodium infection in blood donors from a blood transfusion centre in São Paulo, Brazil. Methods In this cross-sectional study, representative samples of blood were obtained from 1,108 healthy blood donors at the Fundação Pró-Sangue Hemocentro de São Paulo, the main blood transfusion centre in São Paulo. Malaria exposure was defined by the home region (exposed: forest region; non-exposed: non-forest region). Real-time PCR was used to detect Plasmodium falciparum and Plasmodium vivax. Subclinical malaria cases were geo-referenced. Results Eighty-four (7.41%) blood donors tested positive for Plasmodium; 57 of these were infected by P. falciparum, 25 by P. vivax, and 2 by both. The prevalence of P. falciparum and P. vivax was 5.14 and 2.26, respectively. The overall prevalence ratio (PR) was 3.23 (95% confidence interval (CI) 2.03, 5.13); P. falciparum PR was 16.11 (95% CI 5.87, 44.21) and P. vivax PR was 0.47 (95% CI 0.2, 1.12). Plasmodium falciparum subclinical malaria infection in the Atlantic Forest domain was present in the mountain regions while P. vivax infection was observed in cities from forest-surrounded areas. Conclusions The presence of Plasmodium in healthy blood donors from a region known as non-endemic, which is important in the context of transfusion biosafety, was described. Infected recipients may become asymptomatic carriers and a reservoir for parasites, maintaining their transmission. Furthermore, P. falciparum PR was positively associated with the forest environment, and P. vivax was associated with forest fragmentation.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Sérgio P Bydlowski
- Laboratory of Genetics and Molecular Hematology (LIM31), University of Sao Paulo School of Medicine, Av, Dr, Enéas de Carvalho Aguiar, 155 - 1st floor - room 43, São Paulo, SP 05403-000, Brazil.
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Torres KL, Dos Santos Moresco MN, Sales LR, da Silva Abranches J, Araújo Alexandre MA, Malheiro A. Transfusion-transmitted malaria in endemic zone: epidemiological profile of blood donors at the Fundação HEMOAM and use of rapid diagnostic tests for malaria screening in Manaus. Rev Bras Hematol Hemoter 2014; 36:269-74. [PMID: 25031166 PMCID: PMC4207922 DOI: 10.1016/j.bjhh.2014.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Accepted: 03/24/2014] [Indexed: 10/29/2022] Open
Abstract
OBJECTIVE With 99% of the cases in Brazil, malaria is endemic in the Amazon region. Transfusion-transmitted malaria, an important risk in endemic areas, has been reported. The aim of this study was to describe the epidemiological profile of blood donor candidates at the Fundação de Hematologia e Hemoterapia do Amazonas and evaluate the efficacy of rapid diagnostic tests used for malaria screening of blood donors within endemic regions. METHODS Between May 2008 and May 2009, 407 blood donor candidates were selected and grouped based on the Malaria Annual Parasite Index of the geographic area in which they originated: Group 1 (eligible donors - n=265) originated from areas of low to medium risk of exposure to malaria and Group 2 (ineligible donors - n=142) originated from high-risk areas. All samples were concurrently screened using two immunochromatic antigen-based rapid tests and by the thick smear test. RESULTS All samples were negative by all three methods. The demographic profile indicated that the majority of participants were male, ages ranged from 18 to 39 years and less than half the candidates had only elementary schooling. Two issues need to be addressed: one is the ineligibility of donors and its impact on blood donor centers as, in this study, 22.7% of the donors were considered ineligible. The other is the limited sensitivity of the parasitological tests used, allowing a risk of false-negative results. CONCLUSION New methods are needed to ensure transfusion safety without rejecting potential donors, which would ensure safe transfusion without harming the blood supply.
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Affiliation(s)
- Kátia Luz Torres
- Fundação Centro de Controle de Oncologia do Amazonas, Manaus, AM, Brazil; Fundação Hospitalar de Hematologia e Hemoterapia, Manaus, AM, Brazil; Universidade Federal do Amazonas, Manaus, AM, Brazil.
| | | | - Luciane Rodrigues Sales
- Fundação Centro de Controle de Oncologia do Amazonas, Manaus, AM, Brazil; Universidade Federal do Amazonas, Manaus, AM, Brazil
| | | | - Márcia Almeida Araújo Alexandre
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM, Brazil; Universidade do Estado do Amazonas, Manaus, AM, Brazil
| | - Adriana Malheiro
- Fundação Hospitalar de Hematologia e Hemoterapia, Manaus, AM, Brazil; Universidade Federal do Amazonas, Manaus, AM, Brazil
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de Freitas DRC, Gomes LT, Fontes CJF, Tauil PL, Pang LW, Duarte EC. Sensitivity of nested-PCR for plasmodium detection in pooled whole blood samples and its usefulness to blood donor screening in endemic areas. Transfus Apher Sci 2014; 50:242-6. [PMID: 24508148 DOI: 10.1016/j.transci.2014.01.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Revised: 01/07/2014] [Accepted: 01/11/2014] [Indexed: 10/25/2022]
Abstract
Transfusion-transmitted malaria is a severe disease with high fatality rate. Most Brazilian blood banks in the Amazon region perform malaria screening using microscopic examination (thick smears). Since low parasite concentrations are expected in asymptomatic blood donors a high sensitivity test should be used for donor screening. This study determined the sensitivity of a nested-PCR for plasmodium detection in pooled samples. We performed a one-stage criterion validation study with 21 positive samples pooled with samples from ten negative volunteer until three different concentrations were reached (0.33; 0.25; 0.20 parasites/μL - p/μL). Nested PCR was performed as described by Snounou et al. (1993). Sensitivities (and confidence intervals) were determined by stratum of final parasite concentration on the pooled samples. All samples with parasitemia values of 0.33 and 0.25 p/μL had 100% sensitivity (95%CI=86.3-100). One negative result was obtained from a sample with 0.20 p/μL sensitivity=95.2% (95%CI=76.2-99.9). Compared to parasitemia detectable under ideal conditions of thick smear, this nested-PCR in pooled sample was able to detect 40 times more parasites per microliter. Nested-PCR in pooled samples should be considered as a high sensitive alternative to thick smear for donor screening in blood banks at endemic regions. Local authorities need to assess cost:benefit advantages of this method compared to alternatives.
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Affiliation(s)
- Daniel Roberto Coradi de Freitas
- Tropical Medicine Center, Universidade de Brasília, Brasília, DF, Brazil; National Agency for Health Surveillance (Anvisa), Brazil.
| | | | | | - Pedro Luiz Tauil
- Tropical Medicine Center, Universidade de Brasília, Brasília, DF, Brazil
| | - Lorrin W Pang
- Tropical Medicine Center, Universidade de Brasília, Brasília, DF, Brazil
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Batista-dos-Santos S, Raiol M, Santos S, Cunha MG, Ribeiro-dos-Santos Â. Real-time PCR diagnosis of Plasmodium vivax among blood donors. Malar J 2012; 11:345. [PMID: 23062229 PMCID: PMC3523982 DOI: 10.1186/1475-2875-11-345] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Accepted: 10/03/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND When selecting blood donors in transfusion centres, one important problem is to identify, during screening, individuals with infectious diseases that can be transmitted by blood, such as malaria, especially when the parasite densities are very low. This problem is particularly severe in endemic areas, such as the Brazilian Amazon. In the present study, molecular diagnostic (real-time PCR) of Plasmodium vivax was used to identify blood donors infected with malaria parasites. METHODS Samples from 595 blood donors were collected in seven haemotherapy centres in northern Brazil located in areas at risk for malaria transmission, and the analyses were performed by real-time PCR with TaqMan probes on 7500 Real-Time PCR Systems, to genotype the mitochondrial DNA region specific to P. vivax. The experiment was designed for hybridization of the cytochrome c oxidase genes of the mitochondrial genome (GenBank GI63022502). The serological data were obtained using enzyme-linked immunosorbent assay - ELISA (Anti-HIV, Anti-HTLV I-II; Anti-HVC, HBsAg, Anti-HBc, Chagas disease) and VDRL (Syphilis) from the Blood Bank System of the Haematology and Haemotherapy Centre of Pará. RESULTS The assay identified eight individuals in the sample (1.34%) infected with P. vivax at the time of blood donation. This percentage was higher than the altered serological results (reactive or inconclusive) of the prevalence of anti-HIV (0.67%), anti-hepatitis C virus (0.34%), anti-hepatitis B surface antigen (0.67%), anti-human T-lymphotropic virus I/II (1.18%), anti-Chagas disease (0.17%) and syphilis (VDRL) (0.50%), but not higher than anti-hepatitis B core antigen antibodies (4.37%). This result indicates the need to use more sensitive methods of diagnosing malaria in blood banks. CONCLUSION The real-time PCR with TaqMan probes enabled the identification of P. vivax in a high proportion of clinically healthy donors, highlighting the potential risk for transfusion-transmitted malaria. Additionally, this molecular diagnostic tool can be adopted as a new laboratory screening method in haemotherapy centres, especially in malaria-endemic areas.
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Affiliation(s)
- Sergio Batista-dos-Santos
- Centro de Hemoterapia e Hematologia do Pará, Tv. Padre Eutíquio, 2109,CEP, Belém, Pará 660033-000, Brazil
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14
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Survey for asymptomatic malaria cases in low transmission settings of Iran under elimination programme. Malar J 2012; 11:126. [PMID: 22533733 PMCID: PMC3464154 DOI: 10.1186/1475-2875-11-126] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Accepted: 04/25/2012] [Indexed: 11/16/2022] Open
Abstract
Background In malaria endemic areas, continuous exposure to Plasmodium parasites leads to asymptomatic carriers that provide a fundamental reservoir of parasites, contributing to the persistence of malaria transmission. Therefore, in the present investigation, the presence and prevalence of malaria asymptomatic cases were determined to evaluate the reservoir of infection in two malaria endemic areas with a previous history of malaria transmission in the south of Iran, Bashagard and Ghale-Ganj districts of Hormozgan and Kerman provinces, respectively, where malaria transmission has been drastically reduced in the recent years. Methods The population samples (n=500 from each of the studied areas) were randomly collected from non-febrile, long-term residing, aged two to over 60years, during 20092010. Three identical surveys were carried out in both study areas and in each phase all the consent participants were interviewed and clinically examined. In all, three surveys to detect hidden parasite reservoirs (both Plasmodium falciparum and Plasmodium vivax), thick and thin blood smears and a highly sensitive nested-PCR were applied. In addition, the sero-prevalence survey for detecting malaria exposure was done by using a serological marker. Results In this study, P. vivax and P. falciparum parasites were not detected by light microscopy and nested-PCR assay in all three surveys of samples. Antibody responses against P. vivax and P. falciparum were detected in 1 % and 0.2 % of the total examined individuals, respectively, in Bashagard district. Regarding to Ghale-Ganj district, about 0.9% of the individuals had IgG -specific antibody to P. vivax at the first and second surveys, but at the third survey 0.45% of the participants had positive antibody to P. vivax parasite. IgG -specific antibody to P. falciparum was detected in 0.2% of the participants at the first and follow-up surveys. The overall regional differences were not statistically significant (P>0.05). Conclusion Taken together, the lack of asymptomatic carrier with the evidence of extremely low sero-positive to both P. vivax and P. falciparum among examined individuals supported the limited recent transmission in the studied areas and, therefore, these parts of Iran have potential to eliminate the disease in the next few years. However, continued follow up and action are still needed in both studied areas and also in their neighbouring province, Sistan and Baluchistan, which has the highest reported cases of malaria in Iran and also, has the largest border line with Afghanistan and Pakistan, with no elimination activities. This data will provide useful information for managing elimination activities in Iran.
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Laishram DD, Sutton PL, Nanda N, Sharma VL, Sobti RC, Carlton JM, Joshi H. The complexities of malaria disease manifestations with a focus on asymptomatic malaria. Malar J 2012; 11:29. [PMID: 22289302 PMCID: PMC3342920 DOI: 10.1186/1475-2875-11-29] [Citation(s) in RCA: 182] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2011] [Accepted: 01/31/2012] [Indexed: 12/02/2022] Open
Abstract
Malaria is a serious parasitic disease in the developing world, causing high morbidity and mortality. The pathogenesis of malaria is complex, and the clinical presentation of disease ranges from severe and complicated, to mild and uncomplicated, to asymptomatic malaria. Despite a wealth of studies on the clinical severity of disease, asymptomatic malaria infections are still poorly understood. Asymptomatic malaria remains a challenge for malaria control programs as it significantly influences transmission dynamics. A thorough understanding of the interaction between hosts and parasites in the development of different clinical outcomes is required. In this review, the problems and obstacles to the study and control of asymptomatic malaria are discussed. The human and parasite factors associated with differential clinical outcomes are described and the management and treatment strategies for the control of the disease are outlined. Further, the crucial gaps in the knowledge of asymptomatic malaria that should be the focus of future research towards development of more effective malaria control strategies are highlighted.
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Affiliation(s)
- Dolie D Laishram
- Department of Biology, New York University, New York, NY 10003, USA
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Kritsiriwuthinan K, Ngrenngarmlert W. Asymptomatic malaria infections among foreign migrant workers in Thailand. ASIAN PAC J TROP MED 2012; 4:560-3. [PMID: 21803309 DOI: 10.1016/s1995-7645(11)60146-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2011] [Revised: 06/11/2011] [Accepted: 06/15/2011] [Indexed: 10/17/2022] Open
Abstract
OBJECTIVE To determine the prevalence of malaria infections among foreign migrant workers in Thailand. METHODS Giemsa-stained thin and thick blood films were prepared from blood samples of 294 foreign migrant workers recruited in the study. Microscopic examination of these blood films was performed for malaria detection. RESULTS Blood film examination revealed 1.36% malaria infections in these 294 subjects. All positive cases were male Myanmar workers in which their blood films only ring stage of Plasmodium spp. was found at low parasite density (mean= 144 parasites/μ L of blood). The prevalence of malaria infections was not significantly different among foreign migrant workers classified by age, gender, and resident province (P>0.05). Thin blood films of these workers also showed 78.91% hypochromic erythrocytes and 61.9% relative Eosinophilia. CONCLUSIONS These findings indicate a high risk of malaria transmission. Therefore active malaria surveillance by using molecular methods with more sensitive and specific than microscopy should be considered for malaria control in foreign migrant workers.
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Contreras CE, Donato MD, Rivas MA, Rodulfo H, Mora R, Batista ME, Marcano N. Malaria seroprevalence in blood bank donors from endemic and non-endemic areas of Venezuela. Mem Inst Oswaldo Cruz 2011; 106:123-9. [PMID: 21537669 DOI: 10.1590/s0074-02762011000200002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2010] [Accepted: 01/14/2011] [Indexed: 11/22/2022] Open
Abstract
In Venezuela, a total of 363,466 malaria cases were reported between 1999-2009. Several states are experiencing malaria epidemics, increasing the risk of vector and possibly transfusion transmission. We investigated the risk of transfusion transmission in blood banks from endemic and non-endemic areas of Venezuela by examining blood donations for evidence of malaria infection. For this, commercial kits were used to detect both malaria-specific antibodies (all species) and malaria antigen (Plasmodium falciparum only) in samples from Venezuelan blood donors (n = 762). All samples were further studied by microscopy and polymerase chain reaction (PCR). The antibody results showed that P. falciparum-infected patients had a lower sample/cut-off ratio than Plasmodium vivax-infected patients. Conversely, a higher ratio for antigen was observed among all P. falciparum-infected individuals. Sensitivity and specificity were higher for malarial antigens (100 and 99.8%) than for antibodies (82.2 and 97.4%). Antibody-positive donors were observed in Caracas, Ciudad Bolívar, Puerto Ayacucho and Cumaná, with prevalences of 1.02, 1.60, 3.23 and 3.63%, respectively. No PCR-positive samples were observed among the donors. However, our results show significant levels of seropositivity in blood donors, suggesting that more effective measures are required to ensure that transfusion transmission does not occur.
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Overview of the Development, Utility, and Future of Molecular Diagnostics for Parasitic Diseases. Mol Microbiol 2011. [DOI: 10.1128/9781555816834.ch45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Detection of malaria infection in blood transfusion: a comparative study among real-time PCR, rapid diagnostic test and microscopy. Parasitol Res 2011; 108:1519-23. [DOI: 10.1007/s00436-010-2207-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2010] [Accepted: 11/30/2010] [Indexed: 10/18/2022]
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Ndao M, Rainczuk A, Rioux MC, Spithill TW, Ward BJ. Is SELDI-TOF a valid tool for diagnostic biomarkers? Trends Parasitol 2010; 26:561-7. [PMID: 20708969 DOI: 10.1016/j.pt.2010.07.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2010] [Revised: 07/15/2010] [Accepted: 07/19/2010] [Indexed: 01/25/2023]
Abstract
The genome revolution is providing fresh insights into host and parasite genomes, and new tools are becoming available for examining host-parasite interactions at the proteome level. Technologies such as surface-enhanced laser desorption/ionization time-of-flight (SELDI-TOF) mass spectrometry (MS) can be applied to discover biomarkers (alterations in both host and parasite proteomes) associated with parasitic diseases. Such biomarkers can represent host proteins, fragments of host proteins or parasite proteins that appear in body fluids or tissues following infection. Individual biomarkers or biomarker patterns not only have diagnostic utility (e.g. in active disease, prognosis, tests of cure) but can also provide unique insights into the mechanisms underlying host responses and pathogenesis.
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Affiliation(s)
- Momar Ndao
- National Reference Centre for Parasitology, Research Institute of the McGill University Health Centre, Montreal General Hospital, Montreal, Quebec, Canada.
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Bourgeois N, Boutet A, Bousquet PJ, Basset D, Douard-Enault C, Charachon S, Lachaud L. Comparison of three real-time PCR methods with blood smears and rapid diagnostic test in Plasmodium sp. infection. Clin Microbiol Infect 2009; 16:1305-11. [PMID: 19840032 DOI: 10.1111/j.1469-0691.2009.02933.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
In cases of malaria, rapid and accurate diagnosis of Plasmodium sp. is essential. In this study three different quantitative, real-time PCR methods were compared with routine methods used for malaria diagnosis. A comparative study was conducted prospectively in the laboratories of Montpellier and Nîmes University Hospitals. The methods used for routine diagnostic malaria testing consisted of microscopic examination of Giemsa-stained blood smears and rapid diagnostic tests. Three quantitative real-time PCR methods (qRT-PCR) were tested: qRT-PCR1 amplified a specific sequence on the P. falciparum Cox1 gene, qRT-PCR2 amplified a species-specific region of the multicopy 18S rDNA, and qRT-PCR3 amplified a mitochondrial DNA sequence. Among the 196 blood samples collected, 73 samples were positive in at least one of the five tests. Compared with the routine method, there were no false negatives for P. falciparum diagnosis in either qRT-PCR1 or qRT-PCR3. In all P. ovale, P. vivax and P. malariae infections diagnosed from blood smears, qRT-PCR1 was negative, as expected, whereas qRT-PCR2 and qRT-PCR3 were positive and concordant (simple kappa coefficient = 1). One negative sample from microscopy was positive with both qRT-PCR2 and qRT-PCR3. Together, qRT-PCR3 and the combined qRT-PCR1 and qRT-PCR2 were concordant with routine methods for malaria diagnosis (99% and 99.5%, respectively). These three rapid, molecular qRT-PCR methods, used alone or in association, showed excellent results, with high concordance, accuracy and reliability in malaria diagnosis.
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Affiliation(s)
- N Bourgeois
- Laboratoire de Parasitologie-Mycologie, Centre Hospitalier Universitaire de Nîmes, Universite Montpellier I, Nîmes, France
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Cucunubá ZM, Guerra ÁP, Rahirant SJ, Rivera JA, Cortés LJ, Nicholls RS. Asymptomatic Plasmodium spp. infection in Tierralta, Colombia. Mem Inst Oswaldo Cruz 2008; 103:668-73. [DOI: 10.1590/s0074-02762008000700007] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2008] [Accepted: 11/10/2008] [Indexed: 11/22/2022] Open
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Costa MRF, Vieira PPR, Ferreira CDO, Lacerda MVGD, Alecrim WD, Alecrim MDGC. Diagnóstico molecular da malária em uma unidade de atenção terciária na Amazônia Brasileira. Rev Soc Bras Med Trop 2008; 41:381-5. [DOI: 10.1590/s0037-86822008000400011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2007] [Accepted: 07/02/2008] [Indexed: 11/21/2022] Open
Abstract
O exame de rotina para o diagnóstico da malária continua sendo a gota espessa, apesar da comprovada diminuição da sensibilidade e especificidade em situações de densidade parasitária baixa e infecções mistas. A reação em cadeia da polimerase vem sendo cada vez mais utilizada para a detecção molecular e identificação das espécies de plasmódio, por apresentar maior sensibilidade e especificidade. Foi realizada a nested-PCR em amostras de sangue total de 344 pacientes com síndrome febril aguda que se apresentaram para o diagnóstico de malária, em uma unidade terciária de saúde, em Manaus (Amazonas). Nenhum caso de malária por Plasmodium malariae foi diagnosticado à gota espessa ou PCR. Observou-se co-positividade de 96,7%, co-negatividade de 62,2% e coeficiente kappa de 0,44 entre PCR e gota espessa para Plasmodium falciparum. Para Plasmodium vivax, co-positividade de 100%, co-negatividade de 78,1% e coeficiente kappa de 0,56. Na detecção da malária mista, co-positividade de 100%, co-negatividade de 84,9% e coeficiente kappa de 0,26. A reação em cadeia da polimerase detectou alto número de infecções mistas nas amostras analisadas, mas seu uso rotineiro no diagnóstico da malária merece ainda ampla discussão.
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