1
|
Galani BRT, Mapouokam DW, Simo FBN, Mohamadou H, Chuisseu PDD, Njintang NY, Moundipa PF. Investigation of dengue-malaria coinfection among febrile patients consulting at Ngaoundere Regional Hospital, Cameroon. J Med Virol 2021; 93:3350-3361. [PMID: 33325045 DOI: 10.1002/jmv.26732] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 11/17/2020] [Accepted: 12/13/2020] [Indexed: 01/22/2023]
Abstract
This study aimed at evaluating the seroprevalence of dengue among malarious patients consulting at the Ngaoundere Regional Hospital. During 2 months and a half, 174 participants were recruited and their blood samples were screened for Plasmodium spp and then for Dengue virus (DENV) infection using rapid diagnostic tests. Also, hematological asparameters were measured using a hematology autoanalyzer. Among patients tested, 134 (77.01%) were malaria-positive, and 12/134 (8.95%) were coinfected. In this population, 8/12 (66.67%) were only anti-DENV IgM-positive, 3/12 (25%) were both NS1 and anti-DENV IgM positive, and 1/12 (8.33%) were anti-DENV IgG-positive. Furthermore, women were more affected (58.3%) than men (41.7%). The most affected age groups were young people aged less than or equal to 15 years (33.3%) and adults aged between 30 and 45 years (33.3%). A significant association (p < .05; odds ratio [OR] = 5.16) was found between the age range (30-45) and dengue-malaria coinfection. Similarly, we noted a significant association between the coinfection, and joint pain (p < .05; OR = 6.15), fatigue (p < .01; OR = 5.74), and chills (p < .05; OR = 0). Analysis of hematologic parameters showed a significant decrease (p < .001) in platelets in coinfected patients compared with monoinfected patients. In conclusion, dengue-malaria coinfection is a reality in Ngaoundere city and associated with the appearance of clinical features which predict the disease severity.
Collapse
Affiliation(s)
- Borris R T Galani
- Department of Biological Sciences, Faculty of Science, Laboratory of Applied Biochemistry, University of Ngaoundere, Ngaoundere, Cameroon
- Department of Biochemistry, Laboratory of Pharmacology and Toxicology, Faculty of Science, University of Yaounde I, Yaounde, Cameroon
| | - Danielle W Mapouokam
- Department of Biological Sciences, Faculty of Science, Laboratory of Applied Biochemistry, University of Ngaoundere, Ngaoundere, Cameroon
| | - Fredy B N Simo
- Department of Biochemistry, Laboratory of Pharmacology and Toxicology, Faculty of Science, University of Yaounde I, Yaounde, Cameroon
| | | | - Pascal D D Chuisseu
- Department of Biochemistry, Laboratory of Pharmacology and Toxicology, Faculty of Science, University of Yaounde I, Yaounde, Cameroon
- Higher Institute of Health Sciences, Université des Montagnes, Bangangté, Cameroon
| | - Nicolas Y Njintang
- Department of Biological Sciences, Faculty of Science, Laboratory of Applied Biochemistry, University of Ngaoundere, Ngaoundere, Cameroon
| | - Paul F Moundipa
- Department of Biochemistry, Laboratory of Pharmacology and Toxicology, Faculty of Science, University of Yaounde I, Yaounde, Cameroon
| |
Collapse
|
2
|
Rijo-Ferreira F, Acosta-Rodriguez VA, Abel JH, Kornblum I, Bento I, Kilaru G, Klerman EB, Mota MM, Takahashi JS. The malaria parasite has an intrinsic clock. Science 2020; 368:746-753. [PMID: 32409471 PMCID: PMC7409452 DOI: 10.1126/science.aba2658] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 02/11/2020] [Accepted: 04/06/2020] [Indexed: 01/08/2023]
Abstract
Malarial rhythmic fevers are the consequence of the synchronous bursting of red blood cells (RBCs) on completion of the malaria parasite asexual cell cycle. Here, we hypothesized that an intrinsic clock in the parasite Plasmodium chabaudi underlies the 24-hour-based rhythms of RBC bursting in mice. We show that parasite rhythms are flexible and lengthen to match the rhythms of hosts with long circadian periods. We also show that malaria rhythms persist even when host food intake is evenly spread across 24 hours, suggesting that host feeding cues are not required for synchrony. Moreover, we find that the parasite population remains synchronous and rhythmic even in an arrhythmic clock mutant host. Thus, we propose that parasite rhythms are generated by the parasite, possibly to anticipate its circadian environment.
Collapse
Affiliation(s)
- Filipa Rijo-Ferreira
- Department of Neuroscience, Peter O'Donnell Jr. Brain Institute, University of Texas Southwestern Medical Center, Dallas, TX, USA.
- Howard Hughes Medical Institute, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Victoria A Acosta-Rodriguez
- Department of Neuroscience, Peter O'Donnell Jr. Brain Institute, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - John H Abel
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
- Picower Institute for Learning and Memory, Massachusetts Institute of Technology, Boston, MA, USA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
| | - Izabela Kornblum
- Department of Neuroscience, Peter O'Donnell Jr. Brain Institute, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Howard Hughes Medical Institute, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Ines Bento
- Instituto de Medicina Molecular, João Lobo Antunes, Faculdade de Medicina Universidade de Lisboa, Lisbon, Portugal
| | - Gokhul Kilaru
- Department of Neuroscience, Peter O'Donnell Jr. Brain Institute, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Elizabeth B Klerman
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA, USA
| | - Maria M Mota
- Instituto de Medicina Molecular, João Lobo Antunes, Faculdade de Medicina Universidade de Lisboa, Lisbon, Portugal
| | - Joseph S Takahashi
- Department of Neuroscience, Peter O'Donnell Jr. Brain Institute, University of Texas Southwestern Medical Center, Dallas, TX, USA.
- Howard Hughes Medical Institute, University of Texas Southwestern Medical Center, Dallas, TX, USA
| |
Collapse
|
3
|
Jin XU, Jun-Feng H, Chao H, Zhang BG. [Quality of malaria blood smears from fever patients in Zibo City, Shandong Province from 2011 to 2018]. Zhongguo Xue Xi Chong Bing Fang Zhi Za Zhi 2020; 32:627-630. [PMID: 33325199 DOI: 10.16250/j.32.1374.2019279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To analyze the quality of malaria blood smears from fever patients in Zibo City from 2011 to 2018, so as to provide the scientific evidence for the development of the malaria post-elimination surveillance strategy. METHODS All negative malaria blood smears from fever patients reexamined in the municipal microscopic examination station and all positive blood smears in Zibo City during the period from 2011 to 2018 were reexamined, and the blood smear preparation, dyeing, cleanliness and reexamination results were analyzed. RESULTS A total of 2 141 negative malaria blood smears and 39 positive blood smears were re-reviewed by the municipal microscopic examination station of Zibo City from 2011 to 2018, with a 99.44% qualification rate of negative blood smears preparation, a 97.62% qualification rate of dyeing, a 93.65% qualification rate of cleanliness, and a 100% consistence with the re-review, and no missing diagnosis was found. A total of 39 positive blood smears were re-reviewed, with a 46.15% qualification rate of blood smears preparation, a 61.54% qualification rate of dyeing, a 76.92% qualification rate of cleanliness, and a 97.44% consistence with the re-review, and a blood smear mistaking the Plasmodium species was found. There were significant differences in the qualification rate of blood smears preparation and dyeing among all districts (counties) in Zibo City (all P values < 0.05), and no significant difference was detected in the qualification rate of blood smear cleanliness (χ2 = 13.72, P >0.05), while significant differences were seen in the qualification rate of blood smears preparation, dyeing and cleanliness each year from 2011 to 2018 (all P values < 0.05). CONCLUSIONS The quality of malaria blood smears is high in all districts of Zibo City; however, the quality of city-level blood smears remains to be improved. Further actions to improve the training of grassroots microscopic examinations and quality control of malaria blood smears are required to ensure the capability of microscopic examinations of Plasmodium during the malaria post-elimination stage.
Collapse
Affiliation(s)
- X U Jin
- Zibo Municipal Center for Disease Control and Prevention, Key Laboratory of Zibo City, Zibo 255026, China
| | - Hao Jun-Feng
- Zibo Municipal Center for Disease Control and Prevention, Key Laboratory of Zibo City, Zibo 255026, China
| | - Han Chao
- Zibo Municipal Center for Disease Control and Prevention, Key Laboratory of Zibo City, Zibo 255026, China
| | - B G Zhang
- Shandong Institute of Parasitic Diseases, Shandong First Medical University & Shandong Academy of Medical Science, China
| |
Collapse
|
4
|
Zhang Z, Chung H, Gong T. Fever, Abdominal Pain, and Jaundice in a Pacific Islander Woman. JAMA 2020; 323:272-273. [PMID: 31841586 DOI: 10.1001/jama.2019.20118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Zao Zhang
- Department of Medicine, The Queen's Medical Center, Honolulu, Hawaii
| | - Heath Chung
- Department of Infectious Disease, The Queen's Medical Center, Honolulu, Hawaii
| | - Ting Gong
- Department of Tropical Medicine, Medical Microbiology and Pharmacology, University of Hawaii John A. Burns School of Medicine, Honolulu
| |
Collapse
|
5
|
Agbota G, Polman K, Wieringa FT, Campos-Ponce M, Accrombessi M, Yovo E, Roucher C, Ezinmègnon S, Marcos JY, Vachot L, Tissières P, Massougbodji A, Fievet N, Cot M, Briand V. Maternal malaria but not schistosomiasis is associated with a higher risk of febrile infection in infant during the first 3 months of life: A mother-child cohort in Benin. PLoS One 2019; 14:e0222864. [PMID: 31536589 PMCID: PMC6752763 DOI: 10.1371/journal.pone.0222864] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 09/09/2019] [Indexed: 01/21/2023] Open
Abstract
Background Malaria and schistosomiasis represent two of the most prevalent and disabling parasitic infections in developing countries. Few studies have evaluated the effect of maternal schistosomiasis and malaria in the peri-conceptional period on infant’s risk of infection. Methods In Benin, women were followed from the preconception period until delivery. Subsequently, their children were followed from birth to 3 months of age. Pre-pregnancy malaria, malaria in pregnancy (MiP)—determined monthly using a thick blood smear—and urinary schistosomiasis—determined once before pregnancy and once at delivery using urine filtration—were the main maternal exposures. Infant’s febrile infection (fever with respiratory, gastrointestinal and/or cutaneous clinical signs anytime during follow-up) was the main outcome. In a secondary analysis, we checked the relation of malaria and schistosomiasis with infant’s hemoglobin (Hb) concentration. Both effects were separately assessed using logistic/mixed linear regression models. Results The prevalence of MiP was 35.7% with 10.8% occurring during the 1st trimester, and the prevalence of schistosomiasis was 21.8%. From birth to 3 months, 25.3% of infants had at least one episode of febrile infection. In multivariate analysis, MiP, particularly malaria in the 1st trimester, was significantly associated with a higher risk of infant’s febrile infection (aOR = 4.99 [1.1; 22.6], p = 0.03). In secondary results, pre-pregnancy malaria and schistosomiasis were significantly associated with a lower infant’s Hb concentration during the first 3 months. Conclusion We evidenced the deleterious effect of maternal parasitic infections on infant’s health. Our results argue in favor of the implementation of preventive strategies as early as in the peri-conception.
Collapse
Affiliation(s)
- Gino Agbota
- MERIT, IRD, Université Paris 5, Sorbonne Paris Cité, Paris, France
- Centre d’Etude et de Recherche sur le Paludisme Associé à la Grossesse et à l’Enfance (CERPAGE), Cotonou, Bénin
- * E-mail:
| | - Katja Polman
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
- Section Infectious Diseases, Department of Health Sciences, VU Amsterdam, Amsterdam, The Netherlands
| | - Frank T. Wieringa
- Nutripass, UMR204, Institut de Recherche pour le Développement, IRD/UM/SupAgro, Montpellier, France
| | - Maiza Campos-Ponce
- Section Infectious Diseases, Department of Health Sciences, VU Amsterdam, Amsterdam, The Netherlands
| | | | - Emmanuel Yovo
- MERIT, IRD, Université Paris 5, Sorbonne Paris Cité, Paris, France
| | - Clémentine Roucher
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Sem Ezinmègnon
- Medical Diagnostic Discovery Department (MD3), bioMérieux, Marcy l’Etoile, France
- UMR 9198, Institut de biologie Intégrative de la Cellule, Université Paris Saclay, Paris, France
| | | | - Laurence Vachot
- Medical Diagnostic Discovery Department (MD3), bioMérieux, Marcy l’Etoile, France
| | - Pierre Tissières
- UMR 9198, Institut de biologie Intégrative de la Cellule, Université Paris Saclay, Paris, France
| | - Achille Massougbodji
- Centre d’Etude et de Recherche sur le Paludisme Associé à la Grossesse et à l’Enfance (CERPAGE), Cotonou, Bénin
| | - Nadine Fievet
- MERIT, IRD, Université Paris 5, Sorbonne Paris Cité, Paris, France
| | - Michel Cot
- MERIT, IRD, Université Paris 5, Sorbonne Paris Cité, Paris, France
| | - Valérie Briand
- MERIT, IRD, Université Paris 5, Sorbonne Paris Cité, Paris, France
| |
Collapse
|
6
|
Affiliation(s)
- A Agarwal
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - S Soni
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - A Chaudhary
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - A K Pannu
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - A Bhalla
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - V Suri
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - S Kumari
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
7
|
Ramesh A, Nakielny S, Hsu J, Kyohere M, Byaruhanga O, de Bourcy C, Egger R, Dimitrov B, Juan YF, Sheu J, Wang J, Kalantar K, Langelier C, Ruel T, Mpimbaza A, Wilson MR, Rosenthal PJ, DeRisi JL. Metagenomic next-generation sequencing of samples from pediatric febrile illness in Tororo, Uganda. PLoS One 2019; 14:e0218318. [PMID: 31220115 PMCID: PMC6586300 DOI: 10.1371/journal.pone.0218318] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 05/31/2019] [Indexed: 12/15/2022] Open
Abstract
Febrile illness is a major burden in African children, and non-malarial causes of fever are uncertain. In this retrospective exploratory study, we used metagenomic next-generation sequencing (mNGS) to evaluate serum, nasopharyngeal, and stool specimens from 94 children (aged 2–54 months) with febrile illness admitted to Tororo District Hospital, Uganda. The most common microbes identified were Plasmodium falciparum (51.1% of samples) and parvovirus B19 (4.4%) from serum; human rhinoviruses A and C (40%), respiratory syncytial virus (10%), and human herpesvirus 5 (10%) from nasopharyngeal swabs; and rotavirus A (50% of those with diarrhea) from stool. We also report the near complete genome of a highly divergent orthobunyavirus, tentatively named Nyangole virus, identified from the serum of a child diagnosed with malaria and pneumonia, a Bwamba orthobunyavirus in the nasopharynx of a child with rash and sepsis, and the genomes of two novel human rhinovirus C species. In this retrospective exploratory study, mNGS identified multiple potential pathogens, including 3 new viral species, associated with fever in Ugandan children.
Collapse
Affiliation(s)
- Akshaya Ramesh
- Weill Institute for Neurosciences, University of California, San Francisco, California, United States of America
- Department of Neurology, University of California, San Francisco, California, United States of America
- * E-mail: (AR); (JLD)
| | - Sara Nakielny
- Department of Biochemistry and Biophysics, University of California, San Francisco, California, United States of America
| | - Jennifer Hsu
- Division of Infectious Diseases, Department of Medicine, University of California, San Francisco, California, United States of America
| | - Mary Kyohere
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | | | - Charles de Bourcy
- Chan Zuckerberg Biohub, San Francisco, California, United States of America
| | - Rebecca Egger
- Chan Zuckerberg Biohub, San Francisco, California, United States of America
| | - Boris Dimitrov
- Chan Zuckerberg Biohub, San Francisco, California, United States of America
| | - Yun-Fang Juan
- Chan Zuckerberg Biohub, San Francisco, California, United States of America
| | - Jonathan Sheu
- Chan Zuckerberg Biohub, San Francisco, California, United States of America
| | - James Wang
- Chan Zuckerberg Biohub, San Francisco, California, United States of America
| | - Katrina Kalantar
- Department of Biochemistry and Biophysics, University of California, San Francisco, California, United States of America
| | - Charles Langelier
- Division of Infectious Diseases, Department of Medicine, University of California, San Francisco, California, United States of America
| | - Theodore Ruel
- Division of Pediatric Infectious Diseases and Global Health, Department of Pediatrics, University of California, San Francisco, California, United States of America
| | - Arthur Mpimbaza
- Child Health and Development Centre, Makerere University, Kampala, Uganda
| | - Michael R. Wilson
- Weill Institute for Neurosciences, University of California, San Francisco, California, United States of America
- Department of Neurology, University of California, San Francisco, California, United States of America
| | - Philip J. Rosenthal
- Division of Infectious Diseases, Department of Medicine, University of California, San Francisco, California, United States of America
| | - Joseph L. DeRisi
- Department of Biochemistry and Biophysics, University of California, San Francisco, California, United States of America
- Chan Zuckerberg Biohub, San Francisco, California, United States of America
- * E-mail: (AR); (JLD)
| |
Collapse
|
8
|
Martin T, Eliades MJ, Wun J, Burnett SM, Alombah F, Ntumy R, Gondwe M, Onyando B, Onditi S, Guindo B, Hamilton P. Effect of Supportive Supervision on Competency of Febrile Clinical Case Management in Sub-Saharan Africa. Am J Trop Med Hyg 2019; 100:882-888. [PMID: 30793696 PMCID: PMC6447112 DOI: 10.4269/ajtmh.18-0365] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 12/18/2018] [Indexed: 01/22/2023] Open
Abstract
Since 2010, the WHO has recommended that clinical decision-making for malaria case management be performed based on the results of a parasitological test result. Between 2015 and 2017, the U.S. President's Malaria Initiative-funded MalariaCare project supported the implementation of this practice in eight sub-Saharan African countries through 5,382 outreach training and supportive supervision visits to 3,563 health facilities. During these visits, trained government supervisors used a 25-point checklist to observe clinicians' performance in outpatient departments, and then provided structured mentoring and action planning. At baseline, more than 90% of facilities demonstrated a good understanding of WHO recommendations-when tests should be ordered, using test results to develop an accurate final diagnosis, severity assessment, and providing the correct prescription. However, significant deficits were found in history taking, conducting a physical examination, and communicating with patients and their caregivers. After three visits, worker performance demonstrated steady improvement-in particular, with checking for factors associated with increased morbidity and mortality: one sign of severe malaria (72.9-85.5%), pregnancy (81.1-87.4%), and anemia (77.2-86.4%). A regression analysis predicted an overall improvement in clinical performance of 6.3% (P < 0.001) by the third visit. These findings indicate that in most health facilities, there is good baseline knowledge on the processes of quality clinical management, but further training and on-site mentoring are needed to improve the clinical interaction that focuses on second-order decision-making, such as severity of illness, management of non-malarial fever, and completing the patient-provider communication loop.
Collapse
Affiliation(s)
- Troy Martin
- President’s Malaria Initiative (PMI) MalariaCare Project, PATH, Washington, District of Columbia
| | - M. James Eliades
- President’s Malaria Initiative (PMI) MalariaCare Project, PATH, Washington, District of Columbia
- Malaria, Asia; Population Services International, Yangon, Myanmar
- Population and Family Health, Mailman School of Public Health, Columbia University, New York, New York
| | - Jolene Wun
- President’s Malaria Initiative (PMI) MalariaCare Project, PATH, Washington, District of Columbia
| | - Sarah M. Burnett
- President’s Malaria Initiative (PMI) MalariaCare Project, PATH, Washington, District of Columbia
| | - Fozo Alombah
- President’s Malaria Initiative (PMI) MalariaCare Project, PATH, Washington, District of Columbia
| | - Raphael Ntumy
- President’s Malaria Initiative (PMI) MalariaCare Project, PATH, Accra, Ghana
| | - McPherson Gondwe
- President’s Malaria Initiative (PMI) MalariaCare Project, PATH, Lilongwe, Malawi
| | - Beatrice Onyando
- President’s Malaria Initiative (PMI) MalariaCare Project, PATH, Kisumu, Kenya
| | - Samwel Onditi
- President’s Malaria Initiative (PMI) MalariaCare Project, PATH, Kisumu, Kenya
| | - Boubacar Guindo
- President’s Malaria Initiative (PMI) MalariaCare Project, Population Services International, Bamako, Mali
| | - Paul Hamilton
- President’s Malaria Initiative (PMI) MalariaCare Project, PATH, Washington, District of Columbia
| |
Collapse
|
9
|
Romero Estarlich V, Vásquez Grande JP, Gómez-Olano Picabea FJ, Ortiz Alonso FJ, Vidán Astiz MT. [Octogenarian with rheumatoid arthritis, low-grade fever, severe pericardial effusion, and splenomegaly]. Rev Esp Geriatr Gerontol 2018; 53:301-302. [PMID: 29576251 DOI: 10.1016/j.regg.2018.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 01/23/2018] [Accepted: 01/25/2018] [Indexed: 06/08/2023]
|
10
|
Heil TC, Dercksen MW, Blank SN. [Infection or metastases? The amoebic abscess]. Ned Tijdschr Geneeskd 2018; 162:D2580. [PMID: 30182627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Cases of Entamoeba histolytica infections in the Netherlands are usually imported diseases. The most common extra-intestinal manifestation of E. histolytica is the amoebic abscess. Patients can present with a clinical picture of colitis with pain in the upper right abdomen, accompanied by fever in cases of liver abscess. Diagnostics focus mainly on the detection of E. histolytica with PCR or ELISA. Infections are treated with metronidazole, with clioquinol as follow-up treatment. CASE DESCRIPTION A 61-year-old, previously healthy man was admitted to hospital with pain in the upper right abdomen and fever. He had no history of travel in the tropics or sub-tropics. CT imaging revealed liver abscesses or liver metastases. Cultures of abscess fluid were negative. After extensive diagnostics the patient was shown to have an amoebic abscess for which he was successfully treated. CONCLUSION If the bacterial cultures of liver abscess fluid continue to be negative the possibility of an amoebic abscess should be considered, even with a negative history of travel to the tropics or subtropics.
Collapse
Affiliation(s)
- Thea C Heil
- Maxima Medisch Centrum, afd. Interne Geneeskunde, Veldhoven
- Contact: T.C. Heil
| | | | - S N Blank
- Maxima Medisch Centrum, afd. Interne Geneeskunde, Veldhoven
| |
Collapse
|
11
|
Abstract
When malaria isn't the cause, clinics in the developing world often have little to offer.
Collapse
|
12
|
Greer E, Singh KH, Blake G, Stockton MD. Schistosomiasis in a returning international traveler with cyclic fevers and diarrhea. Can Fam Physician 2018; 64:123-126. [PMID: 29449243 PMCID: PMC5964387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Emily Greer
- Family physician with Clinica Family Health Services in Boulder, Colo
| | | | - Gregory Blake
- Professor and Chair in the Department of Family Medicine in the Graduate School of Medicine at the University of Tennessee in Knoxville
| | - M David Stockton
- Professor in the Department of Family Medicine in the Graduate School of Medicine at the University of Tennessee.
| |
Collapse
|
13
|
Affiliation(s)
- Doug Fink
- The Hospital for Tropical Diseases, Mortimer Market Centre, London, UK
- Division of Infection and Immunity, University College London, London, UK
| | - Robert Serafino Wani
- Department of Infection, Barts Health NHS Trust, Royal London Hospital, London, UK
| | - Victoria Johnston
- The Hospital for Tropical Diseases, Mortimer Market Centre, London, UK
- London School of Hygiene and Tropical Medicine, London, UK
| |
Collapse
|
14
|
Hansen KS, Clarke SE, Lal S, Magnussen P, Mbonye AK. Cost-effectiveness analysis of introducing malaria diagnostic testing in drug shops: A cluster-randomised trial in Uganda. PLoS One 2017; 12:e0189758. [PMID: 29244829 PMCID: PMC5731679 DOI: 10.1371/journal.pone.0189758] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Accepted: 12/02/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Private sector drug shops are an important source of malaria treatment in Africa, yet diagnosis without parasitological testing is common among these providers. Accurate rapid diagnostic tests for malaria (mRDTs) require limited training and present an opportunity to increase access to correct diagnosis. The present study was a cost-effectiveness analysis of the introduction of mRDTs in Ugandan drug shops. METHODS Drug shop vendors were trained to perform and sell subsidised mRDTs and artemisinin-based combination therapies (ACTs) in the intervention arm while vendors offered ACTs following presumptive diagnosis of malaria in the control arm. The effect on the proportion of customers with fever 'appropriately treated of malaria with ACT' was captured during a randomised trial in drug shops in Mukono District, Uganda. Health sector costs included: training of drug shop vendors, community sensitisation, supervision and provision of mRDTs and ACTs to drug shops. Household costs of treatment-seeking were captured in a representative sample of drug shop customers. FINDINGS The introduction of mRDTs in drug shops was associated with a large improvement of diagnosis and treatment of malaria, resulting in low incremental costs for the health sector at US$0.55 per patient appropriately treated of malaria. High expenditure on non-ACT drugs by households contributed to higher incremental societal costs of US$3.83. Sensitivity analysis showed that mRDTs would become less cost-effective compared to presumptive diagnosis with increasing malaria prevalence and lower adherence to negative mRDT results. CONCLUSION mRDTs in drug shops improved the targeting of ACTs to malaria patients and are likely to be considered cost-effective compared to presumptive diagnosis, although the increased costs borne by households when the test result is negative are a concern.
Collapse
Affiliation(s)
- Kristian Schultz Hansen
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Department of Public Health, Section for Health Services Research, University of Copenhagen, Copenhagen, Denmark
| | - Siân E. Clarke
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sham Lal
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Pascal Magnussen
- Centre for Medical Parasitology, University of Copenhagen, Copenhagen, Denmark
| | - Anthony K. Mbonye
- Directorate of Clinical and Community Services, Ministry of Health, Kampala, Uganda
- School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| |
Collapse
|
15
|
Daimee UA, Shelly MA, Fine SM. A 77-year-old man with fever and night sweats. Eur J Intern Med 2017; 40:e3-e4. [PMID: 27765389 DOI: 10.1016/j.ejim.2016.09.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 09/30/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Usama A Daimee
- Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA.
| | - Mark A Shelly
- Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Steven M Fine
- Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
| |
Collapse
|
16
|
Abstract
BACKGROUND Babesiosis, a zoonotic parasitic infection transmitted by the Ixodes tick, has become an emerging health problem in humans that is attracting attention worldwide. Most cases of human babesiosis are reported in the United States and Europe. The disease is caused by the protozoa of the genus Babesia, which invade human erythrocytes and lyse them causing a febrile hemolytic anemia. The infection is usually asymptomatic or self-limited in the immunocompetent host, or follows a persistent, relapsing, and/or life threatening course with multi-organ failure, mainly in the splenectomized or immunosuppressed patients. Hematologic manifestations of the disease are common. They can range from mild anemia, to severe pancytopenia, splenic rupture, disseminated intravascular coagulopathy (DIC), or even hemophagocytic lymphohistiocytosis (HLH). CASE PRESENTATION A 70 year old immunocompetent female patient living in New York City presented with a persistent fever, night sweats, and fatigue of 5 days duration. Full evaluation showed a febrile hemolytic anemia along with neutropenia and thrombocytopenia. Blood smear revealed intraerythrocytic Babesia, which was confirmed by PCR. Bone marrow biopsy was remarkable for dyserythropoiesis, suggesting possible HLH, supported by other blood workup meeting HLH-2004 trial criteria. CONCLUSION Human babesiosis is an increasing healthcare problem in the United States that is being diagnosed more often nowadays. We presented a case of HLH triggered by Babesia microti that was treated successfully. Also, we presented the hematologic manifestations of this disease along with their pathophysiologies.
Collapse
Affiliation(s)
- Tamer Akel
- Department of Internal Medicine, Staten Island University Hospital, 475 Seaview Avenue, Staten Island, NY 10305 USA
| | - Neville Mobarakai
- Department of Infectious Diseases, Staten Island University Hospital, 475 Seaview Avenue, Staten Island, NY 10305 USA
| |
Collapse
|
17
|
Haanshuus CG, Chandy S, Manoharan A, Vivek R, Mathai D, Xena D, Singh A, Langeland N, Blomberg B, Vasanthan G, Sitaram U, Appasamy J, Nesaraj J, Henry A, Patil S, Alvarez-Uria G, Armstrong L, Mørch K. A High Malaria Prevalence Identified by PCR among Patients with Acute Undifferentiated Fever in India. PLoS One 2016; 11:e0158816. [PMID: 27389396 PMCID: PMC4936667 DOI: 10.1371/journal.pone.0158816] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 06/22/2016] [Indexed: 11/29/2022] Open
Abstract
Background Approximately one million malaria cases were reported in India in 2015, based on microscopy. This study aims to assess the malaria prevalence among hospitalised fever patients in India identified by PCR, and to evaluate the performance of routine diagnostic methods. Methods During June 2011-December 2012, patients admitted with acute undifferentiated fever to seven secondary level community hospitals in Assam (Tezpur), Bihar (Raxaul), Chhattisgarh (Mungeli), Maharashtra (Ratnagiri), Andhra Pradesh (Anantapur) and Tamil Nadu (Oddanchatram and Ambur) were included. The malaria prevalence was assessed by polymerase chain reaction (PCR), routine microscopy, and a rapid diagnostic test (RDT) with PCR as a reference method. Results The malaria prevalence by PCR was 19% (268/1412) ranging from 6% (Oddanchatram, South India) to 35% (Ratnagiri, West India). Among malaria positive patients P. falciparum single infection was detected in 46%, while 38% had P. vivax, 11% mixed infections with P. falciparum and P. vivax, and 5% P. malariae. Compared to PCR, microscopy had sensitivity of 29% and specificity of 98%, while the RDT had sensitivity of 24% and specificity of 99%. Conclusions High malaria prevalence was identified by PCR in this cohort. Routine diagnostic methods had low sensitivity compared to PCR. The results suggest that malaria is underdiagnosed in rural India. However, low parasitaemia controlled by immunity may constitute a proportion of PCR positive cases, which calls for awareness of the fact that other pathogens could be responsible for the febrile disease in submicroscopic malaria.
Collapse
Affiliation(s)
- Christel Gill Haanshuus
- National Centre for Tropical Infectious Diseases, Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Sara Chandy
- Infectious Diseases Training and Research Center, Department of Medicine Unit-1 and Infectious Diseases, Christian Medical College, Vellore, India
| | - Anand Manoharan
- Infectious Diseases Training and Research Center, Department of Medicine Unit-1 and Infectious Diseases, Christian Medical College, Vellore, India
- * E-mail:
| | - Rosario Vivek
- Infectious Diseases Training and Research Center, Department of Medicine Unit-1 and Infectious Diseases, Christian Medical College, Vellore, India
| | - Dilip Mathai
- Infectious Diseases Training and Research Center, Department of Medicine Unit-1 and Infectious Diseases, Christian Medical College, Vellore, India
| | - Deepika Xena
- Infectious Diseases Training and Research Center, Department of Medicine Unit-1 and Infectious Diseases, Christian Medical College, Vellore, India
| | - Ashita Singh
- Baptist Christian Hospital, Tezpur, Assam, India
| | - Nina Langeland
- National Centre for Tropical Infectious Diseases, Department of Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Bjørn Blomberg
- National Centre for Tropical Infectious Diseases, Department of Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - George Vasanthan
- Infectious Diseases Training and Research Center, Department of Medicine Unit-1 and Infectious Diseases, Christian Medical College, Vellore, India
| | - Usha Sitaram
- Infectious Diseases Training and Research Center, Department of Medicine Unit-1 and Infectious Diseases, Christian Medical College, Vellore, India
| | | | | | - Anil Henry
- Christian Hospital, Mungeli, Chhattisgarh, India
| | - Suvarna Patil
- B.K.L. Walawalkar Hospital, Ratnagiri, Maharashtra, India
| | | | | | - Kristine Mørch
- National Centre for Tropical Infectious Diseases, Department of Medicine, Haukeland University Hospital, Bergen, Norway
| |
Collapse
|
18
|
Affiliation(s)
- C Oduro-Boatey
- Department of Child Health, Korle-BuTeqching Hospital, Accra, Ghana.
| | | |
Collapse
|
19
|
Abstract
Rapid diagnostic tests have the potential to reduce the overtreatment of malaria by 95%, but time and extensive logistical, behavioural, and technical interventions may be required to achieve this, argue Eleanor Ochodo and colleagues
Collapse
Affiliation(s)
- Eleanor Ochodo
- Centre for Evidence-Based Health Care, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 241, Cape Town 8000, South Africa
| | - Paul Garner
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - David Sinclair
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| |
Collapse
|
20
|
Abokyi LN, Asante KP, Mahama E, Gyaase S, Sulemana A, Kwarteng A, Ayaam J, Dosoo D, Adu-Gyasi D, Amenga Etego S, Ogutu B, Akweongo P, Owusu-Agyei S. Use of Antimalarial in the Management of Fever during a Community Survey in the Kintampo Districts of Ghana. PLoS One 2015; 10:e0142106. [PMID: 26580076 PMCID: PMC4651568 DOI: 10.1371/journal.pone.0142106] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 10/16/2015] [Indexed: 11/18/2022] Open
Abstract
Background Epidemiology of malaria and related fevers in most parts of Africa is changing due to scale up of interventions such as appropriate use of ACTs in the effort towards sustained control and eventual elimination of malaria. The use of ACTs in the management of malaria-associated fever was evaluated in the Kintampo districts of Ghana. Methods Household survey was conducted between October 2009 and February, 2011. A random selection of 370 households was generated from 25,000 households existing within the Health and Demographic Surveillance Systems in Kintampo, Ghana at the time. All household members present at the time of survey in the eligible households were interviewed based on a two weeks reported fever recall and the use of antimalarial for the management of fever. A finger-prick blood sample was also obtained from each member of the household present and later examined for malaria parasites using microscopy. Descriptive analysis was performed, with univariate and multivariate analysis used to identify predictors of fever and malaria parasitemia. Results A total of 1436 individuals were interviewed from 370 households. Overall, fever prevalence was 23.8% (341/1436) and was 38.8% (77/198) in children < 5 years, 21.3% (264/1238) in older children plus adults. Participants who sought treatment for fever were 84% (285/341) with 47.7% (136/285) using any anti-malarial. Artemisinin-based Combination Therapy use was in 69.1% (94/136) of cases while 30.9% used mono-therapies. Malaria parasitaemia rate was 28.2% (397/1407). Conclusion The study reports high community fever prevalence, frequent use of antimalarials for fever treatment and relatively high use of mono-therapies especially in children < 5 years in an area with high malaria parasite prevalence in Ghana.
Collapse
Affiliation(s)
- Livesy Naafoe Abokyi
- Kintampo Health Research Centre, P. O. Box 200, Kintampo, Brong Ahafo Region
- * E-mail:
| | - Kwaku Poku Asante
- Kintampo Health Research Centre, P. O. Box 200, Kintampo, Brong Ahafo Region
| | - Emmanuel Mahama
- Kintampo Health Research Centre, P. O. Box 200, Kintampo, Brong Ahafo Region
| | - Stephaney Gyaase
- Kintampo Health Research Centre, P. O. Box 200, Kintampo, Brong Ahafo Region
| | - Abubakari Sulemana
- Kintampo Health Research Centre, P. O. Box 200, Kintampo, Brong Ahafo Region
| | - Anthony Kwarteng
- Kintampo Health Research Centre, P. O. Box 200, Kintampo, Brong Ahafo Region
| | - Jennifer Ayaam
- Kintampo Health Research Centre, P. O. Box 200, Kintampo, Brong Ahafo Region
| | - David Dosoo
- Kintampo Health Research Centre, P. O. Box 200, Kintampo, Brong Ahafo Region
| | - Dennis Adu-Gyasi
- Kintampo Health Research Centre, P. O. Box 200, Kintampo, Brong Ahafo Region
| | - Seeba Amenga Etego
- Kintampo Health Research Centre, P. O. Box 200, Kintampo, Brong Ahafo Region
| | - Bernhards Ogutu
- INDEPTH Network, East Legon, P.O. Box KD 213 Kanda, Accra, Ghana
| | - Patricia Akweongo
- School of Public Health, College of Health Sciences, PO Box LG-13, Legon, Accra, Ghana
| | - Seth Owusu-Agyei
- Kintampo Health Research Centre, P. O. Box 200, Kintampo, Brong Ahafo Region
| |
Collapse
|
21
|
Plucinski MM, Guilavogui T, Sidikiba S, Diakité N, Diakité S, Dioubaté M, Bah I, Hennessee I, Butts JK, Halsey ES, McElroy PD, Kachur SP, Aboulhab J, James R, Keita M. Effect of the Ebola-virus-disease epidemic on malaria case management in Guinea, 2014: a cross-sectional survey of health facilities. Lancet Infect Dis 2015. [PMID: 26116183 DOI: 10.1016/b978-0-12-420118-7.00008-1.dopamine] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
BACKGROUND The ongoing west Africa Ebola-virus-disease epidemic has disrupted the entire health-care system in affected countries. Because of the overlap of symptoms of Ebola virus disease and malaria, the care delivery of malaria is particularly sensitive to the indirect effects of the current Ebola-virus-disease epidemic. We therefore characterise malaria case management in the context of the Ebola-virus-disease epidemic and document the effect of the Ebola-virus-disease epidemic on malaria case management. METHODS We did a cross-sectional survey of public health facilities in Guinea in December, 2014. We selected the four prefectures most affected by Ebola virus disease and selected four randomly from prefectures without any reported cases of the disease. 60 health facilities were sampled in Ebola-affected and 60 in Ebola-unaffected prefectures. Study teams abstracted malaria case management indicators from registers for January to November for 2013 and 2014 and interviewed health-care workers. Nationwide weekly surveillance data for suspect malaria cases reported between 2011 and 2014 were analysed independently. Data for malaria indicators in 2014 were compared with previous years. FINDINGS We noted substantial reductions in all-cause outpatient visits (by 23 103 [11%] of 214 899), cases of fever (by 20249 [15%] of 131 330), and patients treated with oral (by 22 655 [24%] of 94 785) and injectable (by 5219 [30%] of 17 684) antimalarial drugs in surveyed health facilities. In Ebola-affected prefectures, 73 of 98 interviewed community health workers were operational (74%, 95% CI 65-83) and 35 of 73 were actively treating malaria cases (48%, 36-60) compared with 106 of 112 (95%, 89-98) and 102 of 106 (96%, 91-99), respectively, in Ebola-unaffected prefectures. Nationwide, the Ebola-virus-disease epidemic was estimated to have resulted in 74 000 (71 000-77 000) fewer malaria cases seen at health facilities in 2014. INTERPRETATION The reduction in the delivery of malaria care because of the Ebola-virus-disease epidemic threatens malaria control in Guinea. Untreated and inappropriately treated malaria cases lead to excess malaria mortality and more fever cases in the community, impeding the Ebola-virus-disease response. FUNDING Global Fund to Fight AIDS, Tuberculosis and Malaria, and President's Malaria Initiative.
Collapse
Affiliation(s)
- Mateusz M Plucinski
- Malaria Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA; President's Malaria Initiative, Atlanta, GA, USA.
| | | | | | - Nouman Diakité
- National Malaria Control Programme, Ministry of Health, Conakry, Guinea
| | | | - Mohamed Dioubaté
- National Malaria Control Programme, Ministry of Health, Conakry, Guinea
| | | | - Ian Hennessee
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Jessica K Butts
- Malaria Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA; President's Malaria Initiative, Atlanta, GA, USA
| | - Eric S Halsey
- Malaria Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA; President's Malaria Initiative, Atlanta, GA, USA
| | - Peter D McElroy
- Malaria Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA; President's Malaria Initiative, Atlanta, GA, USA
| | - S Patrick Kachur
- Malaria Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jamila Aboulhab
- Malaria Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA; President's Malaria Initiative, Atlanta, GA, USA
| | - Richard James
- Division of Prevention and Disease Control, Ministry of Health, Conakry, Guinea
| | - Moussa Keita
- National Malaria Control Programme, Ministry of Health, Conakry, Guinea
| |
Collapse
|
22
|
Allister LM, Schultz ML, Brown DFM, Miller ES. Altered Mental Status and Fever. J Emerg Med 2015; 49:183-187. [PMID: 26022937 DOI: 10.1016/j.jemermed.2015.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 03/03/2015] [Indexed: 06/04/2023]
Affiliation(s)
- Lauren M Allister
- Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts; Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Megan L Schultz
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts
| | - David F M Brown
- Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts; Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Emily S Miller
- Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts; Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts
| |
Collapse
|
23
|
Rochat L, Bizzini A, Bochud PY, Senn N, De Vallière S, Genton B. [Acute schistosomiasis: lessons learned from a cohort of 42 exposed travelers]. Rev Med Suisse 2015; 11:1017-1022. [PMID: 26103765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Acute schistosomiasis is a regularly encountered disease in travelers. Because of the temporal delay, its unspecific presentation and the spontaneous resolution, acute schistosomiasis can easily remain unrecognized by physicians who are not familiar with tropical pathologies. In December 2011, a female traveler was admitted to the hospital with undetermined fever after having returned from Madagascar where she bathed in fresh water. Acute schistosomiasis was diagnosed and infection was suspected among other travelers of her group. Seroconversion was confirmed among 78% of participants. This article intends to clarify the preventive and diagnostic strategies based on the lessons learned from this cluster of 42 travelers exposed to schistosomiasis.
Collapse
|
24
|
Chipwaza B, Mhamphi GG, Ngatunga SD, Selemani M, Amuri M, Mugasa JP, Gwakisa PS. Prevalence of bacterial febrile illnesses in children in Kilosa district, Tanzania. PLoS Negl Trop Dis 2015; 9:e0003750. [PMID: 25955522 PMCID: PMC4425467 DOI: 10.1371/journal.pntd.0003750] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2014] [Accepted: 04/10/2015] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Bacterial etiologies of non-malaria febrile illnesses have significantly become important due to high mortality and morbidity, particularly in children. Despite their importance, there are few reports on the epidemiology of these diseases in Tanzania, and the true burden of such illnesses remains unknown. This study aimed to identify the prevalence of leptospirosis, brucellosis, typhoid fever and urinary tract infections and their rate of co-infections with malaria. METHODS A cross-sectional study was conducted at Kilosa district hospital in Tanzania for 6 months. Febrile children aged from 2-13 years were recruited from the outpatient department. Patients were screened by serological tests such as IgM and IgG ELISA, and microscopic agglutination test. RESULTS A total of 370 patients were enrolled; of these 85 (23.0%) had malaria parasites, 43 (11.6%) had presumptive acute leptospirosis and 26/200 (13%) had confirmed leptospirosis. Presumptive acute brucellosis due to B. abortus was identified among 26 (7.0%) of patients while B. melitensis was detected in 57 (15.4%) of the enrolled patients. Presumptive typhoid fever due to S. Typhi was identified in thirty eight (10.3%) of the participants and 69 (18.6%) had urinary tract infections. Patients presented with similar symptoms; therefore, the identification of these diseases could not be done based on clinical ground alone. Co-infections between malaria and bacterial febrile illnesses were observed in 146 patients (39.5%). Although antibacterials and/or anti-malarials were prescribed in most patients, some patients did not receive the appropriate treatment. CONCLUSION The study has underscored the importance of febrile bacterial diseases including zoonoses such as leptospirosis and brucellosis in febrile children, and thus such illnesses should be considered by clinicians in the differential diagnoses of febrile diseases. However, access to diagnostic tests for discrimination of febrile illnesses is needed. This would allow febrile patients to receive the correct diagnoses and facilitation of accurate and prompt treatment.
Collapse
Affiliation(s)
- Beatrice Chipwaza
- Nelson Mandela African Institution of Science and Technology, Arusha, Tanzania
- Ifakara Health Institute, Ifakara, Tanzania
| | - Ginethon G. Mhamphi
- Sokoine University of Agriculture, Pest Management Center, Chuo Kikuu, Morogoro, Tanzania
| | | | | | | | - Joseph P. Mugasa
- National Institute for Medical Research, Amani Medical Research Centre, Tanga, Tanzania
| | - Paul S. Gwakisa
- Nelson Mandela African Institution of Science and Technology, Arusha, Tanzania
- Genome Science Centre and Department of Veterinary Microbiology and Parasitology, Sokoine University of Agriculture, Morogoro, Tanzania
| |
Collapse
|
25
|
Tchuinkam T, Nyih-Kong B, Fopa F, Simard F, Antonio-Nkondjio C, Awono-Ambene HP, Guidone L, Mpoame M. Distribution of Plasmodium falciparum gametocytes and malaria-attributable fraction of fever episodes along an altitudinal transect in Western Cameroon. Malar J 2015; 14:96. [PMID: 25889511 PMCID: PMC4354986 DOI: 10.1186/s12936-015-0594-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 01/07/2015] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Highland areas are hypoendemic zones of malaria and are therefore prone to epidemics, due to lack of protective immunity. So far, Cameroon has not succeeded in implementing a convenient and effective method to detect, prevent and forecast malaria epidemic in these peculiar zones. This monitoring and evaluation study aims to assess the operational feasibility of using the human malaria infectious reservoir (HMIR) and the malaria-attributable fraction of fever episodes (MAFE) as indicators, in designing a malaria epidemic early warning system (MEWS). METHODS Longitudinal parasitological surveys were conducted in sentinel health centres installed in three localities, located along an altitudinal transect in Western Cameroon: Santchou (750 m), Dschang (1,400 m) and Djuttitsa (1,965 m). The syndromes of outpatients with malaria-like complaints were recorded and their blood samples examined. The HMIR and the MAFE were estimated and their spatial-temporal variations described. RESULTS The prevalence of asexual Plasmodium infection in outpatients decreased with increasing altitude; meanwhile the HMIR remained fairly constant, indicating that scarcity of malaria disease in highlands is likely due to absence of vectors and not parasites. In lowland, children carried the heaviest malaria burden in the form of febrile episodes, and asexual parasites decreased with age, after an initial peak in the 0-5 year's age group; however, they were similar for all age groups in highland. The HMIR did not show any variation with age in the plain; but some discrepancies were observed in the highland with extreme age groups, and migration of populations between lowland and highland was suspected to be the cause. Plasmodium infection was perennial in the lowland and seasonal uphill, with malaria disease occurring here mostly during the short dry season. The MAFE was high and did not change with altitude. CONCLUSION It is obvious that a malaria outbreak will cause the sudden rise of HMIR and MAFE in highland, prior to the malaria season; the discrepancy with lowland would then help detecting an incipient malaria epidemic. It is recommended that in designing the MEWS, the National Malaria Control Programme should include these parameters and put special emphasis on: altitude, age groups and seasons.
Collapse
Affiliation(s)
- Timoléon Tchuinkam
- Malaria Research Unit of the Laboratory of Applied Biology and Ecology (MRU-LABEA), Department of Animal Biology, Faculty of Sciences of the University of Dschang, P. O. Box 067, Dschang, Cameroon.
- Laboratoire de Recherche sur le Paludisme, Organisation de Coordination pour la lutte contre les Endémies en Afrique Centrale (OCEAC), BP 288, Yaoundé, Cameroun.
| | - Bridget Nyih-Kong
- Malaria Research Unit of the Laboratory of Applied Biology and Ecology (MRU-LABEA), Department of Animal Biology, Faculty of Sciences of the University of Dschang, P. O. Box 067, Dschang, Cameroon.
| | - François Fopa
- Malaria Research Unit of the Laboratory of Applied Biology and Ecology (MRU-LABEA), Department of Animal Biology, Faculty of Sciences of the University of Dschang, P. O. Box 067, Dschang, Cameroon.
- Hôpital Saint Vincent De Paul, Mission Catholique Sacré Cœur, BP 011, Dschang, Cameroon.
| | - Frédéric Simard
- Laboratoire de Recherche sur le Paludisme, Organisation de Coordination pour la lutte contre les Endémies en Afrique Centrale (OCEAC), BP 288, Yaoundé, Cameroun.
- MIVEGEC, UMR IRD224-CNRS5290-UM, Institut de Recherche pour le Développement, 911 Avenue Agropolis, BP 64501, Montpellier, France.
| | - Christophe Antonio-Nkondjio
- Laboratoire de Recherche sur le Paludisme, Organisation de Coordination pour la lutte contre les Endémies en Afrique Centrale (OCEAC), BP 288, Yaoundé, Cameroun.
| | - Herman-Parfait Awono-Ambene
- Laboratoire de Recherche sur le Paludisme, Organisation de Coordination pour la lutte contre les Endémies en Afrique Centrale (OCEAC), BP 288, Yaoundé, Cameroun.
| | - Laura Guidone
- Hôpital Saint Vincent De Paul, Mission Catholique Sacré Cœur, BP 011, Dschang, Cameroon.
| | - Mbida Mpoame
- Malaria Research Unit of the Laboratory of Applied Biology and Ecology (MRU-LABEA), Department of Animal Biology, Faculty of Sciences of the University of Dschang, P. O. Box 067, Dschang, Cameroon.
| |
Collapse
|
26
|
Adebajo AC, Odediran SA, Aliyu FA, Nwafor PA, Nwoko NT, Umana US. In vivo antiplasmodial potentials of the combinations of four nigerian antimalarial plants. Molecules 2014; 19:13136-46. [PMID: 25162955 PMCID: PMC6271372 DOI: 10.3390/molecules190913136] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 08/18/2014] [Accepted: 08/19/2014] [Indexed: 12/04/2022] Open
Abstract
Various combinations of Nauclea latifolia root, Artocarpus altilis stem bark, Murraya koenigii leaf and Enantia chlorantha stem bark used in African ethnomedicine as decoctions for malaria and fevers, and combinations with standard drugs, were investigated for antiplasmodial activities using Plasmodium berghei berghei-infected mice. The respective prophylactic and curative ED50 values of 189.4 and 174.5 mg/kg for N. latifolia and chemosuppressive ED50 value of 227.2 mg/kg for A. altilis showed that they were the best antimalarial herbal drugs. A 1.6-fold increase of the survival time given by the negative control was elicited by M. koenigii, thereby confirming its curative activity. Pyrimethamine with an ED50 of 0.5 ± 0.1 mg/kg for the prophylactic, and chloroquine with ED50 = 2.2 ± 0.1 and 2.2 ± 0.0 mg/kg for the chemosuppressive and curative tests, respectively, were significantly (p < 0.05) more active. Co-administrations of N. latifolia with the standard drugs significantly reduced their prophylactic, chemosuppressive and curative actions, possibly increasing the parasites' resistance. Binary combinations of N. latifolia or M. koenigii with any of the other plants significantly increased the prophylactic and suppressive activities of their individual plants, respectively. Also, E. chlorantha with A. altilis or N. latifolia enhanced their respective prophylactic or curative activities, making these combinations most beneficial against malaria infections. Combinations of three and four extracts gave varied activities. Hence, the results justified the combinations of ethnomedicinal plants in antimalarial herbal remedies and showed the importance of the three in vivo models in establishing antimalarial activity.
Collapse
Affiliation(s)
- Adeleke Clement Adebajo
- Department of Pharmacognosy, Faculty of Pharmacy, Obafemi Awolowo University, Ile-Ife 220282, Osun State, Nigeria.
| | - Samuel Akintunde Odediran
- Department of Pharmacognosy, Faculty of Pharmacy, Obafemi Awolowo University, Ile-Ife 220282, Osun State, Nigeria
| | - Fatimah Abosede Aliyu
- Department of Pharmacognosy, Faculty of Pharmacy, Obafemi Awolowo University, Ile-Ife 220282, Osun State, Nigeria
| | - Paul Alozie Nwafor
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, University of Uyo, Uyo 520003, Akwa Ibom State, Nigeria
| | - Ndifreke Thomas Nwoko
- Department of Pharmacognosy and Herbal Medicine, Faculty of Pharmacy, University of Uyo, Uyo 520003, Akwa Ibom State, Nigeria
| | - Usenobong Samuel Umana
- Department of Pharmacognosy and Herbal Medicine, Faculty of Pharmacy, University of Uyo, Uyo 520003, Akwa Ibom State, Nigeria
| |
Collapse
|
27
|
Khattak AL, Ali W, Samore NA, Idris M, Khan MN, Pasha W. Complicated plasmodium falciparum malaria initially presenting as myocardites. J Ayub Med Coll Abbottabad 2014; 26:413-415. [PMID: 25671963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Despite recent advancements in diagnostic and treatment modalities, malaria is still one of the most prevalent human diseases with high mortality and morbidity. We described a case of 45 years old man with Plasmodium falciparum malaria primarily presenting with myocarditis. The possibility of malaria was Subsequently considered when he developed fever followed by signs of cerebral involvement. This happens to be a distinctly unusual presentation and we highlighted various features of this case. Thus in hyperendemic areas complicated Plasomdium falciparum malaria may present initially With atypical features and high index of suspicion may lead to prompt early aggressive antimalarial therapy and reduce the complications.
Collapse
|
28
|
Otokpa AO, Asuzu MC. A cross-sectional study for algorithm in diagnosing simple uncomplicated malaria in children in health facilities without laboratory backup in Nigeria. Niger Postgrad Med J 2014; 21:115-121. [PMID: 25126864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
AIMS AND OBJECTIVES The objective of this study was to determine an algorithm for malaria diagnosis using presenting signs and symptoms of children (aged 0-13 years) with uncomplicated malaria in Gwagwalada Area Council of Abuja, Nigeria. MATERIALS AND METHODS A validated questionnaire was used to obtain relevant data from 400 children diagnosed presumptively of simple malaria by clinicians and 400 other children of similar sex and age considered as not having malaria. Giemsa-stained thick blood films were used to determine parasitaemia. Data obtained was analysed using Epi-Info version 3.3.2. RESULTS Thirty-eight per cent of children with presumptive diagnosis of malaria had parasitaemia. Fever, rigor, vomiting, jaundice, pallor and spleen enlargement had significant statistical relationship with parasitaemia on bivariate analysis, but only fever (p=0.00), rigor (p=0.00), vomiting (p=0.00), and pallor (p=0.00) maintained the relationship when subjected to logistic regression analysis. But these symptoms individually had low sensitivity and/or specificity. Candidate algorithms (combinations of symptoms) were then successively subjected to bivariate, logistic and validity analyses. Fever with vomiting gave the highest sensitivity (56.2%), specificity (76.4%) and PPV (60.0%) and were therefore adopted as the algorithm of choice. CONCLUSION AND RECOMMENDATIONS Children presenting with fever and vomiting without any other obvious cause in health facilities without laboratory support in the research area should receive antimalarial treatment, to help reduce the malaria scourge. This algorithm should be field-tested and if found reliable should be adopted to ease the problem of malaria diagnosis in peripheral health facilities.
Collapse
Affiliation(s)
- A O Otokpa
- Department of Community Medicine, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | | |
Collapse
|
29
|
Italiano CM, Wong KT, AbuBakar S, Lau YL, Ramli N, Syed Omar SF, Kahar Bador M, Tan CT. Sarcocystis nesbitti causes acute, relapsing febrile myositis with a high attack rate: description of a large outbreak of muscular sarcocystosis in Pangkor Island, Malaysia, 2012. PLoS Negl Trop Dis 2014; 8:e2876. [PMID: 24854350 PMCID: PMC4031117 DOI: 10.1371/journal.pntd.0002876] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Accepted: 04/03/2014] [Indexed: 11/18/2022] Open
Abstract
Background From the 17th to 19th January 2012, a group of 92 college students and teachers attended a retreat in a hotel located on Pangkor Island, off the west coast of Peninsular Malaysia. Following the onset of symptoms in many participants who presented to our institute, an investigation was undertaken which ultimately identified Sarcocystis nesbitti as the cause of this outbreak. Methodology/Principal Findings All retreat participants were identified, and clinical and epidemiological information was obtained via clinical review and self-reported answers to a structured questionnaire. Laboratory, imaging and muscle biopsy results were evaluated and possible sources of exposure, in particular water supply, were investigated. At an average of 9–11 days upon return from the retreat, 89 (97%) of the participants became ill. A vast majority of 94% had fever with 57% of these persons experiencing relapsing fever. Myalgia was present in 91% of patients. Facial swelling from myositis of jaw muscles occurred in 9 (10%) patients. The median duration of symptoms was 17 days (IQR 7 to 30 days; range 3 to 112). Out of 4 muscle biopsies, sarcocysts were identified in 3. S. nesbitti was identified by PCR in 3 of the 4 biopsies including one biopsy without observed sarcocyst. Non-Malaysians had a median duration of symptoms longer than that of Malaysians (27.5 days vs. 14 days, p = 0.001) and were more likely to experience moderate or severe myalgia compared to mild myalgia (83.3% vs. 40.0%, p = 0.002). Conclusions/Significance The similarity of the symptoms and clustered time of onset suggests that all affected persons had muscular sarcocystosis. This is the largest human outbreak of sarcocystosis ever reported, with the specific Sarcocystis species identified. The largely non-specific clinical features of this illness suggest that S. nesbitti may be an under diagnosed infection in the tropics. Sarcocystis species are protozoan organisms that have been associated with disease in animals but less frequently so in humans. Following a retreat on Pangkor Island off Peninsular Malaysia, a number of persons presented to our hospital with prolonged fever and muscle pain that was initially difficult to attribute to a known infectious cause. Investigations, including muscle biopsies and PCR, showed that this outbreak was most likely due to Sarcocystis nesbitti infection. The most common clinical features were fever and myalgia that was relapsing-remitting in more than half the patients. Some patients had visible swelling of muscle groups, including of the face, with magnetic resonance imaging also demonstrating inflammation in these muscles. Herein, we present the clinical and investigation findings in 89 symptomatic persons in the largest reported outbreak of human muscular sarcocystosis to date. Our findings provide insights and suggestions for the most appropriate forms of investigation, treatment and possible source of infection.
Collapse
Affiliation(s)
- Claire M. Italiano
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Kum Thong Wong
- Department of Pathology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Sazaly AbuBakar
- TIDREC, Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Yee Ling Lau
- Department of Parasitology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Norlisah Ramli
- Department of Medical Imaging, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Maria Kahar Bador
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chong Tin Tan
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- * E-mail:
| |
Collapse
|
30
|
Cifuentes SG, Trostle J, Trueba G, Milbrath M, Baldeón ME, Coloma J, Eisenberg JNS. Transition in the cause of fever from malaria to dengue, Northwestern Ecuador, 1990-2011. Emerg Infect Dis 2014; 19:1642-5. [PMID: 24047566 PMCID: PMC3810737 DOI: 10.3201/eid1910.130137] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
In tropical areas, the predominant cause of fever has historically been malaria. However by 2011, among febrile patients in northwestern Ecuador, dengue was identified in 42% and malaria in none. This finding suggests a transition in the cause of fever from malaria to other illnesses, such as dengue.
Collapse
|
31
|
Hetzel MW, Paul S, Benjamin L, Makita L, Mueller I, Siba PM. The proportion of fevers attributable to malaria varies significantly between sites in Papua New Guinea. P N G Med J 2014; 57:39-51. [PMID: 26930887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Malaria is endemic across lowland Papua New Guinea (PNG) and case management has been based on symptomatic diagnosis and presumptive treatment of fever cases with an antimalarial. This study aimed to investigate the prevalence of malaria infection among fever cases presenting to 5 purposely selected sentinel health facilities in order to estimate the proportion of patients requiring antimalarial drugs. A total of 1807 fever patients were screened. Overall, 45% of fever patients had a positive malaria blood slide; 35% were infected with Plasmodium falciparum, 9% with P. vivax and 2% with P. malariae. Slide positivity was highest in Dreikikir (75%) and lowest in Wipim (2%). Among patients aged 1-4 years, 22% had moderate to severe anaemia (Hb < 8 g/dI) and 21% of children 2-9 years of age showed signs of splenomegaly (Hackett score 1-5). Comorbidity differed significantly between study sites and was not closely correlated with malaria infection. Clinical diagnosis by health facility staff was malaria for 67% of all fever cases, including 89% of slide-positive and 48% of slide-negative patients. 70% of rapid diagnostic test-negative cases were treated with an antimalarial. It is estimated that due to the lack of parasitological diagnosis the selected health facilities reported an excess of 18% (Dreikikir) to 98% (Wipim) malaria patients on average each month. In consideration of the significant differences in malaria-attributable fevers between study sites, the implementation of parasitological diagnosis in health facilities and administration of antimalarials only to test-positive patients has the potential to significantly improve the management of fever cases and reporting of malaria. A better tailoring to different settings may increase the effectiveness of malaria control interventions.
Collapse
|
32
|
Moxon CA, Chisala NV, Wassmer SC, Taylor TE, Seydel KB, Molyneux ME, Faragher B, Kennedy N, Toh CH, Craig AG, Heyderman RS. Persistent endothelial activation and inflammation after Plasmodium falciparum Infection in Malawian children. J Infect Dis 2014; 209:610-5. [PMID: 24048963 PMCID: PMC3903368 DOI: 10.1093/infdis/jit419] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Accepted: 06/26/2013] [Indexed: 11/27/2022] Open
Abstract
Endothelial dysregulation is central to the pathogenesis of acute Plasmodium falciparum infection. It has been assumed that this dysregulation resolves rapidly after treatment, but this return to normality has been neither demonstrated nor quantified. We therefore measured a panel of plasma endothelial markers acutely and in convalescence in Malawian children with uncomplicated or cerebral malaria. Evidence of persistent endothelial activation and inflammation, indicated by increased plasma levels of soluble intracellular adhesion molecule 1, angiopoetin 2, and C-reactive protein, were observed at 1 month follow-up visits. These vascular changes may represent a previously unrecognized contributor to ongoing malaria-associated morbidity and mortality.
Collapse
|
33
|
Tiono AB, Kangoye DT, Rehman AM, Kargougou DG, Kaboré Y, Diarra A, Ouedraogo E, Nébié I, Ouédraogo A, Okech B, Milligan P, Sirima SB. Malaria incidence in children in South-West Burkina Faso: comparison of active and passive case detection methods. PLoS One 2014; 9:e86936. [PMID: 24475198 PMCID: PMC3901722 DOI: 10.1371/journal.pone.0086936] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2013] [Accepted: 12/16/2013] [Indexed: 11/26/2022] Open
Abstract
Background The aim of this study was to determine the incidence and seasonal pattern of malaria in children in South-West Burkina Faso, and to compare, in a randomized trial, characteristics of cases detected by active and passive surveillance. This study also enabled the planning of a malaria vaccine trial. Methods Households with young children, located within 5 kilometers of a health facility, were randomized to one of two malaria surveillance methods. In the first group, children were monitored actively. Each child was visited twice weekly; tympanic temperature was measured, and if the child had a fever or history of fever, a malaria rapid diagnostic test was performed and a blood smear collected. In the second group, children were monitored passively. The child’s parent or caregiver was asked to bring the child to the nearest clinic if he was unwell. Follow up lasted 13 months from September 2009. Results Incidence of malaria (Fever with parasitaemia ≥5,000/µL) was 1.18 episodes/child/year in the active cohort and 0.89 in the passive cohort (rate ratio 1.32, 95% CI 1.13–1.54). Malaria cases in the passive cohort were more likely to have high grade fever; but parasite densities were similar in the two groups. Incidence was highly seasonal; when a specific case definition was used, about 60% of cases occurred within the 4 months June-September. Conclusion Passive case detection required at least a 30%–40% increase in the sample size for vaccine trials, compared to active detection, to achieve the same power. However we did not find any evidence that parasite densities were higher with passive than with active detection. The incidence of malaria is highly seasonal and meets the WHO criteria for Seasonal Malaria Chemoprevention (SMC). At least half of the malaria cases in these children could potentially be prevented if SMC was effectively deployed.
Collapse
Affiliation(s)
- Alfred B. Tiono
- Centre National de Recherche et de Formation sur le Paludisme (CNRFP), Ouagadougou, Burkina Faso
| | - David T. Kangoye
- Centre National de Recherche et de Formation sur le Paludisme (CNRFP), Ouagadougou, Burkina Faso
| | - Andrea M. Rehman
- MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine (LSHTM), London, United Kingdom
| | - Désiré G. Kargougou
- Centre National de Recherche et de Formation sur le Paludisme (CNRFP), Ouagadougou, Burkina Faso
| | - Youssouf Kaboré
- Centre National de Recherche et de Formation sur le Paludisme (CNRFP), Ouagadougou, Burkina Faso
| | - Amidou Diarra
- Centre National de Recherche et de Formation sur le Paludisme (CNRFP), Ouagadougou, Burkina Faso
| | - Esperance Ouedraogo
- Centre National de Recherche et de Formation sur le Paludisme (CNRFP), Ouagadougou, Burkina Faso
| | - Issa Nébié
- Centre National de Recherche et de Formation sur le Paludisme (CNRFP), Ouagadougou, Burkina Faso
| | - Alphonse Ouédraogo
- Centre National de Recherche et de Formation sur le Paludisme (CNRFP), Ouagadougou, Burkina Faso
| | | | - Paul Milligan
- MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine (LSHTM), London, United Kingdom
| | - Sodiomon B. Sirima
- Centre National de Recherche et de Formation sur le Paludisme (CNRFP), Ouagadougou, Burkina Faso
- * E-mail:
| |
Collapse
|
34
|
Marete IK, Mutugi M, Lagat Z, Obala A, Simba J, Mwangi A, Esamai F. MALARIA PARASITAEMIA AMONG FEBRILE CHILDREN INFECTED WITH HUMAN IMMUNODEFICIENCY VIRUS IN THE CONTEXT OF PROPHYLACTIC COTRIMOXAZOLE AS STANDARD OF CARE: A CROSS- SECTIONAL SURVEY IN WESTERN KENYA. East Afr Med J 2014; 91:21-28. [PMID: 26862632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To document the prevalence of malaria parasitaemia among the HIV infected febrile children in a malaria endemic area. DESIGN A cross-sectional study. SETTING An ambulatory paediatric HIV clinic in Western Kenya, between November 2011 and December 2012. SUBJECTS A total of 245 febrile HIV infected children aged less than 14 years attending the HIV clinic in the Webuye level IV hospital were included in the study. A systematic sampling method was used. MAIN OUTCOMES A blood sample was taken for malaria parasite testing. Presence or absence of malaria parasites was documented. Clinical and socio-demographic characteristics of the participants were also recorded. RESULTS A total of 245 participants were recruited mean age being 5.53 years. Malaria prevalence was 81.9%. Most participants (97%) were on cotrimoxazole prophylaxis. Some of the factors found to be positively associated with malaria parasitaemia were; male sex, care taker category (parent), WHO stage 3 and 4 of HIV disease, and a high absolute CD4 count. However, only the caretaker association was statistically significant. CONCLUSION The frequency of malaria parasitaemia among febrile HIV infected children is still high regardless of the high cotrimoxazole prophylaxis uptake. It is also noted that there is a shift in the age group of fever among children toward the older age group. This implies that policies may need to be relooked at to include the older age group in the aggressive malaria prevention measures to avoid losing on the already made gains.
Collapse
|
35
|
Utuk EE, Ikpeme EE, Udo JJ, Akpan MU. PREDICTORS OF C-REACTIVE PROTEIN RESPONSE IN CHILDREN INFECTED WITH PLASMODIUM FALCIPARUM MALARIA. East Afr Med J 2014; 91:1-7. [PMID: 26862629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To assess the predictors of C-reactive protein response in plasmodium falciparum malaria as seen in children in a malaria endemic region of Nigeria. DESIGN A prospective cross-sectional study. SETTING The Children Out-patient (CHOP) Clinic, Children Emergency Unit (CHEU), Child Welfare/Growth Monitoring Clinic, Immunisation Centre and Paediatric Ward of the University of Uyo Teaching Hospital (UUTH), Uyo in Akwa-Ibom State. SUBJECTS Three hundred and sixty children aged six to sixty months with microscopically confirmed P. falciparum malaria compared with 360 healthy children without malaria parasitaemia matched for age and gender. RESULTS The predictors of the C-reactive protein response in malaria (CRP ≥ 10mg/l) were fever (t = 6.867; p = 0.001), malaria parasite count (t = 5.387; p = 0.001), severe anaemia (t = -11.23; p = 0.001) and age. Younger children had a greater CRP response. The logistic regression curve showed a 66.9% sensitivity, 92.1% specificity, positive predictive value, 83.2% and negative predictive value of 82.2% of predicting C-reactive protein response in malaria. CONCLUSION P. falciparum malaria induces significant CRP responses. Younger children who present with fever, hyperparasitaemia and severe anaemia are more likely to have C-reactive protein response with malaria.
Collapse
|
36
|
Desoubeaux G, Chaussade H, Thellier M, Poussing S, Bastides F, Bailly E, Lanotte P, Alison D, Brunereau L, Bernard L, Chandenier J. Unusual multiple large abscesses of the liver: interest of the radiological features and the real-time PCR to distinguish between bacterial and amebic etiologies. Pathog Glob Health 2013; 108:53-7. [PMID: 24548161 DOI: 10.1179/2047773213y.0000000121] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
We report a rare case of amebiasis generating 19 large liver abscesses. Such a quantity of abscesses is rare, especially when occurring in a young casual traveler without any immunodeficiency disorders. A possible co-infection was excluded. By contrast, the amebic etiology was confirmed by means of serology and real-time PCR.
Collapse
|
37
|
Lakshmi SPA, Palaniappan N, Arunagiri A. Ascariasis: challenges in the diagnosis of single worm disease. J Indian Med Assoc 2013; 111:621-622. [PMID: 24968530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
One of the most common parasitic infections in humans is ascariasis. While most infectionsare asymptomatic, mild to moderate symptoms may occur due to migration of adult worms. The frequency of single worm infection seems to be increasing. Ascaris eggs are not found in the faeces of most cases infected with a single worm because it is an immature male or female. Diagnosis of such single worm infection is challenging.
Collapse
|
38
|
Baird JK, Barcus MJ, Elyazar IRF, Bangs MJ, Maguire JD, Fryauff DJ, Richie TL, Kalalo W. Onset of clinical immunity toPlasmodium falciparumamong Javanese migrants to Indonesian Papua. Annals of Tropical Medicine & Parasitology 2013; 97:557-64. [PMID: 14511553 DOI: 10.1179/000349803225001472] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Onset of clinical immunity to Plasmodium falciparum occurred among Javanese migrants to Indonesian Papua. Surveillance of the 243 migrants investigated began on the day of their arrival in Indonesian Papua and continued for 33 months. Asexual parasitaemia without fever constituted objective evidence of clinical immunity. Compared with first infection, the odds ratio (OR) for not having fever at the fourth infection within 24 months was 3.2 [95% confidence interval (CI)=1.03-10.2; P=0.02]. The corresponding OR with fewer infections within 24 months was not distinguishable from 1.0. The level of the fourth parasitaemia within 24 months (N=58) was classified as 'high' or 'low' in relation to the median count at first infection (840 parasites/microl; N=187). Fourth parasitaemias that were low-but not those that were high (OR=1.8; CI=0.6-5.4; P=0.35)-were associated with dramatic protection from fever (OR=31; CI=3.5-1348; P=0.0001). Among the adult subjects, the risk of fever with low parasitaemia was significantly higher at the first infection than at the fourth (OR=12.6; CI=1.7-530; P=0.005), indicating the development of clinical immunity. A similar but less marked pattern appeared among the children investigated (OR=6.5; CI=0.8-285; P=0.06).
Collapse
Affiliation(s)
- J K Baird
- United States Naval Medical Research Unit No.2, American Embassy Jakarta, FPO AP 96520-8132, USA.
| | | | | | | | | | | | | | | |
Collapse
|
39
|
Abstract
We present a case of hyperreactive malarial splenomegaly, a disease which is exceptional in Caucasian people, but which is expected to become more important since the increasing number of travelling to tropical areas. It is the chronic stage of an abnormal long-term stimulation of the immune system secondary to plasmodial infection. Diagnostic criteria include long-term stay in an endemic zone, large splenomegaly and overproduction of both IgM and IgG antibodies. The disease can be treated by a short-term antimalarial therapy as long as the patient resides out of a malarial endemic country.
Collapse
Affiliation(s)
- D Masfrancx
- Department of Internal Medicine, University Hospitals Leuven.
| | | | | |
Collapse
|
40
|
Singh N, Bharti PK, Singh MP, Mishra S, Shukla MM, Sharma RK, Singh RK. Comparative evaluation of bivalent malaria rapid diagnostic tests versus traditional methods in field with special reference to heat stability testing in Central India. PLoS One 2013; 8:e58080. [PMID: 23472135 PMCID: PMC3589473 DOI: 10.1371/journal.pone.0058080] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Accepted: 01/30/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Malaria presents a diagnostic challenge in areas where both Plasmodium falciparum and P.vivax are co-endemic. Bivalent Rapid Diagnostic tests (RDTs) showed promise as diagnostic tools for P.falciparum and P.vivax. To assist national malaria control programme in the selection of RDTs, commercially available seven malaria RDTs were evaluated in terms of their performance with special reference to heat stability. METHODOLOGY/PRINCIPAL FINDINGS This study was undertaken in four forested districts of central India (July, 2011- March, 2012). All RDTs were tested simultaneously in field along with microscopy as gold standard. These RDTs were stored in their original packing at 25°C before transport to the field or they were stored at 35°C and 45°C upto 100 days for testing the performance of RDTs at high temperature. In all 2841 patients with fever were screened for malaria of which 26% were positive for P.falciparum, and 17% for P.vivax. The highest sensitivity of any RDT for P.falciparum was 98% (95% CI; 95.9-98.8) and lowest sensitivity was 76% (95% CI; 71.7-79.6). For P.vivax highest and lowest sensitivity for any RDT was 80% (95% CI; 94.9 - 83.9) and 20% (95% CI; 15.6-24.5) respectively. Heat stability experiments showed that most RDTs for P.falciparum showed high sensitivity at 45°C upto 90 days. While for P.vivax only two RDTs maintained good sensitivity upto day 90 when compared with RDTs kept at room temperature. Agreement between observers was excellent for positive and negative readings for both P.falciparum and P.vivax (Kappa >0.6-0.9). CONCLUSION This is first field evaluation of RDTs regarding their temperature stability. Although RDTs are useful as diagnostic tool for P.falciparum and P.vivax even at high temperature, the quality of RDTs should be regulated and monitored more closely.
Collapse
Affiliation(s)
- Neeru Singh
- Regional Medical Research Centre for Tribals, Nagpur Road, Garha, Jabalpur, Madhya Pradesh, India.
| | | | | | | | | | | | | |
Collapse
|
41
|
Hendriksen ICE, White LJ, Veenemans J, Mtove G, Woodrow C, Amos B, Saiwaew S, Gesase S, Nadjm B, Silamut K, Joseph S, Chotivanich K, Day NPJ, von Seidlein L, Verhoef H, Reyburn H, White NJ, Dondorp AM. Defining falciparum-malaria-attributable severe febrile illness in moderate-to-high transmission settings on the basis of plasma PfHRP2 concentration. J Infect Dis 2013; 207:351-61. [PMID: 23136222 PMCID: PMC3532834 DOI: 10.1093/infdis/jis675] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Accepted: 08/23/2012] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND In malaria-endemic settings, asymptomatic parasitemia complicates the diagnosis of malaria. Histidine-rich protein 2 (HRP2) is produced by Plasmodium falciparum, and its plasma concentration reflects the total body parasite burden. We aimed to define the malaria-attributable fraction of severe febrile illness, using the distributions of plasma P. falciparum HRP2 (PfHRP2) concentrations from parasitemic children with different clinical presentations. METHODS Plasma samples were collected from and peripheral blood slides prepared for 1435 children aged 6-60 months in communities and a nearby hospital in northeastern Tanzania. The study population included children with severe or uncomplicated malaria, asymptomatic carriers, and healthy control subjects who had negative results of rapid diagnostic tests. The distributions of plasma PfHRP2 concentrations among the different groups were used to model severe malaria-attributable disease. RESULTS The plasma PfHRP2 concentration showed a close correlation with the severity of infection. PfHRP2 concentrations of >1000 ng/mL denoted a malaria-attributable fraction of severe disease of 99% (95% credible interval [CI], 96%-100%), with a sensitivity of 74% (95% CI, 72%-77%), whereas a concentration of <200 ng/mL denoted severe febrile illness of an alternative diagnosis in >10% (95% CI, 3%-27%) of patients. Bacteremia was more common among patients in the lowest and highest PfHRP2 concentration quintiles. CONCLUSIONS The plasma PfHRP2 concentration defines malaria-attributable disease and distinguishes severe malaria from coincidental parasitemia in African children in a moderate-to-high transmission setting.
Collapse
Affiliation(s)
- Ilse C E Hendriksen
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Rabiu OR, Kosoko AM, Falade CO, Ademowo OG. Evaluation of the performances of two rapid diagnostic tests (Cyscope®mini and Paracheck-Pf®) in the diagnosis of malaria among febrile children in southwest Nigeria. Med Princ Pract 2013; 22:255-9. [PMID: 23258268 PMCID: PMC5586738 DOI: 10.1159/000345642] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2012] [Accepted: 11/06/2012] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The aim of this study was to test the diagnostic performances of Cyscope®mini and Paracheck-Pf® for Plasmodium falciparum relative to microscopy. SUBJECTS AND METHODS 209 children aged 6 months to 12 years presenting with symptoms suggestive of malaria were enrolled at the University College Hospital, Ibadan, Nigeria, within a period of 6 months. Malaria parasites were identified in capillary blood samples using Cyscope®mini (parasite DNA-based fluorescence microscope) and Paracheck-Pf® (an HRP-II-based test) with microscopy of Giemsa-stained thick blood films as reference gold standard. The overall performances were calculated using OpenEpi version 2.3 statistical package. 209 samples were performed for Cyscope®mini and light microscopy while 140 samples were done by Paracheck-Pf®. RESULTS The prevalence of malaria parasitaemia by light microscopy was 22.0% (46/209), while those of Cyscope®mini and Paracheck-Pf® were 85.2% (178/209) and 32.1% (45/140), respectively. Parasite density ranged from 40 to 203,883/µl. Cyscope®mini and Paracheck-Pf® had sensitivities of 91.3 and 86.21%, respectively. The respective specificities were 16.56 and 81.98% for Cyscope®mini and Paracheck-Pf® with diagnostic accuracies of 33.01 and 82.86%. The diagnostic performances of the two rapid diagnostic tests were significantly different. CONCLUSION Paracheck-Pf® performed better than Cyscope®mini for diagnosis of falciparum malaria and will be a good diagnostic tool for field studies.
Collapse
Affiliation(s)
- Olawunmi R Rabiu
- Department of Zoology, College of Medicine, University of Ibadan, Ibadan, Nigeria.
| | | | | | | |
Collapse
|
43
|
Affiliation(s)
- Thein Myint
- Division of Infectious Diseases, Department of Internal Medicine, University of Kentucky, Lexington, Kentucky, USA
| | | | | |
Collapse
|
44
|
Agyemang EA, Virk A. 57-Year-old man with fever, rash, chronic watery diarrhea, cough, and sweats. Mayo Clin Proc 2012; 87:e83-6. [PMID: 23127742 PMCID: PMC3532673 DOI: 10.1016/j.mayocp.2012.05.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2012] [Revised: 04/25/2012] [Accepted: 05/14/2012] [Indexed: 10/27/2022]
Affiliation(s)
- Elfriede A. Agyemang
- Resident in Internal Medicine, Mayo School of Graduate Medical Education, Rochester, MN
| | - Abinash Virk
- Adviser to resident and Consultant in Infectious Diseases, Mayo Clinic, Rochester, MN
- Correspondence: Address to Abinash Virk, MD, Division of Infectious Diseases, Mayo Clinic, 200 First St SW, Rochester, MN 55905
| |
Collapse
|
45
|
Affiliation(s)
- Bhavna Dhingra
- Department of Pediatrics, Maulana Azad Medical College, and Associated Chacha Nehru Bal Chikitsalaya and Lok Nayak Hospital, New Delhi, India.
| | | |
Collapse
|
46
|
Wasnik PN, Manohar TP, Humaney NR, Salkar HR. Study of clinical profile of falciparum malaria in a tertiary referral centre in Central India. J Assoc Physicians India 2012; 60:33-36. [PMID: 23777023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND AND OBJECTIVE Malaria, a disease with protean manifestations is endemic in India with an estimated 70-100 million cases each year. Of these 45-50% are plasmodium falciparum. The present study is aimed at to study clinical features, complications, response to treatment and outcome in a tertiary care hospital. METHODOLOGY This hospital based cross sectional study was done on 80 confirmed cases of falciparum malaria (either by peripheral smear or rapid diagnostic test) more than 12 years of age admitted in NKPSIMS and LMH from December 2009 to December 2010.A case sheet proforma was prepared and data (demographic profile, clinical feature, investigation, treatment, and complication) from all indoor patients was collected and analyzed. RESULT Out of 80 patients, 60 (75%) were males and 20 (25%) were females. Most of the patients were between the age group 21-40 years with the highest incidence between the age group of 21-30. The numbers of admissions due to malaria increased from June onward with maximum number of cases were found in the month of September. Fever was the most common symptom followed by impaired consciousness. Anemia was present in 52 (65%) patients, out of which 5 (6.25%) patients had severe anemia. Thrombocytopenia was present in 46 (57.5%) patients. Abnormal liver function tests were observed in 28 (35%) subjects while abnormal kidney function tests were observed in 26 (32.5%) patients. As per WHO definition of severe falciparum malaria, 37 patients suffered from severe falciparum malaria (46.25%) in the form of impaired consciousness or unarousable coma, clinical jaundice plus evidence of other organ dysfunction, severe renal impairment, severe anemia, circulatory collapse and ARDS. Maximum number, 62 (77%) patients received the combination of artesunate and clindamycin. This also showed that the combination of artesunate and clindamycin in severe Plasmodium falciparum malaria is a very good therapeutic option. Apart from being effective in seriously ill patients it is quite safe also. Mortality rate was 6.25%.Cause of death was acute renal failure with metabolic acidosis, aspiration pneumonia secondary to seizure, cerebral malaria and circulatory shock. CONCLUSION Early diagnosis, anticipation of complications, close monitoring of vital parameters and combination therapy to overcome drug resistance perhaps helped to curtail the extent of mortality in this study.
Collapse
Affiliation(s)
- Preetam N Wasnik
- Department of Medicine, NKP Salve Institute of Medical Sciences and Research Center, Lata Mangeshkar Hospital, Nagpur
| | | | | | | |
Collapse
|
47
|
Sud R, Singh H, Aggarwal A, Bhatnagar MK. Resurgence of complicated malaria associated with severe thrombocytopenia in a tertiary care hospital in Delhi. J Assoc Physicians India 2012; 60:68. [PMID: 23777034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
|
48
|
Mohapatra MK, Dash LK, Barih PK, Karua PC. Profile of mixed species (Plasmodium vivax and falciparum) malaria in adults. J Assoc Physicians India 2012; 60:20-24. [PMID: 23777020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE Studies on malaria due to co-existent P. falciparum and P. vivax infections are negligible in India. Therefore, this study was undertaken to find out the clinical profile, prognostic factors, and outcome of mixed species malaria and to compare it with P. falciparum malaria. METHODS This prospective, comparative study has been conducted in a tertiary health care institution with high prevalence of malaria. A cohort of 888 patients of malaria was enrolled in this study. The diagnosis of malaria was made either by Giemsa stained peripheral blood smear or RDT. Mixed species (MS) malaria was diagnosed when both P. vivax and P. falciparum were detected either from peripheral blood smear or RDT. Patients with P. falciparum malaria were grouped in to Pf group. The differences in clinical presentation, biochemical and haematological findings, occurrence of severe malaria, and outcome were recorded, compared, and analyzed. The severity of complication was assessed and Malaria Severity Score (MSS) was calculated. All the patients were treated according to WHO guidelines. RESULTS Of them MS and Pf malaria constituted 118 (13.2%) and 770 (86.7%) patients respectively. Severe malaria was found in 17.8% (21 of 118) patients of MS and 57.1% (440 of 770) patients Pf malaria. Pf constituted 440 (95.5%) cases where as MS constituted 21 (4.5%) respectively. The number of severe malaria was significantly (p < 0.001) more in Pf than MS. Out of 21 cases of severe malaria in MS infection, 14 (66.6%) had single complication and 7 (33.3%) cases had multiple complication. However, in Pf mono infection there were 200 (45.5%) patients with single and 240 (54.5%) with multiple complication. There were 4 independent risk factors for a patient of developing complicated malaria. They were: presenting without fever, high parasite count, Pf mono infection, and fever to treatment interval. Multiple complications and high MSS are associated with increased death in Pf malaria. The outcome of patients of MS was good. CONCLUSION In conclusion mixed species infection is not uncommon in the locality where both species coexists. Mixed species infection can complicate with severe malaria. However, its incidence and severity is less than severe falciparum malaria. In mixed infection, P.vivax malaria has a protective effect against the severity of falciparum malaria.
Collapse
|
49
|
Abstract
BACKGROUND Fever is common in malaria, and drugs and sponging are widely used for symptomatic relief. Some researchers have suggested that fever reduction may prolong malaria illness. OBJECTIVES We aimed to assess whether treatments to reduce fever in malaria influence the course of the illness. SEARCH METHODS We searched the Cochrane Infectious Diseases Group Trial Register (June 2012), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 6, 2012), MEDLINE (1966 to June 2012); EMBASE (1980 to June 2012) and LILACS (June 2012). We contacted researchers and organisations working in the field to enable us identify other unpublished or ongoing trials. SELECTION CRITERIA Randomized controlled trials of fever reduction measures in adults or children with confirmed malaria. DATA COLLECTION AND ANALYSIS Inclusion criteria were independently applied by two authors. We extracted data from trials that met our pre-specified criteria using a standard data extraction form. Mean differences with 95% confidence intervals (CI) were calculated for continuous data. GRADE was used to evaluate and summarize the quality of the evidence. MAIN RESULTS Ten randomized controlled trials with 990 participants including both adults and children met our inclusion criteria. All were small scale trials with methodological limitations and were conducted in a variety of patients. Some trials detected an impact of antipyretic drugs on fever clearance time, while others did not. Regarding parasite clearance,no clear influence of anti-pyresis was demonstrated (six trials, 423 participants, very low quality of evidence). No difference in the number or severity of adverse events between antipyretic drugs and control was detected. AUTHORS' CONCLUSIONS We do not know whether antipyretics alter parasite clearance time. Whether further trials are worthwhile to investigate this or not would require a judgement of whether this was an important question to resolve using interventional trials.
Collapse
Affiliation(s)
- Martin M Meremikwu
- Department of Paediatrics, University of Calabar Teaching Hospital, Calabar, Nigeria.
| | | | | | | |
Collapse
|
50
|
Abstract
Malaria includes a global disease burden with approximately 300-500 million cases worldwide annually. Varied symptomatology creates a diagnostic challenge. This is a case report of a stroke rehabilitation facility resident who developed Plasmodium ovale infection, several months post-exposure. Physicians should maintain a broad list of differential diagnoses, thinking beyond the range of common diagnoses.
Collapse
Affiliation(s)
- Patrick Redmond
- TCD/HSE General Practice Training Scheme, Trinity College Centre for Health Sciences, Tallaght Hospital, Dublin 24, Ireland.
| | | | | |
Collapse
|