[Malaria morbidity in Barkedji, village of Ferlo, in Senegal Sahelian area]. / Morbidité palustre 'a Barkedji, village du Ferlo, en zone sahélienne du Sénégal.

A study of malaria morbidity was carried out from November 1994 to October 1995, in a Ferlo village (Barkedji) characterized by a long persistence of the temporary ponds. The objective was to evaluate the repercussions of the strong and long anopheles transmission in humans. A clinical follow-up of a group of residents was conducted at home every 10 days by an investigator trained for taking axillary temperature and making thick smears, when suspecting malaria. Were included in the group, 123 voluntary subjects among whom 50% were children under 10 years old. Any feverish subject (T degree >37 degrees 5) or subject presenting other malaria symptoms (headaches, hot body shivers, sweats, aches...) was regarded as having a malaria attack as well as a parasitemia >2500 P/mm3 in children aged of 0 to 14 years old and 1000 P/mm3 in the oldest. During the study subjects with at least one feverish access, plasmodium infection and malaria attack were 58%, 33% and 22%, respectively. On 172 hyperthermias observed, 49% were accompanied by a circulating parasitemia and 30% corresponded to malaria attack. The feverish subjects (74% vs. 42%), the subjects with parasitemia (51% vs. 16%) and the cases of malaria (34% vs. 10%) were more frequently encountered in children under10 than in the oldest. The cases of malaria attacks were more frequent from November to January (70%). The strong intensity of malaria transmission in Barkedji and the persistence of its temporary ponds until January were sufficient to influence the level of malaria morbidity and consequently the development of an anti-malaria immunity by the indigenous population.

[First autochthonous cases, caused by the Dengue-3 serotype in Federal District, Brazil]. / Apparition des premiers cas autochtones causes par le sérotype Dengue-3 dans le District fédéral, Brésil.

During the first four months of 2003, the survey laboratory of the Federal District (LACEN Laboratory of Virology), Brasília, Brazil, isolated ten strains of dengue virus serotype 3, five of them autochthonous, and the remaining ones from cases imported from Tocantins, Goias and Bahia States. The virus isolations were performed in C6/36 cell culture inoculated with total blood collected between the 1st and the 5th days after the onset of the symptoms. The age of the patients varied from 26 to 59 years old. The strains were typed as DEN-3 by indirect immunofluorescence assay using serotype-specific monoclonal antibodies. Viral RNAs were extracted from total blood using the trizol method. The nested RT-PCR method detected DNA products of 290 bp, confirming the serotype identifications. The introduction of DEN-3 in Brazil and especially in the Federal District represents a serious threat, since most people are susceptible to this serotype and many have already been infected by serotypes DEN-1 or DEN-2, thus increasing the risk of epidemic of more severe forms of the disease. The use of a fast and reliable method for continuous monitoring of the circulation of this serotype is of primary importance for the prevention and control of future epidemics.

Safety of Seasonal Malaria Chemoprevention (SMC) with Sulfadoxine-Pyrimethamine plus Amodiaquine when Delivered to Children under 10 Years of Age by District Health Services in Senegal: Results from a Stepped-Wedge Cluster Randomized Trial.

BACKGROUND: It is recommended that children aged 3 months to five years of age living in areas of seasonal transmission in the sub-Sahel should receive Seasonal Malaria Chemoprevention (SMC) with sulfadoxine-pyrimethamine plus amodiaquine (SPAQ) during the malaria transmission season. The purpose of this study was to evaluate the safety of SMC with SPAQ in children when delivered by community health workers in three districts in Senegal where SMC was introduced over three years, in children from 3 months of age to five years of age in the first year, then in children up to 10 years of age. METHODS: A surveillance system was established to record all deaths and all malaria cases diagnosed at health facilities and a pharmacovigilance system was established to detect adverse drug reactions. Health posts were randomized to introduce SMC in a stepped wedge design. SMC with SPAQ was administered once per month from September to November, by nine health-posts in 2008, by 27 in 2009 and by 45 in 2010. RESULTS: After three years, 780,000 documented courses of SMC had been administered. High coverage was achieved. No serious adverse events attributable to the intervention were detected, despite a high level of surveillance. CONCLUSIONS: SMC is being implemented in countries of the sub-Sahel for children under 5 years of age, but in some areas the age distribution of cases of malaria may justify extending this age limit, as has been done in Senegal. Our results show that SMC is well tolerated in children under five and in older children. However, pharmacovigilance should be maintained where SMC is implemented and provision for strengthening national pharmacovigilance systems should be included in plans for SMC implementation. TRIAL REGISTRATION: ClinicalTrials.gov NCT 00712374.

Correction: Safety of Seasonal Malaria Chemoprevention (SMC) with Sulfadoxine-Pyrimethamine plus Amodiaquine when Delivered to Children under 10 Years of Age by District Health Services in Senegal: Results from a Stepped-Wedge Cluster Randomized Trial.

[This corrects the article DOI: 10.1371/journal.pone.0162563.].

The historical question of acquired immunodeficiency syndrome in the 1960s in the Congo River basin area in relation to cryptococcal meningitis.

In Europe before the advent of the acquired immunodeficiency syndrome (AIDS), fatal cases of infection with Cryptococcus neoformans resembling acute meningitis were rarely described and never in young adults. However, rapidly fatal cryptococcal meningitis in young Africans has been known to exist in central Africa for at least 30 years, mainly in the lower area of the Congo River basin. Cases have been reported in this area since 1953, particularly in young patients during the 1950s. It is also known that central African AIDS patients frequently suffer from cryptococcosis, and there is a possibility that earlier clinical reports of encephalitis were actually fatal cases of AIDS in young Africans. It appears possible that the central part of the African continent is the area where human immunodeficiency virus originated.

PIP: Rapidly fatal cryptococcal meningitis has existed in central Africa for more than 30 years, mainly in the lower area of the Congo River basin. Cases have been reported in that area since 1953, especially among young patients during the 1950s. People with AIDS in central Africa also often have cryptococcosis, and it is possible that earlier clinical reports of encephalitis were actually fatal cases of AIDS in young Africans. Before the advent of AIDS in Europe, fatal cases of infection with Cryptococcus neoformans resembling acute meningitis were rare and nonexistent in young adults. The available evidence suggests that HIV may have originated in central Africa, where it had long remained in a specific, but unknown and overlooked habitat. Cryptococcosis infection, cryptococcosis in the Congo River basin, the historical presence of HIV, and HIV in Haiti and among Haitians are discussed.

Short report: gametocytes, chloroquine pressure, and the relative parasite survival advantage of resistant strains of falciparum malaria in west Africa.

Patients with Plasmodium falciparum infections were selected with an in vivo chloroquine sensitivity assay. Fourteen days after treatment, the gametocytes were studied in relation to asexual parasite responses classified as drug-sensitive or showing RI or RII resistance. Gametocyte prevalence and density appeared significantly higher in RII than RI strains and higher in RI than in sensitive strains. This finding on gametocyte variation in vivo may explain why the RII type of chloroquine resistance has became more prevalent than RI everywhere in tropical Africa in the short time since its emergence. The biological and epidemiologic advantage of chloroquine-resistant malaria mediated through gametocytes is discussed in the context of the present drug pressure in Africa.

High human malarial infectivity to laboratory-bred Anopheles gambiae in a village in Burkina Faso.

The malarial infectivity of an African village population was tested by selecting a demographically representative sample of individuals for study, regardless of parasitemia or gametocytemia. The infectivity of this population people to laboratory-bred mosquitoes was investigated using membrane feeding techniques. Tests on 322 subjects (greater than four years of age) indicated that approximately 48.4% were capable of infecting mosquitoes. There were similar proportions of infectious individuals among gametocyte carriers (52.5%) and nongametocyte carriers (46.6%). All age groups appeared to contribute equally to this infective reservoir. Most of the infections resulted in low oocyst loads (1.8 oocysts) on the midgut of the positive mosquitoes and only a few mosquitoes per batch were infected (11.5%). A previous entomologic survey estimated 90 infected bites/person/year and a low parity index in Anopheles gambiae (< 60%) as well as in An. funestus (< 40%), the two main malaria vectors in this region. This low parity index could indicate a low life expectancy for infected mosquitoes and could therefore explain an inoculation rare lower than expected considering the high degree of infectivity of the human population studied.

Enzyme typing of Plasmodium falciparum from African and some other Old World countries.

Freeze-dried and freshly cultured isolates of Plasmodium falciparum from different countries have been examined for variation in six enzymes, GPI, PGD, LDH, GDH, ADA and PEPE, using starch gel electrophoresis. Variant forms of each enzyme occur. For most enzymes, similar forms occur in isolates from different parts of the world, although differences in frequencies of each form are found. LDH-2 has been found only in African isolates. PEPE variants vary markedly in their frequency between East and West Africa, although further work is needed to confirm this finding.

Comparison of behavior and vector efficiency of Anopheles gambiae and An. arabiensis (Diptera:Culicidae) in Barkedji, a Sahelian area of Senegal.

The ecology, population dynamics, and malaria vector efficiency of Anopheles gambiae and An. arabiensis were studied for 2 yr in a Sahelian village of Senegal. Anophelines were captured at human bait and resting indoors by pyrethrum spray. Mosquitoes belonging to the An. gambiae complex were identified by polymerase chain reaction. Of 26,973 females, An. arabiensis represented 79% of the mosquitoes captured and remained in the study area longer than An. gambiae after the rains terminated. There were no differences in nocturnal biting cycles or endophagous rates between An. gambiae and An. arabiensis. Based on an enzyme-linked immunosorbent assay test of bloodmeals, the anthropophilic rate of these 2 vectors were both approximately 60%, when comparisons were made during the same period. Overall, 18% of the resting females had patent mixed bloodmeals, mainly human-bovine. The parity rates of An. gambiae and An. arabiensis varied temporally. Despite similar behavior, the Plasmodium falciparum circumsporozoite protein (CSP) rates were different between An. gambiae (4.1%) and An. arabiensis (1.3%). P. malariae and P. ovale only represented 4% of the total Plasmodium identified in mosquitoes. Transmission was seasonal, occurring mainly during 4 mo. The CSP entomological inoculation rates were 128 bites per human per year for the 1st yr and 100 for the 2nd yr. Because of the combination of a high human biting rate and a low CSP rate, An. arabiensis accounted for 63% of transmission. Possible origin of differences in CSP rate between An. gambiae and An. arabiensis is discussed in relation to the parity rate, blood feeding frequency, and the hypothesis of genetic factors.

[Zoophagia and alternative host selection of the marlaia vectors in Senegal]. / Zoophagie et hôtes alternatifs des vecteurs du paludisme au Sénégal.

Blood-engorged females of An. gambiae s.l., An. funestus, An. pharoensis and An. rufipes caught resting indoors were tested (precipitin or enzyme-linked immunosorbent assay) to determine the source of bloodmeal. The species of the An. gambiae complex fed mainly on human hosts in all prospected areas, except in those of the mid Senegal river valley where an important zoophily was observed within and near the irrigation zone. Among 4,597 blood-engorged females of An. gambiae s.l., 29% fed on cattle with 7.5% of mixed boodmeals, mainly human-bovine or human-equine. The presence of cattle, culicid population densities and individual mosquito safety devices were the most determinant factors of animal deviation. Blood of most domestic animals was found in the stomach of collected females, but according to areas, bovines and equines were the main hosts for zoophilic females of An. gambiae s.l. Females of An. funestus collected in the middle-west were more anthropophilic than those collected in south-eastern areas. An. pharoensis was most prevalent in the Senegal river delta where it was found to be very anthropophilic. An. rufipes was strongly endophilic but exclusively zoophilic in all prospected areas.

[Role of Anopheles melas Theobald (1903) on malaria transmission in a mangrove swamp in Saloum (Senegal)]. / Rôle d'Anopheles melas Theobald (1903) dans la transmission du paludisme dans la mangrove du Saloum (Sénégal).

From June 1995 to January 1998, entomological studies carried out in five villages located in the Delta's Saloum have allowed to better understand the contribution of An. melas Theobald (1903) to malaria transmission in mangrove swamp. Among the five villages studied, three of them (Simal, Djilor and Marlothie) located along the Saloum river, are colonised by An. arabiensis; the two others (Djifere and Diakhanor) located between the sea and the river, are colonised by An. melas. During the rainy season and at the beginning of the dry season, An. melas and An. arabiensis are sympatric. The ratio of An. melas/An. arabiensis increases when we go closer the coast where An. melas becomes quite exclusive. When An. melas is predominant, endophagy, endophily and anthropophily are very marked. The parturity rates are lower in An. melas than in An. arabiensis. In the predominance area of each species, transmission is on the same level. During the period of sympatry, An. arabiensis is responsible for the transmission and when it is absent, An. melas carries on. Transmission occurs from July to March with a maximum at the beginning of the dry season. In the villages of the mangrove swamp, its prolongation until the middle of the dry season is due to An. melas.

[Bioecology in Haiti of Anopheles albimanus Wiedemann, 1820 (Diptera:Culicidae)]. / Bio-écologie en Haïti d'Anopheles albimanus Wiedemann, 1820 (Diptera: Culicidae).

Hispaniola has the highest malaria rate in the West Indies. A study of the bio-ecology of the major vector Anopheles albimanus was carried out in Haïti. Our observations concerned the length of pre-imaginal stages, biting rates and the gonotrophic cycle. A table of its complete life cycle, stage by stage, was produced as well as a graph illustrating its whole larval development in its natural habitat. Results in the field and insectarium were compared. In the laboratory, the development was shorter, except for pupae. The temperature was the main factor governing the length of pre-imaginal development. Preimaginal development decreased from 15 days in the field to 9 days in the insectarium whereas the temperature was a high of 4 degrees C. The nycthemeral activity and seasonal variations of An. albimanus were studied, by monthly all-night captures on human volunteers, during a full year in exo- and endophilic situations. Two sampling sites were chosen for comparison, An. albimanus were caught at every hour of the nycthemeral cycle, with a peak around midnight. Monthly variations were affected by the rains. The vector was more exophagous, when its density was high. The parity rate of the biting population varied between 85.8% and 20.0%; it was low at the beginning of the rains and increased when the rains stopped and breeding places dried out. To study the gonotrophic cycle of wild An. albimanus, several techniques were used jointly; follicles dissection; follicular relics; length of maturation of follicles. The length of the full cycle and of each of its components was estimated (quest of host for blood meal; maturation phase; breeding site seeking). In Haïti 41 h (nulliparous), or 21 h (parous) were necessary for females to have a complete maturation of the follicles. The lengthening of the gonotrophic cycle of parous An. albimanus, in the natural field site, was estimated to last about 4 days. For nulliparous it was 5 days, and 7 days if a pregravid stage was necessary. Considering the sporogonic cycle of Plasmodium falciparum (12 days), the wild population of An. albimanus females could become infective at the third blood feeding in Haïti.

[Establishing a strain of Anopheles arabiensis (Diptera:Culicidae) in an insectarium]. / Mise en place en insectarium d'une souche d'Anopheles arabiensis (Diptera: Culicidae).

For the first time in Dakar (Senegal), we managed to establish a local colony of Anopheles arabiensis (Diptera: Culicidae) in insectarium. The observations on the productivity of the colony showed a gradual adaptation of the preimaginal stages to insectarium conditions. The estimated duration of the development of the various preimaginal stages showed an interval of 24 hours for egg hatching, 48 h for stage I, 24 h for stage II, 24 h for stage III and 36 h for the pupal stage. Stage IV which makes the difference in the duration of the adult-egg cycle, varied from 1 to 13 days. Pupal moulting occurred mainly between 11 h and 19 h, with a peak between 14 h and 15 h. The duration of the preimaginal cycle in insectarium was from 8 to 11 days. This fits with the duration shown in natural breeding places during the rainy season (the best period for the development) which was from 9.5 to 13.3 days. Emergence, faster in males, occurred in the evening around 6.30-7 p.m. The emergence rate was higher in insectarium (92.9%) compared with that shown in the field (6 to 20%) (the natural breeding places are subject to biological and biochemical variations and to predators's action). The sex-ratio is equal to 1. The studies in insectarium showed that the gonotrophic cycle is 3 days in neonate blood fed after day 2 and also in parous ones. This cycle is 5 days in nulliparous with pregravid stage. The average longevity is 16 days with a maximum of 26 days in females and 43 days in males.

[Placental infections with Plasmodium in an endemic zone. Risk factors]. / Infection du placenta par les Plasmodium en zone d'endémie. Les facteurs de risque.

A survey has been carried out during eight months in the hospital of Bobo-Dioulasso (Burkina Faso) in view to observe the infection of the placentas by Plasmodium and their risk factors. One thousand forty pregnant women were included. Infection rates were 6.5% during the low transmission season and 24.5% during the high transmission season. P. falciparum was present in all the infections. Thirty eight per cent of the women under 18 years old and 26% of the primigravidae were infected. The mean difference in birth weights between the newborn babies of primigravidae with infected or non-infected placentas was 275 g. The regular visits to antenatal clinics, a high level of education and sufficient income were linked with a low level of placental infection. The use of bed nets was linked with a low level of placental infections even after suppression of the other socio-economic data. These observations are discussed in view of an action against malaria in endemic areas.

[In vivo chemosensitivity tests of Plasmodium falciparum to chloroquine in Senegal: the development of resistance and the assessment of therapeutic efficacy]. / Tests in vivo de chimiosensibilité de Plasmodium falciparum à la chloroquine au Sénégal: évolution de la résistance et estimation de l'efficacité thérapeutique.

The efficacity of oral chloroquine was assessed in 360 out-clinic patients with symptomatic Plasmodium falciparum malaria who were enrolled at five sites, in four administrative regions of Senegal, between 1991 and 1995. They were three rural areas: Mlomp (Casamance), Bandafassilbel (Eastern Senegal), Diohine (Sine-Saloum) and one urban area: Pikine (agglomeration of Dakar). Parasitological failure at Day-7 was observed in 108 patients (30%) and ranged from 14% to 50% according to the study areas. The proportion of RI, RII and RIII responses were 6%, 23% and 1%, respectively. Chloroquine resistance was lowest in Bandafassi, one of the most remote area of Senegal. It was highest in Mlomp where a malaria control programme with mass chemoprophylaxis had been carried out since 1975. The therapeutic failure rate defined by the persistence or reappearance of fever and P. falciparum trophozoites on days 4-7 was 6%. The percentages of therapeutic failure for RI, RII and RIII patients were respectively 14%, 19% and 100%. These results and those of previous studies in Senegal suggest that chloroquine resistance, which first emerged in vivo in 1988 in Dakar, spread between 1990 and 1993 in all regions of this country. The limitations of in vivo tests for the determination of the therapeutic efficacy of chloroquine in malaria endemic regions with increasing chemoresistance are discussed. The low proportion of potentially severe malaria infections in semi-immune persons, the biases in patients selection, and the possibility of delayed complications, considerably limit the potential of these tests for guiding the choice of the best adapted first line treatment.

[Anopheles of Senegal. An annotated and illustrated list]. / Les anophèles du Sénégal. Liste commentée et illustrée.

Twenty species of Anopheles are presently known from Senegal. An. gambiae, An. arabiensis, An. pharoensis, An. rufipes and An. ziemanni have an extensive distribution. Probably because of climatic change, An. funestus is no more found in some areas and An. paludis tend to disappear. An. melas is located in coastal areas. The other species, namely An. coustani, An. brohieri, An. brunnipes, An. domicola, An. flavicosta, An. freetownensis, An. hancocki, An. maculipalpis, An. nili, An. pretoriensis, An. squamosus and An. wellcomei, are mainly found in southern Senegal. Only An. gambiae, An. arabiensis and An. funestus are of epidemiological significance as vectors of malaria and bancroftian filariasis. Twelve arboviruses have been isolated from eight Anopheles species. Each Anopheles species is illustrated and an identification key is given.

[Demonstration of Cryptococcus neoformans in a fatal meningeal disease in the Congo]. / Mise en évidence de Cryptococcus neoformans dans une affection méningée mortelle au Congo.

Cryptococcus neoformans, mainly widespread in Occidental Europe, America and South East of Asia, was rarely described in African pathology. In Central Africa, it was isolated several times in Zaïre. All reported cases concern young people and present no associated pathology. A first fatal case, looking like an acute meningitis, was described in 1959, in a 18 years old Congolese girl. This second case discovered in Brazzaville in a 37 years old young man was a fatal encephalitis after a primary pneumopathy.

[Malaria morbidity and therapeutic efficacy of antimalarials. Study conducted in the Dakar region]. / Morbidité palustre et efficacité thérapeutique des antipaludéens. Etude menée dans la région de Dakar.

During November and December 1992, the authors surveyed the malaria morbidity and the drugs efficiency in an urban area of Dakar region. Malaria represented 13.68% of the fevers in Dakar district and 12.4% in Pikine. The mean parasitic density was evaluated at 5000/mm3. Good efficiency of antimalarial drugs were noted but chloroquine-resistance is present with 24% of prevalence.

[Plasmodium falciparum and drepanocytic gene in Popular Republic of Congo. I. Prevalence of malaria and drepanocytic trait among school children in Brazzaville area (author's transl)]. / Le paludisme à Plasmodium falciparum et le gène de la drépanocytose en République Populaire du Congo. I. -- Prevalence du paludisme et du trait drepanocytaire, en milieu scolaire dans la région Brazzavilloise.

From 1978 to 1979, 5 surveys, among schoolchildren, were carried out during the rainy season in the neighbourhood of Brazzaville (R.P. Congo): 3 in PK 45 village (northern part of the capital), 2 in Djoumouna village (southern part), and 1 in "Talangai" (a suburb of the capital). 868 exams (plasmodic and splenic index fitted with hemoglobin composition [Hb AA or Hb AS]) were done. It appeared that 19,6% of schoolchildren examined were heterozygous sicklers (AS). This percentage confirmed the previous results from other authors in different countries of Central Africa. On the other hand, in spite of an intense transmission, both plasmodic and splenic index were, on the average, relatively low (24,5 and 24,8% respectively). Plasmodium falciparum was largely predominant (95,3% of infections) but P. ovale and P. malariae were also found (1,9% for each species). From our study no obvious "protecting effect" can be attributed to sickle cell trait because plasmodic index of children AA and AS were similar (23,8 and 27,6% respectively). A slight decrease of splenic index was noticed in AS in regard to AA (19,4 and 26.1% respectively). It is difficult to consider this no significative regression as a definitive proof of a premunition stronger in AS than in AA. Effectively some splenic infarctus are well known to be a regular physiopathological process occurring in homozygous SS but often in heterozygous AS too. In such highly endemic and stable malaria area the problem of a suitable antimalaria strategy remains to be solved.

[A case of a combination heterozygote with hemoglobin K Woolwich and hemoglobin C (Hb Kw/HbC) discovered in Bobo-Dioulasso (Burkina Faso)]. / Remarques à propos d'un hétérozygote composite présentant une hémoglobine K Woolwich et une hémoglobine C (Hb Kw/HbC) dépisté à Bobo-Dioulasso (Burkina Faso).

During a study on malaria in pregnant women in Burkina Faso, the authors gave a particular attention to the hemoglobin of a mother and her new-born child (blood of cord) and they noticed an hemoglobin migrating before the HbA which was identified by isoelectric focusing (IEF). The child is a composite HbK/HbC heterozygote. A survey was carried out to check the transmission of such a K Woolwich hemoglobin within the family of the mother. Out of 40 people, 17 got HbKw. A noticeable anemia was found in HbKw/HbC heterozygote. The authors tried to identified a possible thalassemia. There was little probability for an association of a minor alpha-thalassemia in the absence of Bart's hemoglobin in the blood of the cord (IEF test) and there was no associated beta-thalassemia.