1
|
Cerilo-Filho M, Arouca MDL, Medeiros EDS, de Jesus MCS, Sampaio MP, Reis NF, Silva JRS, Baptista ARS, Storti-Melo LM, Machado RLD. Worldwide distribution, symptoms and diagnosis of the coinfections between malaria and arboviral diseases: a systematic review. Mem Inst Oswaldo Cruz 2024; 119:e240015. [PMID: 38922217 PMCID: PMC11197440 DOI: 10.1590/0074-02760240015] [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: 01/20/2024] [Accepted: 05/02/2024] [Indexed: 06/27/2024] Open
Abstract
The coinfection between malaria (ML) and arboviral diseases represents a major global public health problem, particularly in tropical and subtropical countries. Despite its relevance, this topic is still insufficiently discussed in the current literature. Here, we aimed to investigate the worldwide distribution, symptoms, and diagnosis during coinfection between ML and arboviral diseases. We conducted a systematic review following the Preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement and assessed the selection and eligibility criteria, created and diagrammed maps, and analysed major symptoms with 95% confidence intervals (CI) using prevalence ratio and effect size, also performing latent class analysis. A total of 85,485 studies were retrieved, of which 56 were included: 57.14% in Asia, 25% in Africa, 14.30% in South America, and 3.56% in Europe. A total of 746 individuals were reported to be coinfected with Plasmodium and arbovirus. Concurrent ML, Dengue (DEN), Chikungunya (CHIK), and Zika (ZIK) patients are more likely to present headache and skin rash. Regarding diagnosis, 58,253 were made, of which 38,176 were positive (ML and at least one arboviral disease). The magnitude of these pathogens' coexistence points out the pressing need for improvements in public health policies towards diagnosis and prevention of both diseases, especially in endemic areas.
Collapse
Affiliation(s)
- Marcelo Cerilo-Filho
- Universidade Federal Fluminense, Centro de Investigação de Microrganismos, Instituto Biomédico, Departamento de Microbiologia e Parasitologia, Niterói, RJ, Brasil
- Universidade Federal Fluminense, Instituto Biomédico, Departamento de Microbiologia e Parasitologia, Programa de Pós-Graduação em Microbiologia e Parasitologia Aplicadas, Niterói, RJ, Brasil
| | - Marcelo de L Arouca
- Universidade Federal Fluminense, Centro de Investigação de Microrganismos, Instituto Biomédico, Departamento de Microbiologia e Parasitologia, Niterói, RJ, Brasil
- Universidade Federal Fluminense, Programa de Pós-Graduação em Ciências e Biotecnologia, Niterói, RJ, Brasil
| | - Estela dos S Medeiros
- Universidade Federal de Sergipe, Centro de Ciências Biológicas e da Saúde, Departamento de Biologia, Programa de Pós-Graduação em Biologia Parasitária, São Cristóvão, SE, Brasil
| | - Myrela CS de Jesus
- Universidade Federal Fluminense, Centro de Investigação de Microrganismos, Instituto Biomédico, Departamento de Microbiologia e Parasitologia, Niterói, RJ, Brasil
- Universidade Federal Fluminense, Instituto Biomédico, Departamento de Microbiologia e Parasitologia, Programa de Pós-Graduação em Microbiologia e Parasitologia Aplicadas, Niterói, RJ, Brasil
| | - Marrara P Sampaio
- Universidade Federal Fluminense, Centro de Investigação de Microrganismos, Instituto Biomédico, Departamento de Microbiologia e Parasitologia, Niterói, RJ, Brasil
- Universidade Federal Fluminense, Instituto Biomédico, Departamento de Microbiologia e Parasitologia, Programa de Pós-Graduação em Microbiologia e Parasitologia Aplicadas, Niterói, RJ, Brasil
| | - Nathália F Reis
- Universidade Federal Fluminense, Centro de Investigação de Microrganismos, Instituto Biomédico, Departamento de Microbiologia e Parasitologia, Niterói, RJ, Brasil
- Universidade Federal Fluminense, Instituto Biomédico, Departamento de Microbiologia e Parasitologia, Programa de Pós-Graduação em Microbiologia e Parasitologia Aplicadas, Niterói, RJ, Brasil
| | - José RS Silva
- Universidade Federal de Sergipe, Centro de Ciências Biológicas e da Saúde, Departamento de Biologia, Programa de Pós-Graduação em Biologia Parasitária, São Cristóvão, SE, Brasil
| | - Andréa RS Baptista
- Universidade Federal Fluminense, Centro de Investigação de Microrganismos, Instituto Biomédico, Departamento de Microbiologia e Parasitologia, Niterói, RJ, Brasil
- Universidade Federal Fluminense, Instituto Biomédico, Departamento de Microbiologia e Parasitologia, Programa de Pós-Graduação em Microbiologia e Parasitologia Aplicadas, Niterói, RJ, Brasil
- Universidade Federal Fluminense, Programa de Pós-Graduação em Ciências e Biotecnologia, Niterói, RJ, Brasil
| | - Luciane M Storti-Melo
- Universidade Federal de Sergipe, Centro de Ciências Biológicas e da Saúde, Departamento de Biologia, Programa de Pós-Graduação em Biologia Parasitária, São Cristóvão, SE, Brasil
| | - Ricardo LD Machado
- Universidade Federal Fluminense, Centro de Investigação de Microrganismos, Instituto Biomédico, Departamento de Microbiologia e Parasitologia, Niterói, RJ, Brasil
- Universidade Federal Fluminense, Instituto Biomédico, Departamento de Microbiologia e Parasitologia, Programa de Pós-Graduação em Microbiologia e Parasitologia Aplicadas, Niterói, RJ, Brasil
- Universidade Federal Fluminense, Programa de Pós-Graduação em Ciências e Biotecnologia, Niterói, RJ, Brasil
- Universidade Federal de Sergipe, Centro de Ciências Biológicas e da Saúde, Departamento de Biologia, Programa de Pós-Graduação em Biologia Parasitária, São Cristóvão, SE, Brasil
| |
Collapse
|
2
|
Hossain MJ, Das M, Islam MW, Shahjahan M, Ferdous J. Community engagement and social participation in dengue prevention: A cross-sectional study in Dhaka City. Health Sci Rep 2024; 7:e2022. [PMID: 38572117 PMCID: PMC10987789 DOI: 10.1002/hsr2.2022] [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: 10/25/2023] [Revised: 03/09/2024] [Accepted: 03/13/2024] [Indexed: 04/05/2024] Open
Abstract
Background Dengue is a major public health concern in Bangladesh. This study aimed to assess the perceptions and practices of community members in Dhaka regarding community engagement and social participation for dengue prevention. Methods A cross-sectional online survey was conducted in Dhaka City from May 2022 to December 2022. The respondents were randomly selected. The association between community participation and prevention practices was tested using the χ 2 test. Results The findings of this study indicate that the majority of participants (92%) believed that community effort would be relied upon in the event of a dengue outbreak. Environmental cleaning campaigns were the preferred approach, and religious leaders viewed them positively. This study also revealed significant variations in knowledge levels, with those involved in community efforts and mass gatherings demonstrating greater knowledge. This study sheds light on the demographic factors that influence dengue knowledge and provides valuable insights into the development of targeted public health interventions. Conclusion The study revealed negative perceptions and limited participation in dengue prevention among participants, with the majority demonstrating a poor understanding of preventive measures. While some showed positive attitudes towards community engagement, significant disparities existed in participation, highlighting the need for targeted educational campaigns and enhanced community mobilization efforts. Moreover, the importance of multisectoral collaboration is emphasized, underscoring the need for coordinated efforts among health departments, NGOs, religious institutions, and community leaders to effectively combat dengue transmission. Recommendations include ongoing educational initiatives, targeted interventions to promote community involvement, and fostering collaboration across sectors to strengthen dengue prevention efforts and to safeguard public health.
Collapse
Affiliation(s)
- Md Jubayer Hossain
- Population Health Studies Division, Center for Health InnovationResearch, Action, and Learning—Bangladesh (CHIRAL Bangladesh)DhakaBangladesh
| | - Manisha Das
- Population Health Studies Division, Center for Health InnovationResearch, Action, and Learning—Bangladesh (CHIRAL Bangladesh)DhakaBangladesh
- Dhaka Medical College and HospitalDhakaBangladesh
| | - Md Wahidul Islam
- Population Health Studies Division, Center for Health InnovationResearch, Action, and Learning—Bangladesh (CHIRAL Bangladesh)DhakaBangladesh
- Department of MicrobiologyJagannath UniversityDhakaBangladesh
| | - Muhibullah Shahjahan
- Population Health Studies Division, Center for Health InnovationResearch, Action, and Learning—Bangladesh (CHIRAL Bangladesh)DhakaBangladesh
- Department of MicrobiologyJagannath UniversityDhakaBangladesh
| | - Jannatul Ferdous
- Population Health Studies Division, Center for Health InnovationResearch, Action, and Learning—Bangladesh (CHIRAL Bangladesh)DhakaBangladesh
- Department of MicrobiologyJagannath UniversityDhakaBangladesh
| |
Collapse
|
3
|
Shrestha DB, Budhathoki P, Gurung B, Subedi S, Aryal S, Basukala A, Aryal B, Adhikari A, Poudel A, Yadav GK, Khoury M, Rayamajhee B, Shrestha LB. Epidemiology of dengue in SAARC territory: a systematic review and meta-analysis. Parasit Vectors 2022; 15:389. [PMID: 36280877 PMCID: PMC9594905 DOI: 10.1186/s13071-022-05409-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 07/13/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Dengue is one of the common arboviral infections and is a public health problem in South East Asia. The aim of this systematic review and meta-analysis was to evaluate the prevalence and distribution of dengue in SAARC (South Asian Association for Regional Cooperation) countries. METHODS The PubMed, PubMed Central, Embase and Scopus databases were searched for relevant studies. Statistical analysis on data extracted from the selected studied was conducted using the Comprehensive Meta-Analysis Software (CMA) version 3 software package. Proportions were used to estimate the outcome with a 95% confidence interval (CI). RESULTS Across all studies, among cases of suspected dengue, 30.7% were confirmed dengue cases (proportion: 0.307, 95% CI: 0.277-0.339). The seroprevalence of dengue immunoglobulin (Ig)G, IgM or both (IgM and IgG) antibodies and dengue NS1 antigen was 34.6, 34.2, 29.0 and 24.1%, respectively. Among the different strains of dengue, dengue virus (DENV) strains DENV-1, DENV-2, DENV-3 and DENV-4 accounted for 21.8, 41.2, 14.7 and 6.3% of cases, respectively. The prevalence of dengue fever, dengue hemorrhagic fever and dengue shock syndrome was 80.5, 18.2 and 1.5%, respectively. Fever was a commonly reported symptom, and thrombocytopenia was present in 44.7% of cases. Mortality was reported in 1.9% of dengue cases. CONCLUSIONS Dengue is a common health problem in South East Asia with high seroprevalence. DENV-2 was found to be the most common strain causing infection, and most dengue cases were dengue fever. In addition, thrombocytopenia was reported in almost half of the dengue cases.
Collapse
Affiliation(s)
| | | | | | | | | | - Anisha Basukala
- Nepalese Army Institute of Health Sciences, Kathmandu, Nepal
| | - Barun Aryal
- Department of Emergency Medicine, Patan Academy of Health Sciences, Lalitpur, Nepal
| | - Anurag Adhikari
- Department of Emergency Medicine, Nepal National Hospital, Kathmandu, Nepal
| | - Ayusha Poudel
- Department of Emergency Medicine, Alka Hospital, Kathmandu, Nepal
| | | | - Mtanis Khoury
- Department of Internal Medicine, Mount Sinai Hospital, Chicago, IL USA
| | - Binod Rayamajhee
- School of Optometry & Vision Science, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
- Department of Infection and Immunology, Kathmandu Research Institute for Biological Sciences (KRIBS), Lalitpur, Nepal
| | - Lok Bahadur Shrestha
- Department of Microbiology & Infectious Diseases, B. P. Koirala Institute of Health Sciences, Dharan, 56700 Nepal
- School of Medical Sciences and the Kirby Institute, University of New South Wales, Sydney, Australia
| |
Collapse
|
4
|
Rahman KM, Sharker Y, Rumi RA, Khan MUI, Shomik MS, Rahman MW, Billah SM, Rahman M, Streatfield PK, Harley D, Luby SP. An Association between Rainy Days with Clinical Dengue Fever in Dhaka, Bangladesh: Findings from a Hospital Based Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17249506. [PMID: 33353025 PMCID: PMC7765799 DOI: 10.3390/ijerph17249506] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 12/08/2020] [Accepted: 12/15/2020] [Indexed: 12/03/2022]
Abstract
Background: Dengue, a febrile illness, is caused by a Flavivirus transmitted by Aedes aegypti and Aedes albopictus mosquitoes. Climate influences the ecology of the vectors. We aimed to identify the influence of climatic variability on the occurrence of clinical dengue requiring hospitalization in Zone-5, a high incidence area of Dhaka City Corporation (DCC), Bangladesh. Methods and Findings: We retrospectively identified clinical dengue cases hospitalized from Zone-5 of DCC between 2005 and 2009. We extracted records of the four major catchment hospitals of the study area. The Bangladesh Meteorological Department (BMD) provided data on temperature, rainfall, and humidity of DCC for the study period. We used autoregressive integrated moving average (ARIMA) models for the number of monthly dengue hospitalizations. We also modeled all the climatic variables using Poisson regression. During our study period, dengue occurred throughout the year in Zone-5 of DCC. The median number of hospitalized dengue cases was 9 per month. Dengue incidence increased sharply from June, and reached its peak in August. One additional rainy day per month increased dengue cases in the succeeding month by 6% (RR = 1.06, 95% CI: 1.04–1.09). Conclusions: Dengue is transmitted throughout the year in Zone-5 of DCC, with seasonal variation in incidence. The number of rainy days per month is significantly associated with dengue incidence in the subsequent month. Our study suggests the initiation of campaigns in DCC for controlling dengue and other Aedes mosquito borne diseases, including Chikunguniya from the month of May each year. BMD rainfall data may be used to determine campaign timing.
Collapse
Affiliation(s)
- Kazi Mizanur Rahman
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh; (R.A.R.); (M.-U.I.K.); (M.S.S.); (M.W.R.); (S.M.B.); (P.K.S.)
- North Coast Public Health Unit, New South Wales Health, Lismore, NSW 2480, Australia
- University Centre for Rural Health, University of Sydney, Lismore, NSW 2480, Australia
- Correspondence:
| | - Yushuf Sharker
- Department of Biostatistics, Yale School of Public Health, New Haven, CT 06520-0834, USA;
| | - Reza Ali Rumi
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh; (R.A.R.); (M.-U.I.K.); (M.S.S.); (M.W.R.); (S.M.B.); (P.K.S.)
| | - Mahboob-Ul Islam Khan
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh; (R.A.R.); (M.-U.I.K.); (M.S.S.); (M.W.R.); (S.M.B.); (P.K.S.)
| | - Mohammad Sohel Shomik
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh; (R.A.R.); (M.-U.I.K.); (M.S.S.); (M.W.R.); (S.M.B.); (P.K.S.)
| | - Muhammad Waliur Rahman
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh; (R.A.R.); (M.-U.I.K.); (M.S.S.); (M.W.R.); (S.M.B.); (P.K.S.)
| | - Sk Masum Billah
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh; (R.A.R.); (M.-U.I.K.); (M.S.S.); (M.W.R.); (S.M.B.); (P.K.S.)
| | - Mahmudur Rahman
- Institute of Epidemiology, Disease Control and Research (IEDCR), Dhaka 1212, Bangladesh;
| | - Peter Kim Streatfield
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh; (R.A.R.); (M.-U.I.K.); (M.S.S.); (M.W.R.); (S.M.B.); (P.K.S.)
| | - David Harley
- Children’s Health Queensland Clinical Unit, Faculty of Medicine, The University of Queensland, Queensland Children’s Hospital, South Brisbane, QLD 4101, Australia;
| | - Stephen P. Luby
- Center for Innovation in Global Health, Stanford University, Stanford, CA 94305, USA;
| |
Collapse
|
5
|
Salam N, Mustafa S, Hafiz A, Chaudhary AA, Deeba F, Parveen S. Global prevalence and distribution of coinfection of malaria, dengue and chikungunya: a systematic review. BMC Public Health 2018; 18:710. [PMID: 29879935 PMCID: PMC5992662 DOI: 10.1186/s12889-018-5626-z] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 05/29/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Malaria, Dengue and Chikungunya are vector borne diseases with shared endemic profiles and symptoms. Coinfections with any of these diseases could have fatal outcomes if left undiagnosed. Understanding the prevalence and distribution of coinfections is necessary to improve diagnosis and designing therapeutic interventions. METHODS We have carried out a systematic search of the published literature based on PRISMA guidelines to identify cases of Malaria, Dengue and Chikungunya coinfections. We systematically reviewed the literature to identify eligible studies and extracted data regarding cases of coinfection from cross sectional studies, case reports, retrospective studies, prospective observational studies and surveillance reports. RESULTS Care full screening resulted in 104 publications that met the eligibility criteria and reported Malaria/Dengue, Dengue/Chikungunya, Malaria/Chikungunya and Malaria/Dengue/Chikungunya coinfections. These coinfections were spread over six geographical locations and 42 different countries and are reported more frequently in the last 15 years possibly due to expanding epidemiology of Dengue and Chikungunya. Few of these reports have also analysed distinguishing features of coinfections. Malaria/Dengue coinfections were the most common coinfection followed by Dengue/Chikungunya, Malaria/Chikungunya and Malaria/Dengue/Chikungunya coinfections. P. falciparum and P. vivax were the commonest species found in cases of malaria coinfections and Dengue serotype-4 commonest serotype in cases of dengue coinfections. Most studies were reported from India. Nigeria and India were the only two countries from where all possible combinations of coinfections were reported. CONCLUSION We have comprehensively reviewed the literature associated with cases of coinfections of three important vector borne diseases to present a clear picture of their prevalence and distribution across the globe. The frequency of coinfections presented in the study suggests proper diagnosis, surveillance and management of cases of coinfection to avoid poor prognosis of the underlying etiology.
Collapse
Affiliation(s)
- Nasir Salam
- College of Medicine, Al-Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh, Saudi Arabia
| | - Shoeb Mustafa
- College of Medicine, Al-Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh, Saudi Arabia
| | - Abdul Hafiz
- Department of Parasitology, College of Medicine, Umm Al-Qura University, Mecca, Saudi Arabia
| | - Anis Ahmad Chaudhary
- College of Medicine, Al-Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh, Saudi Arabia
| | - Farah Deeba
- Centre for Interdisciplinary Research in Basic Sciences, Jamia Millia Islamia, New Delhi, 110025 India
| | - Shama Parveen
- Centre for Interdisciplinary Research in Basic Sciences, Jamia Millia Islamia, New Delhi, 110025 India
| |
Collapse
|
6
|
Low GKK, Ogston SA, Yong MH, Gan SC, Chee HY. Global dengue death before and after the new World Health Organization 2009 case classification: A systematic review and meta-regression analysis. Acta Trop 2018; 182:237-245. [PMID: 29545158 DOI: 10.1016/j.actatropica.2018.03.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 02/22/2018] [Accepted: 03/10/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Since the introduction of 2009 WHO dengue case classification, no literature was found regarding its effect on dengue death. This study was to evaluate the effect of 2009 WHO dengue case classification towards dengue case fatality rate. METHODS Various databases were used to search relevant articles since 1995. Studies included were cohort and cross-sectional studies, all patients with dengue infection and must report the number of death or case fatality rate. The Joanna Briggs Institute appraisal checklist was used to evaluate the risk of bias of the full-texts. The studies were grouped according to the classification adopted: WHO 1997 and WHO 2009. Meta-regression was employed using a logistic transformation (log-odds) of the case fatality rate. The result of the meta-regression was the adjusted case fatality rate and odds ratio on the explanatory variables. RESULTS A total of 77 studies were included in the meta-regression analysis. The case fatality rate for all studies combined was 1.14% with 95% confidence interval (CI) of 0.82-1.58%. The combined (unadjusted) case fatality rate for 69 studies which adopted WHO 1997 dengue case classification was 1.09% with 95% CI of 0.77-1.55%; and for eight studies with WHO 2009 was 1.62% with 95% CI of 0.64-4.02%. The unadjusted and adjusted odds ratio of case fatality using WHO 2009 dengue case classification was 1.49 (95% CI: 0.52, 4.24) and 0.83 (95% CI: 0.26, 2.63) respectively, compared to WHO 1997 dengue case classification. There was an apparent increase in trend of case fatality rate from the year 1992-2016. Neither was statistically significant. CONCLUSIONS The WHO 2009 dengue case classification might have no effect towards the case fatality rate although the adjusted results indicated a lower case fatality rate. Future studies are required for an update in the meta-regression analysis to confirm the findings.
Collapse
|
7
|
Shrestha P, Roberts T, Homsana A, Myat TO, Crump JA, Lubell Y, Newton PN. Febrile illness in Asia: gaps in epidemiology, diagnosis and management for informing health policy. Clin Microbiol Infect 2018; 24:815-826. [PMID: 29581051 DOI: 10.1016/j.cmi.2018.03.028] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Revised: 03/12/2018] [Accepted: 03/16/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Increasing evidence is becoming available on the aetiology and management of fevers in Asia; the importance of these fevers has increased with the decline in the incidence of malaria. AIMS To conduct a narrative review of the epidemiology and management of fevers in South and South-East Asia and to highlight gaps in our knowledge that impair evidence-based health policy decisions. SOURCES A narrative review of papers published since 2012 on developments in fever epidemiology, diagnosis and treatment in South and South-East Asia. The papers that the authors felt were pivotal, from their personal perspectives, are discussed. CONTENT We identified 100 studies. Among the 30 studies (30%)-including both children and adults-that investigated three or more pathogens, the most frequently reported fever aetiology was dengue (reported by 15, 50%), followed by leptospirosis (eight, 27%), scrub typhus (seven, 23%) and Salmonella serovar Typhi (six, 20%). Among four studies investigating three or more pathogens in children, dengue and Staphylococcus aureus were the most frequent, followed by non-typhoidal Salmonella spp, Streptococcus pneumoniae, Salmonella serovar Typhi, and Orientia tsutsugamushi. Increased awareness is needed that rickettsial pathogens are common but do not respond to cephalosporins, and that alternative therapies, such as tetracyclines, are required. IMPLICATIONS Many key gaps remain, and consensus guidelines for study design are needed to aid comparative understanding of the epidemiology of fevers. More investment in developing accurate and affordable diagnostic tests for rural Asia and independent evaluation of those already on the market are needed. Treatment algorithms, including simple biomarker assays, appropriate for empirical therapy of fevers in different areas of rural Asia should be a major aim of fever research. Enhanced antimicrobial resistance (AMR) surveillance and openly accessible databases of geography-specific AMR data would inform policy on empirical and specific therapy. More investment in innovative strategies facilitating infectious disease surveillance in remote rural communities would be an important component of poverty reduction and improving public health.
Collapse
Affiliation(s)
- P Shrestha
- Infectious Diseases Data Observatory, University of Oxford, UK
| | - T Roberts
- Lao-Oxford-Mahosot-Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Laos; Madihol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
| | - A Homsana
- Lao-Oxford-Mahosot-Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Laos
| | - T O Myat
- Department of Microbiology, University of Medicine 1, Yangon, Myanmar; Centre for International Health, University of Otago, Dunedin, New Zealand
| | - J A Crump
- Centre for International Health, University of Otago, Dunedin, New Zealand
| | - Y Lubell
- Madihol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine and Global Health, University of Oxford, UK
| | - P N Newton
- Infectious Diseases Data Observatory, University of Oxford, UK; Lao-Oxford-Mahosot-Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Laos; Centre for Tropical Medicine and Global Health, University of Oxford, UK.
| |
Collapse
|
8
|
Faruque LI, Zaman RU, Gurley ES, Massung RF, Alamgir ASM, Galloway RL, Powers AM, Bai Y, Kosoy M, Nicholson WL, Rahman M, Luby SP. Prevalence and clinical presentation of Rickettsia, Coxiella, Leptospira, Bartonella and chikungunya virus infections among hospital-based febrile patients from December 2008 to November 2009 in Bangladesh. BMC Infect Dis 2017; 17:141. [PMID: 28193163 PMCID: PMC5307764 DOI: 10.1186/s12879-017-2239-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 02/02/2017] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND We conducted a study to identify Rickettsia, Coxiella, Leptospira, Bartonella, and Chikungunya virus infections among febrile patients presenting at hospitals in Bangladesh. METHODS We collected blood samples from patients at six tertiary hospitals from December 2008 to November 2009 and performed laboratory tests at the United States Centers for Disease Control and Prevention (CDC). RESULTS Out of 720 enrolled patients, 263 (37%) were infected with Rickettsia; 132 patients had immunofluorescence antibody titer >64 against spotted fever, 63 patients against scrub typhus fever and 10 patients against typhus fever. Ten patients were identified with Coxiella. We isolated Leptospira from two patients and Bartonella from one patient. Ten patients had antibodies against Chikungunya virus. The proportion of patients who died was higher with rickettsial fever (5%) compared to those without a diagnosis of rickettsial infection (2%). None of the patients were initially diagnosed with rickettsial fever. CONCLUSIONS Rickettsial infections are frequent yet under-recognized cause of febrile illness in Bangladesh. Clinical guidelines should be revised so that local clinicians can diagnose rickettsial infections and provide appropriate drug treatment.
Collapse
Affiliation(s)
- Labib Imran Faruque
- International Centre for Diarrheal Diseases Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Rashid Uz Zaman
- International Centre for Diarrheal Diseases Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Emily S. Gurley
- International Centre for Diarrheal Diseases Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | - A. S. M. Alamgir
- Institute of Epidemiology, Disease Control and Research (IEDCR), Dhaka, Bangladesh
| | | | - Ann M. Powers
- Centers for Disease Control and Prevention (CDC), Atlanta, GA USA
| | - Ying Bai
- Centers for Disease Control and Prevention (CDC), Atlanta, GA USA
| | - Michael Kosoy
- Centers for Disease Control and Prevention (CDC), Atlanta, GA USA
| | | | - Mahmudur Rahman
- Institute of Epidemiology, Disease Control and Research (IEDCR), Dhaka, Bangladesh
| | - Stephen P. Luby
- International Centre for Diarrheal Diseases Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| |
Collapse
|
9
|
Chong SE, Mohamad Zaini RH, Suraiya S, Lee KT, Lim JA. The dangers of accepting a single diagnosis: case report of concurrent Plasmodium knowlesi malaria and dengue infection. Malar J 2017; 16:2. [PMID: 28049485 PMCID: PMC5210313 DOI: 10.1186/s12936-016-1666-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 12/21/2016] [Indexed: 11/10/2022] Open
Abstract
Background Dengue and malaria are two common, mosquito-borne infections, which may lead to mortality if not managed properly. Concurrent infections of dengue and malaria are rare due to the different habitats of its vectors and activities of different carrier mosquitoes. The first case reported was in 2005. Since then, several concurrent infections have been reported between the dengue virus (DENV) and the malaria protozoans, Plasmodium falciparum and Plasmodium vivax. Symptoms of each infection may be masked by a simultaneous second infection, resulting in late treatment and severe complications. Plasmodium knowlesi is also a common cause of malaria in Malaysia with one of the highest rates of mortality. This report is one of the earliest in literature of concomitant infection between DENV and P. knowlesi in which a delay in diagnosis had placed a patient in a life-threatening situation. Case presentation A 59-year old man staying near the Belum-Temengor rainforest at the Malaysia–Thailand border was admitted with fever for 6 days, with respiratory distress. His non-structural protein 1 antigen and Anti-DENV Immunoglobulin M tests were positive. He was treated for severe dengue with compensated shock. Treating the dengue had so distracted the clinicians that a blood film for the malaria parasite was not done. Despite aggressive supportive treatment in the intensive care unit (ICU), the patient had unresolved acidosis as well as multi-organ failure involving respiratory, renal, liver, and haematological systems. It was due to the presentation of shivering in the ICU, that a blood film was done on the second day that revealed the presence of P. knowlesi with a parasite count of 520,000/μL. The patient was subsequently treated with artesunate-doxycycline and made a good recovery after nine days in ICU. Conclusions This case contributes to the body of literature on co-infection between DENV and P. knowlesi and highlights the clinical consequences, which can be severe. Awareness should be raised among health-care workers on the possibility of dengue-malaria co-infection in this region. Further research is required to determine the real incidence and risk of co-infection in order to improve the management of acute febrile illness.
Collapse
Affiliation(s)
- Soon Eu Chong
- Department of Anaesthesiology and Intensive Care, School of Medical Sciences, Universiti Sains Malaysia, 16150, Kota Bharu, Kelantan, Malaysia. .,Advanced Medical and Dental Institute, Universiti Sains Malaysia, Bertam, 13200, Kepala Batas, Penang, Malaysia.
| | - Rhendra Hardy Mohamad Zaini
- Department of Anaesthesiology and Intensive Care, School of Medical Sciences, Universiti Sains Malaysia, 16150, Kota Bharu, Kelantan, Malaysia
| | - Siti Suraiya
- Department of Medical Microbiology and Parasitology, School of Medical Sciences, Universiti Sains Malaysia, 16150, Kota Bharu, Kelantan, Malaysia
| | - Kok Tong Lee
- Department of Anaesthesiology and Intensive Care, School of Medical Sciences, Universiti Sains Malaysia, 16150, Kota Bharu, Kelantan, Malaysia
| | - Jo Anne Lim
- Hospital Raja Perempuan Zainab II, 15000, Kota Bharu, Kelantan, Malaysia
| |
Collapse
|
10
|
Dengue fever virus in Pakistan: effects of seasonal pattern and temperature change on distribution of vector and virus. Rev Med Virol 2016; 27. [DOI: 10.1002/rmv.1899] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 07/18/2016] [Accepted: 07/19/2016] [Indexed: 02/01/2023]
|
11
|
Macpherson C, Noël T, Fields P, Jungkind D, Yearwood K, Simmons M, Widjaja S, Mitchell G, Noel D, Bidaisee S, Myers TE, LaBeaud AD. Clinical and Serological Insights from the Asian Lineage Chikungunya Outbreak in Grenada, 2014: An Observational Study. Am J Trop Med Hyg 2016; 95:890-893. [PMID: 27527629 DOI: 10.4269/ajtmh.16-0122] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 07/03/2016] [Indexed: 11/07/2022] Open
Abstract
Chikungunya virus (CHIKV) spread rapidly throughout the Caribbean region in 2014, and the first serologically confirmed case was seen in Grenada in July. This study investigated the outbreak of CHIKV in Grenada to identify the distinguishing clinical manifestations and the symptoms that corresponded the closest with serological test results. Sera were tested by IgM enzyme-linked immunosorbent assay and polymerase chain reaction to distinguish between cases positive or negative for CHIKV. Of 493 cases, 426 (86%) tested positive for CHIKV. The diagnostic decision rule, "Define as CHIKV positive a patient presenting with joint pain and any combination of fever, body pain, or rash," produced the closest agreement (85%) with the serological test results (Cohen's kappa, k = 0.289, P value < 0.001). When laboratory facilities are not available for diagnostic confirmation, syndromic surveillance using these four symptoms could be useful to define cases during a CHIKV outbreak when CHIKV is the predominant circulating arbovirus.
Collapse
Affiliation(s)
- Calum Macpherson
- St. George's University School of Medicine, Saint George, Grenada. Windward Islands Research and Education Foundation, Saint George, Grenada.
| | - Trevor Noël
- St. George's University School of Medicine, Saint George, Grenada. Windward Islands Research and Education Foundation, Saint George, Grenada
| | - Paul Fields
- Windward Islands Research and Education Foundation, Saint George, Grenada
| | - Donald Jungkind
- St. George's University School of Medicine, Saint George, Grenada
| | | | | | | | | | - Dolland Noel
- St. George's University School of Medicine, Saint George, Grenada. Ministry of Health, Saint George, Grenada
| | - Satesh Bidaisee
- St. George's University School of Medicine, Saint George, Grenada. Windward Islands Research and Education Foundation, Saint George, Grenada
| | - Todd E Myers
- Naval Medical Research Center, Silver Spring, Maryland
| | | |
Collapse
|
12
|
Selvaretnam AA, Sahu PS, Sahu M, Ambu S. A review of concurrent infections of malaria and dengue in Asia. Asian Pac J Trop Biomed 2016. [DOI: 10.1016/j.apjtb.2016.05.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
13
|
Halsey ES, Baldeviano GC, Edgel KA, Vilcarromero S, Sihuincha M, Lescano AG. Symptoms and Immune Markers in Plasmodium/Dengue Virus Co-infection Compared with Mono-infection with Either in Peru. PLoS Negl Trop Dis 2016; 10:e0004646. [PMID: 27128316 PMCID: PMC4851334 DOI: 10.1371/journal.pntd.0004646] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 03/30/2016] [Indexed: 11/23/2022] Open
Abstract
Background Malaria and dengue are two of the most common vector-borne diseases in the world, but co-infection is rarely described, and immunologic comparisons of co-infection with mono-infection are lacking. Methodology and Principal Findings We collected symptom histories and blood specimens from subjects in a febrile illness surveillance study conducted in Iquitos and Puerto Maldonado, Peru, between 2002–2011. Nineteen symptoms and 18 immune markers at presentation were compared among those with co-infection with Plasmodium/dengue virus (DENV), Plasmodium mono-infection, and DENV mono-infection. Seventeen subjects were identified as having Plasmodium/DENV co-infection and were retrospectively matched with 51 DENV mono-infected and 44 Plasmodium mono-infected subjects. Those with Plasmodium mono-infection had higher levels of IL-4, IL-6, IL-10, IL-12, IL-13, IL-17A, IFN-γ, and MIP1-α/CCL3 compared with DENV mono-infection or co-infection; those with Plasmodium mono-infection had more cough than those with DENV mono-infection. Subjects with DENV mono-infection had higher levels of TGF-β1 and more myalgia than those with Plasmodium mono-infection. No symptom was more common and no immune marker level was higher in the co-infected group, which had similar findings to the DENV mono-infected subjects. Conclusions/Significance Compared with mono-infection with either pathogen, Plasmodium/DENV co-infection was not associated with worse disease and resembled DENV mono-infection in both symptom frequency and immune marker level. Dengue and malaria are two of the most important diseases spread by mosquitoes. Clinical manifestations of both febrile diseases overlap considerably, and either can be fatal. In addition, they are co-endemic in many places throughout the world. Despite this, only a handful of reports of co-infection with dengue virus and Plasmodium species are reported in the literature. Through our febrile surveillance program in the Peruvian Amazon, we were able to retrospectively identify 17 cases of co-infection with dengue virus and Plasmodium. Our study aimed to assess whether co-infection was associated with more symptoms or a different immune response compared with mono-infection alone. To answer this question, we utilized data and blood specimens collected during the acute presentation of these 17 subjects and compared them to a matched group of subjects with either dengue virus mono-infection or Plasmodium mono-infection. Our findings indicate co-infection with both pathogens was not associated with more symptoms and the immune profile of co-infection resembled dengue virus mono-infection more than Plasmodium mono-infection.
Collapse
Affiliation(s)
- Eric S Halsey
- Virology Department, U.S. Naval Medical Research Unit No. 6, Lima and Iquitos, Peru.,The President's Malaria Initiative, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.,Malaria Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | | | - Kimberly A Edgel
- Parasitology Department, U.S. Naval Medical Research Unit No. 6, Lima, Peru
| | - Stalin Vilcarromero
- Virology Department, U.S. Naval Medical Research Unit No. 6, Lima and Iquitos, Peru
| | - Moises Sihuincha
- Infectious Diseases Department, Hospital de Apoyo, DISA-Loreto, Iquitos, Peru
| | - Andres G Lescano
- Parasitology Department, U.S. Naval Medical Research Unit No. 6, Lima, Peru.,School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| |
Collapse
|
14
|
Morales I, Salje H, Saha S, Gurley ES. Seasonal Distribution and Climatic Correlates of Dengue Disease in Dhaka, Bangladesh. Am J Trop Med Hyg 2016; 94:1359-61. [PMID: 27114293 DOI: 10.4269/ajtmh.15-0846] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 03/12/2016] [Indexed: 11/07/2022] Open
Abstract
Dengue has been regularly reported in Dhaka, Bangladesh, since a large outbreak in 2000. However, to date, we have limited information on the seasonal distribution of dengue disease and how case distribution correlates with climate. Here, we analyzed dengue cases detected at a private diagnostic facility in Dhaka during 2010-2014. We calculated Pearson cross-correlation coefficients to examine the relationship between the timing of cases and both rainfall and temperature. There were 2,334 cases diagnosed during the study period with 76% over the age of 15 years. Cases were reported in every month of the study; however, 90% of cases occurred between June and November. Increases in rainfall were correlated with increases in cases 2 months later (correlation of 0.7). The large proportion of adult cases is consistent with substantial population susceptibility and suggests Dhaka remains at risk for outbreaks. Although cases occurred year-round, public health preparedness should be focused during peak months.
Collapse
Affiliation(s)
- Ivonne Morales
- Section on Membrane and Cellular Biophysics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Child Health Research Foundation, Department of Microbiology, Dhaka Shishu Hospital, Dhaka, Bangladesh; Department of Microbiology, Popular Diagnostic Centre, Dhaka, Bangladesh; International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh; Mathematical Modelling of Infectious Diseases Unit, Institut Pasteur, Paris, France
| | - Henrik Salje
- Section on Membrane and Cellular Biophysics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Child Health Research Foundation, Department of Microbiology, Dhaka Shishu Hospital, Dhaka, Bangladesh; Department of Microbiology, Popular Diagnostic Centre, Dhaka, Bangladesh; International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh; Mathematical Modelling of Infectious Diseases Unit, Institut Pasteur, Paris, France
| | - Samir Saha
- Section on Membrane and Cellular Biophysics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Child Health Research Foundation, Department of Microbiology, Dhaka Shishu Hospital, Dhaka, Bangladesh; Department of Microbiology, Popular Diagnostic Centre, Dhaka, Bangladesh; International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh; Mathematical Modelling of Infectious Diseases Unit, Institut Pasteur, Paris, France
| | - Emily S Gurley
- Section on Membrane and Cellular Biophysics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Child Health Research Foundation, Department of Microbiology, Dhaka Shishu Hospital, Dhaka, Bangladesh; Department of Microbiology, Popular Diagnostic Centre, Dhaka, Bangladesh; International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh; Mathematical Modelling of Infectious Diseases Unit, Institut Pasteur, Paris, France
| |
Collapse
|
15
|
Shahida SM, Islam A, Dey BR, Islam F, Venkatesh K, Goodman A. Hospital Acquired Infections in Low and Middle Income Countries: Root Cause Analysis and the Development of Infection Control Practices in Bangladesh. ACTA ACUST UNITED AC 2016. [DOI: 10.4236/ojog.2016.61004] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
16
|
Sharmin S, Viennet E, Glass K, Harley D. The emergence of dengue in Bangladesh: epidemiology, challenges and future disease risk. Trans R Soc Trop Med Hyg 2015; 109:619-27. [PMID: 26333430 DOI: 10.1093/trstmh/trv067] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 07/23/2015] [Indexed: 11/14/2022] Open
Abstract
Dengue occurred sporadically in Bangladesh from 1964 until a large epidemic in 2000 established the virus. We trace dengue from the time it was first identified in Bangladesh and identify factors favourable to future dengue haemorrhagic fever epidemics. The epidemic in 2000 was likely due to introduction of a dengue virus strain from a nearby endemic country, probably Thailand. Cessation of dichlorodiphenyltrichloroethane (DDT) spraying, climatic, socio-demographic, and lifestyle factors also contributed to epidemic transmission. The largest number of cases was notified in 2002 and since then reported outbreaks have generally declined, although with increased notifications in alternate years. The apparent decline might be partially due to public awareness with consequent reduction in mosquito breeding and increased prevalence of immunity. However, passive hospital-based surveillance has changed with mandatory serological confirmation now required for case reporting. Further, a large number of cases remain undetected because only patients with severe dengue require hospitalisation. Thus, the reduction in notification numbers may be an artefact of the surveillance system. Indeed, population-based serological survey indicates that dengue transmission continues to be common. In the future, the absence of active interventions, unplanned urbanisation, environmental deterioration, increasing population mobility, and economic factors will heighten dengue risk. Projected increases in temperature and rainfall may exacerbate this.
Collapse
Affiliation(s)
- Sifat Sharmin
- National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, ACT 2601, Australia
| | - Elvina Viennet
- National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, ACT 2601, Australia
| | - Kathryn Glass
- National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, ACT 2601, Australia
| | - David Harley
- National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, ACT 2601, Australia
| |
Collapse
|
17
|
Mendonça VRR, Andrade BB, Souza LCL, Magalhães BML, Mourão MPG, Lacerda MVG, Barral-Netto M. Unravelling the patterns of host immune responses in Plasmodium vivax malaria and dengue co-infection. Malar J 2015; 14:315. [PMID: 26271921 PMCID: PMC4536664 DOI: 10.1186/s12936-015-0835-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 08/04/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Concurrent malaria and dengue infection is frequently diagnosed in endemic countries, but its immunopathology remains largely unknown. In the present study, a large panel of cytokines/chemokines and clinical laboratory markers were measured in patients with Plasmodium vivax and dengue co-infection as well as in individuals with malaria or dengue mono-infections in order to identify biosignatures of each clinical condition. METHODS Individuals from the Brazilian Amazon were recruited between 2009 and 2013 and classified in three groups: vivax malaria (n = 52), dengue (n = 30) and vivax malaria and dengue co-infection (n = 30). P. vivax malaria was diagnosed by thick blood smear and confirmed by PCR; dengue cases were detected by IgM ELISA or NS1 protein. The plasma levels of cytokines and chemokines were determined by multiplex assay. RESULTS Individuals with malaria and dengue co-infection displayed lower levels of platelets and haemoglobin than those with malaria or dengue mono-infections (p = 0.0047 and p = 0.0001, respectively). The group of individuals co-infected exhibited the highest median concentrations of IFN-γ, IL-6, CCL4 than the mono-infected groups. Network analyses of plasma cytokines/chemokines revealed that malaria and dengue co-infection exhibits a distinct immune profile with critical roles for TNF, IL-6 and IFN-γ. Further, parasitaemia levels displayed positive significant interactions with IL-6, CCL4 and IL-10 in the group of patients co-infected with malaria and dengue. No differences were observed in distribution of dengue virus serotypes and Plasmodium parasitaemia levels between the groups. CONCLUSIONS The findings described here identify unique patterns of circulating immunological markers in cases of malaria and dengue co-infection and provide insights on the immunopathology of this co-morbid condition.
Collapse
Affiliation(s)
- Vitor R R Mendonça
- Laboratório Integrado de Microbiogia e Imunoregulação (LIMI), Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz (FIOCRUZ), Salvador, Brazil. .,Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Brazil.
| | - Bruno B Andrade
- Laboratório Integrado de Microbiogia e Imunoregulação (LIMI), Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz (FIOCRUZ), Salvador, Brazil.
| | - Ligia C L Souza
- Laboratório Integrado de Microbiogia e Imunoregulação (LIMI), Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz (FIOCRUZ), Salvador, Brazil. .,Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Brazil.
| | - Belisa M L Magalhães
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil. .,Universidade do Estado do Amazonas, Manaus, Brazil.
| | - Maria P G Mourão
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil. .,Universidade do Estado do Amazonas, Manaus, Brazil.
| | - Marcus V G Lacerda
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil. .,Universidade do Estado do Amazonas, Manaus, Brazil.
| | - Manoel Barral-Netto
- Laboratório Integrado de Microbiogia e Imunoregulação (LIMI), Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz (FIOCRUZ), Salvador, Brazil. .,Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Brazil. .,Instituto de Investigação em Imunologia, Instituto Nacional de Ciência e Tecnologia, São Paulo, Brazil.
| |
Collapse
|
18
|
Prasad N, Murdoch DR, Reyburn H, Crump JA. Etiology of Severe Febrile Illness in Low- and Middle-Income Countries: A Systematic Review. PLoS One 2015; 10:e0127962. [PMID: 26126200 PMCID: PMC4488327 DOI: 10.1371/journal.pone.0127962] [Citation(s) in RCA: 121] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 04/22/2015] [Indexed: 02/04/2023] Open
Abstract
Background With apparent declines in malaria worldwide during the last decade and more widespread use of malaria rapid diagnostic tests, healthcare workers in low-resource areas face a growing proportion of febrile patients without malaria. We sought to describe current knowledge and identify information gaps of the etiology severe febrile illness in low-and middle-income countries. Methods and Findings We conducted a systematic review of studies conducted in low-and-middle income countries 1980–2013 that prospectively assessed consecutive febrile patients admitted to hospital using rigorous laboratory-based case definitions. We found 45 eligible studies describing 54,578 patients; 9,771 (17.9%) had a positive result for ≥1 pathogen meeting diagnostic criteria. There were no eligible studies identified from Southern and Middle Africa, Eastern Asia, Oceania, Latin American and Caribbean regions, and the European region. The median (range) number of diagnostic tests meeting our confirmed laboratory case definitions was 2 (1 to 11) per study. Of diagnostic tests, 5,052 (10.3%) of 49,143 had confirmed bacterial or fungal bloodstream infection; 709 (3.8%) of 18,142 had bacterial zoonosis; 3,488 (28.5%) of 12,245 had malaria; and 1,804 (17.4%) of 10,389 had a viral infection. Conclusions We demonstrate a wide range of pathogens associated with severe febrile illness and highlight the substantial information gaps regarding the geographic distribution and role of common pathogens. High quality severe febrile illness etiology research that is comprehensive with respect to pathogens and geographically representative is needed.
Collapse
Affiliation(s)
- Namrata Prasad
- Centre for International Health, Dunedin School of Medicine, University of Otago, PO Box 56, Dunedin, 9054, New Zealand
| | - David R. Murdoch
- Department of Pathology, University of Otago Christchurch, 2 Riccarton Avenue, PO Box 4345, Christchurch, 8011, New Zealand
| | - Hugh Reyburn
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, United Kingdom
| | - John A. Crump
- Centre for International Health, Dunedin School of Medicine, University of Otago, PO Box 56, Dunedin, 9054, New Zealand
- * E-mail:
| |
Collapse
|
19
|
Infrastructure and contamination of the physical environment in three Bangladeshi hospitals: putting infection control into context. PLoS One 2014; 9:e89085. [PMID: 24586516 PMCID: PMC3929649 DOI: 10.1371/journal.pone.0089085] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Accepted: 01/18/2014] [Indexed: 11/19/2022] Open
Abstract
Objective This paper describes the physical structure and environmental contamination in selected hospital wards in three government hospitals in Bangladesh. Methods The qualitative research team conducted 48 hours of observation in six wards from three Bangladeshi tertiary hospitals in 2007. They recorded environmental contamination with body secretions and excretions and medical waste and observed ward occupant handwashing and use of personal protective equipment. They recorded number of persons, number of open doors and windows, and use of fans. They measured the ward area and informally observed waste disposal outside the wards. They conducted nine focus group discussions with doctors, nurses and support staff. Results A median of 3.7 persons were present per 10 m2 of floor space in the wards. A median of 4.9 uncovered coughs or sneezes were recorded per 10 m2 per hour per ward. Floors in the wards were soiled with saliva, spit, mucous, vomitus, feces and blood 125 times in 48 hours. Only two of the 12 patient handwashing stations had running water and none had soap. No disinfection was observed before or after using medical instruments. Used medical supplies were often discarded in open containers under the beds. Handwashing with soap was observed in only 32 of 3,373 handwashing opportunities noted during 48 hours. Mosquitoes and feral cats were commonly observed in the wards. Conclusions The physical structure and environment of our study hospitals are conducive to the spread of infection to people in the wards. Low-cost interventions on hand hygiene and cleaning procedures for rooms and medical equipment should be developed and evaluated for their practicality and effectiveness.
Collapse
|
20
|
Swoboda P, Fuehrer HP, Ley B, Starzengruber P, Ley-Thriemer K, Jung M, Matt J, Fally MA, Mueller MKS, Reismann JAB, Haque R, Khan WA, Noedl H. Evidence of a major reservoir of non-malarial febrile diseases in malaria-endemic regions of Bangladesh. Am J Trop Med Hyg 2014; 90:377-82. [PMID: 24420774 DOI: 10.4269/ajtmh.13-0487] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
In malaria-endemic regions any febrile case is likely to be classified as malaria based on presumptive diagnosis largely caused by a lack of diagnostic resources. A district-wide prevalence study assessing etiologies of fever in 659 patients recruited in rural and semi-urban areas of Bandarban district in southeastern Bangladesh revealed high proportions of seropositivity for selected infectious diseases (leptospirosis, typhoid fever) potentially being misdiagnosed as malaria because of similarities in the clinical presentation. In an area with point prevalences of more than 40% for malaria among fever cases, even higher seroprevalence rates of leptospirosis and typhoid fever provide evidence of a major persistent reservoir of these pathogens.
Collapse
Affiliation(s)
- Paul Swoboda
- Institute of Specific Prophylaxis and Tropical Medicine, Medical University of Vienna, Vienna, Austria; MARIB, Malaria Research Initiative Bandarban, Bandarban, Bangladesh; Institute of Parasitology, Department of Pathobiology, University of Veterinary Medicine Vienna; ICDDR,B, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Islam N, Bonovas S, Nikolopoulos GK. An epidemiological overview of malaria in Bangladesh. Travel Med Infect Dis 2013; 11:29-36. [PMID: 23434288 DOI: 10.1016/j.tmaid.2013.01.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Revised: 12/17/2012] [Accepted: 01/22/2013] [Indexed: 10/27/2022]
Abstract
Bangladesh is one of the four major malaria-endemic countries in South-East Asia having approximately 34% of its population at risk of malaria. This paper aims at providing an overview of the malaria situation in this country. Relevant information was retrieved from published articles and reports in PubMed and Google Scholar. Malaria in Bangladesh is concentrated in 13 districts with a prevalence ranging between 3.1% and 36%, and is mostly caused by Plasmodium falciparum. Geographical conditions pose a potential risk for Plasmodium knowlesi malaria. Resistance to a number of drugs previously recommended for treatment has been reported. Low socio-economic status, poor schooling and close proximity to water bodies and forest areas comprise important risk factors. Despite the significant steps in Long Lasting Insecticide Net (LLIN)/Insecticide Treated Net (ITN) coverage in Bangladesh, there are still many challenges including the extension of malaria support to the remote areas of Bangladesh, where malaria prevalence is higher, and further improvements in the field of referral system and treatment.
Collapse
Affiliation(s)
- Nazrul Islam
- Cyprus International Institute for Environmental and Public Health, Limassol, Cyprus
| | | | | |
Collapse
|