Falciparum malaria is associated with risk markers of type 2 diabetes mellitus in individuals with or without COVID-19 exposure

Background: Scientific information on the impact of malaria on the risk of developing type 2 diabetes mellitus (T2DM) after recovery from the coronavirus disease 2019 (COVID-19) is limited in the Ghanaian context. The purpose of this study was to examine the association between selected risk markers of T2DM in falciparum malaria patients post-COVID-19 or not at a tertiary hospital in Ghana. Methodology: This was a descriptive cross-sectional comparative study of 38-recovered COVID-19 adult participants with malaria and 40 unexposed COVID-19 adults with malaria at the Tamale Teaching Hospital, Ghana. Demographic, anthropometric and levels of glucose, insulin, C-reactive protein and lipid profiles were measured in the two groups of participants under fasting conditions. Parasitaemia was assessed microscopically but insulin resistance and beta-cell function were assessed by the homeostatic model. Results: The COVID-19 exposed participants were older (p=0.035) with lower parasitaemia (p=0.025) but higher mean levels of insulin, insulin resistance, and beta-cell function compared with their unexposed counterparts (p<0.05). Parasitaemia correlated positively with a number of the measured indices of diabetogenic risk markers in the COVID-19 exposed group only, and predicted (Adjusted R2=0.751; p=0.031) by beta-cell function, C-reactive protein and triglycerides with the model explaining about 75% of the observed variation. Parasitaemia could only be predicted (Adjusted R2=0.245; p=0.002) by C-reactive protein with the model explaining just about a quarter of the observed variation in the COVID-19 unexposed group. Insulin resistance and sub-optimal beta-cell function were detected in both groups of participants. Conclusion: Falciparum malaria is associated with risk markers for development of T2DM irrespective of COVID-19 exposure. Insulin resistance, inflammation and sub-optimal beta-cell secretory function may drive the risk. The observed diabetogenic risk is higher in the recovered COVID-19 participants.

Sequential analysis of erythrocyte aggregation in P. falciparum malaria with and without ASAQ therapy by optical signal and image analysis

The aggregation of erythrocytes is an important mechanism for blood flow through the cardiovascular system. In malaria, this is complicated by infection caused by P. falciparum and is further complicated by the severity of parasitemia. Hence analysis of this micro-mechanism is essential to know the changes in blood not only in diseased conditions but also after artemisinin combination therapy (ASAQ) to alleviate suffering. For analysis purposes, aggregation of erythrocytes was determined by LED laser aggregometer, represented in terms of various parameters related to the changes in laser transmitted intensity. Formed aggregates are further analyzed by imaging and image-processing methods. For this study blood samples from young adults (18 – 40 years old) infected with P. falciparum (n= 80), without any other serious illness, were performed. These samples were selected based on the severity of parasitemia, and were divided into low (LP), medium1 (MP1), medium 2 (MP2), and high (HP) parasitemia. For three days, the selected individuals were treated with artemisinin-based combination therapy ASAQ (Artesunate 4 mg/kg and amodiaquine 10 mg base/ kg once a day). Healthy subjects (n=20) without any history of the disease were selected as a control group. The results, as obtained by various parameters, show a significant elevation of aggregation of erythrocytes (P< 0.05) in P. falciparum malaria with the increase of parasitemia level. There was a decrease in the aggregation after treatment on day four tending towards normal. Thus the current study shows the potential beneficial role of ASAQ on erythrocytes aggregation, which may contribute to reducing the harmful effects on various organs in P. falciparum-infected blood.

Fiebre biliosa hemoglobinúrica como forma de presentación de la malaria aguda grave por Plasmodium falciparum / Hemoglobinuric bilious fever as a presentation of severe acute Plasmodium falciparum malaria

RESUMEN Introducción: La fiebre biliosa hemoglobinúrica es una de las complicaciones del paludismo grave, notificada con poca frecuencia, que se caracteriza por una hemólisis intravascular aguda en ocasiones masiva que conduce a hemoglobinuria y, finalmente, a una lesión renal aguda. Objetivo: Describir un caso de fiebre biliosa hemoglobinúrica como forma clínica de presentación de la malaria aguda grave. Caso clínico: Paciente masculino procedente de una zona endémica de paludismo con antecedentes de episodios recurrentes de malaria, quien, al tercer día de indicarle quimioprofilaxis antipalúdica con mefloquina, presentó un cuadro clínico de decaimiento, marcada astenia, fatiga, náuseas, vómitos, dolor abdominal difuso y emisión de orina oscura escasa, descritas por el paciente como "coca cola". Se diagnosticó fiebre biliosa hemoglobinúrica como forma clínica de presentación de una malaria aguda grave con baja parasitemia, constatado mediante examen de diagnóstico rápido y gota gruesa positivos a paludismo y hemoglobinuria masiva en el examen de orina con tira reactiva. La evolución del paciente fue favorable. Conclusiones: Este caso representa una forma no habitual de presentación de la enfermedad, que aunque no se sospecha usualmente, puede ocurrir. Este artículo es una alerta a los médicos que ejercen en áreas endémicas de malaria a permanecer atentos. Esta temible complicación puede ser la forma clínica de presentación de la malaria grave, particularmente en paciente expuestos crónicamente a infección por Plasmodium falciparum, que presenten una reacción hemolítica aguda masiva en ausencia de parasitemia elevada, cuando se administra quinina o mefloquina como tratamiento preventivo o curativo contra la malaria.

ABSTRACT Introduction: Hemoglobinuric bilious fever is one of the complications of severe malaria, infrequently notified, characterized by an acute intravascular hemolysis, massive in occasions, that leads to homoglobinuria and, finally to an acute renal lesion. Objective: To describe a case of hemoglobinuric bilious fever as clinical presentation of severe acute malaria. Clinical case: Male patient from a malaria-endemic area with a history of recurrent events of malaria, who, on the third day after receiving antimalarial chemoprophylaxis with mefloquine, presented with malaise, marked asthenia, fatigue, nausea, vomiting, diffuse abdominal pain, and scanty and dark urine emission, described by the patient as "Coca-Cola" like. Hemoglobinuric bilious fever was diagnosed as clinical presentation of severe acute malaria of low parasitemia, confirmed by malaria-positive quick diagnostic test and thick film, and massive homoglobinuria on urine dipstick test. Conclusions: This case represents an uncommon presentation of the disease, which is not usually suspected. This paper alerts physicians working in malaria-endemic areas to be attentive. This dread complication could be the clinical presentation of severe malaria, especially in patients chronically exposed to Plasmodium falciparum infection, who present with massive acute hemolytic reaction in the absence of high parasitemia when quinine or mefloquine is administered as preventive or curative treatment against malaria.

Paludismo importado no falciparum: aspectos de interés para el tratamiento de los pacientes / Imported non-falciparum malaria: aspects of interest for patient therapeutic management

Introducción: El paludismo es una enfermedad febril aguda potencialmente mortal causada por parásitos transmitidos por el mosquito Anopheles. El paludismo no falciparum (PNF), producido por otras especies de Plasmodium, está menos documentado en la literatura internacional, a pesar de su prevalencia. Objetivos: Describir aspectos clínicos y epidemiológicos de interés para el tratamiento en pacientes ingresados con diagnóstico de PNF importado, y determinar la relación existente entre la respuesta al tratamiento y otras variables. Métodos: Se realizó un estudio transversal analítico de 89 pacientes adultos con PNF importado, ingresados en el Departamento de Medicina del Instituto de Medicina Tropical Pedro Kourí, entre enero de 1997 a diciembre de 2017. Se determinó la pauta de profilaxis y tratamiento según los criterios de las guías publicadas y los fármacos disponibles en Cuba, y la definición de paludismo complicado según la OMS en 2003. Hubo respuesta demorada al tratamiento, cuando el paciente demoraba más de 7 días en negativizar la gota gruesa. Resultados: Predominaron los pacientes del sexo masculino, y una media de edad de 37,2 años. El 55,1 por ciento de los pacientes provenía de la región de las Américas y en el 85,4 por ciento se aisló Plasmodium vivax. La respuesta al tratamiento fue excelente con los esquemas combinados utilizados a base de cloroquina. Fue significativa la relación existente entre la demorada respuesta al tratamiento con la gravedad del cuadro clínico y el estado no inmune de los pacientes. Conclusiones: El PNF es una importante causa de paludismo importado en pacientes provenientes de áreas endémicas, fundamentalmente de América. Se distingue por parasitemias bajas, un cuadro clínico caracterizado por fiebre, escalofríos, cefaleas y evolución hacia cuadros no complicados. La cloroquina fue el medicamento de elección, aunque la repuesta demorada al tratamiento no justifica su suspensión o variación(AU)

Introduction: Malaria is a potentially fatal acute febrile illness caused by parasites transmitted by the Anopheles mosquito. Non-falciparum malaria (NFM), caused by other Plasmodium species, is less documented in the international literature, despite its prevalence. Objectives: To describe clinical and epidemiological aspects of interest for the treatment of patients hospitalized with a diagnosis of imported NFM, and to determine the relationship between response to treatment and other variables. Methods: It was conducted an analytical cross-sectional study of 89 adult patients with imported NFM, admitted to the Department of Medicine of the Institute of Tropical Medicine Pedro Kourí, between January 1997 to December 2017. The prophylaxis and treatment guideline was determined according to the published guidelines and drugs available in Cuba, and the definition of severe malaria by WHO in 2003. There was delayed response to treatment when the patient took more than 7 days to become negative for thick blood smear. Results: Patients were predominantly male, with a mean age of 37.2 years. Plasmodium vivax was isolated in 85.4 percent of the patients and 55.1 percent were from the Americas region. The response to treatment was excellent with the chloroquine-based combination regimens used. The relationship between the delayed response to treatment and the severity of the clinical picture and the non-immune status of the patients was significant. Conclusions: NFM is an important cause of imported malaria in patients from endemic areas, mainly from the Americas. It is characterized by low parasitemia, clinical manifestations of fever, chills, headache and evolution towards uncomplicated symptoms. Chloroquine was the drug of choice, although the delayed response to treatment does not justify its suspension or variation(AU)

Molecular characterization of the severe falciparum malaria with typhoid co-infection A case report

Malaria and typhoid co-infections can be a serious public health issue in tropical countries leading to incorrect diagnosis due to overlapping clinical presentations of malaria and typhoid and hence, causing a delay in implementing the appropriate treatment regimen for these concurrent infections. This study reports a case of six-year-old female child co-infected with severe malaria (Plasmodium falciparum) and typhoid (Salmonella typhi) diagnosed by rapid malaria antigen test (RMAT) and blood culture respectively. Further, analysis of the chloroquine resistance gene Pfcrt for the falciparum demonstrated the presence of K76T mutant allele in pfcrt gene with high IC50 (150nM) for chloroquine (CQ) drug. The present case highlights the significance of timely identification and treatment of co-infections and also provides information about the circulating P. falciparum clinical strains.

Analysis of the clinical treatment effect of 116 imported falciparum malaria cases in Wuhan City / 公共卫生与预防医学

Objective To analyze and evaluate the clinical characteristics of imported falciparum malaria cases and the antimalarial effect of artemisinin-based drugs, to promote rational and standardized drug use, and to improve the clinical cure rate of falciparum malaria. Methods A total of 116 imported cases of falciparum malaria admitted to the provincial malaria designated hospital in Wuhan were collected, and the clinical characteristics of the patients and use of artemisinin, and the therapeutic effects of the artemisinin-based drugs were retrospectively analyzed. Results The clinical manifestations of imported falciparum malaria were complicated and varied and had many complications, including mainly fever, anorexia, anemia, and jaundice, etc. The symptoms were alleviated or disappeared after treatment with artemisinin, without obvious adverse drug reactions. The median time of fever reduction was 2 days, the median time of Plasmodium becoming negative was 3 days, and the median time of clinical symptom relief was 3 days. 109 cases of common falciparum malaria were treated by oral artemisinin compound or artesunate injection combined with oral artemisinin compound, including 30 cases of oral artemisinin compound treatment for 1 to 4 days (1 case relapsed) and 79 cases of artesunate injection combined with oral artemisinin compound for 4 to 6 days (4 cases relapsed). Seven severe cases were cured after long-term and high-dose treatment with artesunate injection combined with oral multiple artemisinin compounds, and the total cure rate was 95.69% (111/116). Conclusion The present study demonstrates that the treatment of falciparum malaria by oral injection of artemisinin is safe and effective, and the cure rate is high. However, some patients have recurrence of the malaria parasite after stopping artemisinin drugs. It is necessary to ensure the use of artemisinin-based drugs in a “standardized, full-process, and adequate” way to contain the risk of severe illness and drug resistance.

Association between blood test parameters and intensity of Plasmodium falciparum infections in imported falciparum malaria cases in Tianjin City from 2015 to 2019 / 中国血吸虫病防治杂志

Objective To evaluate the association between blood test parameters and intensity of Plasmodium falciparum infections among imported falciparum malaria cases in Tianjin City from 2015 to 2019, so as to provide insights into the early diagnosis of imported P. falciparum malaria. Methods The epidemiological data of 37 imported cases with confirmed diagnosis of P. falciparum malaria in Tianjin City from 2015 to 2019 were collected, and the epidemiological features and clinical manifestations were retrospectively analyzed. In addition, the association between blood test parameters and intensity of P. falciparum infections was evaluated among the imported P. falciparum malaria cases. Results Among the 31 imported P. falciparum malaria cases, there were 31 cases (83.8%) with a reduction in platelet (PLT) counts, 16 cases (43.2%) with a reduction in red blood cell (RBC) counts, 16 cases (43.2%) with a reduction in hemoglobin (Hb) concentrations, 23 cases (62.2%) with a rise in neutrophil percentage (NEUT%), 32 cases (86.5%) with a rise in total bilirubin (TBIL) concentrations, 29 cases (78.4%) with a rise in alanine aminotransferase (ALT) concentrations, 28 cases (75.7%) with a rise in aspartate transaminase (AST) concentrations, and 23 cases (62.2%) with a rise in gamma-glutamyl transpetidase (GGT) concentrations. The PLT count and Hb concentration correlated negatively with the intensity of P. falciparum infections (Goodman-Kruskal γ = –0.568 and –0.521, both P values < 0.05) and the TBIL concentration and NEUT% correlated positively with the intensity of P. falciparum infections (Goodman-Kruskal γ = 0.496 and 0.610, both P values < 0.05) among imported falciparum malaria cases; however, there were no associations of ALT, AST, GGT levels or RBC count with the intensity of P. falciparum infections among the imported falciparum malaria cases (Goodman-Kruskal γ = 0.370, 0.497, 0.314 and –0.434, all P values > 0.05). Conclusions PLT, Hb, TBIL and NEUT% may serve as markers for early auxiliary diagnosis of imported P. falciparum malaria, and PLT and TBIL may provide valuable information for the diagnosis of severe imported P. falciparum malaria.

Imported falciparum malaria in Suzhou City: a report of two cases in 2019 / 中国血吸虫病防治杂志

The demographic features, epidemiology, diagnosis and treatment of two cases with falciparum malaria imported into Suzhou City in 2019 were reported. These findings indicate a risk of imported malaria in visitors besides high prevalence in migrant labors, and much attention should be paid to children that are at a high risk of infections.

Plasmodium falciparum infection complicated by bronchopneumonia in a peacekeeper: a case report / 中国血吸虫病防治杂志

Malaria is an acute febrile illness caused by Plasmodium. In Africa where the burden of malaria is extremely high, febrile symptoms caused by respiratory tract infections may challenge the diagnosis of malaria, and patients with unclear diagnosis and administration of antimalarial drugs require more attention. Hereby, a peacekeeper with Plasmodium falciparum infection complicated with bronchopneumonia was reported.

Efficacy, safety and tolerability of three regimens of artemisinin combination therapy in the management of Plasmodium falciparum malaria: a comparative study

Background: The WHO now recommends the use of artemisinin-based combination therapies for the first-line treatment of Plasmodium falciparum malaria to reduce the drug resistance. Hence, this study was designed to compare the efficacy, safety and tolerability of three regimens of artemisinin combination therapies in malaria diagnosed patients of Kamineni Institute of Medical Sciences Hospital, Narketpally.Methods: Total of 104 subjects had been allocated to 3 different artemisinin-based combinations regimens in a period of 2 years during December 2013 - November 2015. Out of 104 subjects, 34 received artemisinin-sulphadoxine pyrimethamine regimen, 33 subjects received artemisinin-lumefantrine regimen, and 37 subjects received artemisinin-doxycycline regimen. All the three regimens were studied for their efficacy, safety and tolerability.Results: The mean number of febrile days in artesunate-sulfadoxine pyrimethamine group (3.43±0.92) and artesunate-doxycycline group (3.51± 0.74) were comparatively less than artemether-lumefantrine group (4.33±0.77) which is statistically significant. The mean Hb%, RBC count, WBC count was not significantly different on day 7 in comparison to day 1 in all the three regimens of treatment groups. 14 subjects among the 104 had mild thrombocytopenia which was significantly improved on day 7 in all the three regimens of treatment groups.Conclusions: Artesunate-sulfadoxine-pyrimethamine and artesunate-doxycycline regimens showed better efficacy, safety and tolerability than artemether-lumefantrine regimen.

Adrenal Insufficiency in Severe Falciparum Malaria: Its Outcome and Prediction by Discriminant Score

Introduction: Severe falciparum malaria (SFM) is acomplex syndrome which affect different organs of the bodywith variable severity. But adrenal insufficiency (AI) isa less described entity in SFM. The present study aimed atdescribing AI, its prediction with Discriminant Score (DS),effect of replacement of hydrocortisone in such cases.Material and Methods: This study was conducted in twosteps among two cohort of patients. In Step-1, AI has beendetected by cortisol assay among 142 consecutive cases ofSFM. Taking different clinical and biochemical variables,Discriminant Function Analysis was performed to find out aDS to predict AI. In Step-2 study DS has been validated in 74new cases of SFM. Patients with AI have been replaced withInj. hydrocortisone and compared with the patients withouthydrocortisone of Step-1 study.Results: Out of 142 cases of SFM, 50 (35.2%) patients had AIas defined by cortisol level <10ug/dl. DS of >0.35 could ableto discriminate AI with sensitivity, specificity, and predictivevalue of 92.5%, 91.6%, and 85.7% respectively. The mostcommon presentations are hypotension, hypoglycemia, andhyponatremia. After replacement of steroid the mortality waslow (7.4%) compared to without replacement (18.0%).Conclusion: The present study showed that AI is common inSFM and replacement of hydrocortisone is necessary in thosepatients for reduction of mortality. DS can be used to predictAI and patients with score >0.35 may be administered withlow dose steroid.

Epidemiological investigation of blood transfusion - induced malaria caused by an imported case with Plasmodium falciparum infection / 中国血吸虫病防治杂志

Objective To analyze a case infected with Plasmodium falciparum due to blood transfusion in Taizhou City, so as to provide scientific evidence for malaria control. Methods The epidemiological investigation of a case with P. falciparum malaria was conducted, and the blood donors’blood samples were collected and detected in laboratory to identify the origin of the infection. Results Microscopy detected Plasmodium in the blood samples from a 64-year-old male inpatient with nephropathy, and P. falciparum malaria was diagnosed. The case had no history of travel to Africa or Southeast Asia except blood transfusion, and he had received blood transfusion 14 times during his hospital stay. Detection of blood donors’blood samples showed P. falciparum in the archived blood samples from an Indonesian student studying in China, as revealed by PCR assay, and the student was found to have a history of malaria. Conclusions The patient was confirmed to be a case with P. falciparum malaria due to blood transfusion. Screening of malaria should be intensified in blood donors to prevent the development of malaria transmitted by blood transfusion.

Epidemiological investigation of blood transfusion - induced malaria caused by an imported case with Plasmodium falciparum infection / 中国血吸虫病防治杂志

Objective To analyze a case infected with Plasmodium falciparum due to blood transfusion in Taizhou City, so as to provide scientific evidence for malaria control. Methods The epidemiological investigation of a case with P. falciparum malaria was conducted, and the blood donors’blood samples were collected and detected in laboratory to identify the origin of the infection. Results Microscopy detected Plasmodium in the blood samples from a 64-year-old male inpatient with nephropathy, and P. falciparum malaria was diagnosed. The case had no history of travel to Africa or Southeast Asia except blood transfusion, and he had received blood transfusion 14 times during his hospital stay. Detection of blood donors’blood samples showed P. falciparum in the archived blood samples from an Indonesian student studying in China, as revealed by PCR assay, and the student was found to have a history of malaria. Conclusions The patient was confirmed to be a case with P. falciparum malaria due to blood transfusion. Screening of malaria should be intensified in blood donors to prevent the development of malaria transmitted by blood transfusion.

Study of neurological manifestations in patients of falciparum malaria

Background: Several types of neurological manifestations are associated with falciparum malaria. Cerebral malaria is one of the most dreaded complications. A significant number of survivors are left with disabling neurological sequelae, most of which are self-limiting. Neurological involvement is more frequent with falciparum malaria because of its unique characteristics leading to micro-vascular involvement.Methods: Present study was conducted at department of General Medicine, VIMSAR, Burla (Odisha). This observational study included in total 110 patients, who were confirmed cases of falciparum malaria. Clinical profile including detailed neurological examination with relevant investigations was done. Spectrum of neuropsychiatric manifestations were observed.Results: Out of 110 patients male and female ratio was 1:1 (M 55 and F 55). The mean age of presentation in male was 36.09 + 14.85 yrs. and in female was 31.85 + 14.00 yrs. The major presenting symptoms were fever, headache, vomiting, altered sensorium, altered behaviour and convulsions in their decreasing order of frequency. On neurological evaluation, diminished level of consciousness was found in 56.4% cases. 14% cases had GCS score ? 7 and 63% had GCS score ? 11. Convulsion was found in 31% cases, cranial neuropathy in 10.9%, cerebellar dysfunction in 12.7%, neck rigidity in 22.7%, speech abnormality in 3.6%, peripheral neuropathy in 8.2%, fundoscopic changes suggestive of retinal involvement in 44.5% cases. Atypical manifestation like; Intracerebral haemorrhage, subarachnoid haemorrhage, cortical venous sinus thrombosis were also found in few cases. 32.72% patients had Neuropsychiatric manifestations at discharge in the form of focal neurological deficits, psychosis, depression, speech disorder, memory loss, cerebellar abnormality & peripheral neuropathy.Conclusions: Neurological manifestations in falciparum malaria patients are common and encompass a wide spectrum of clinical presentation. In an endemic area, falciparum malaria should be kept as a differential diagnosis in patients presenting with atypical neurological manifestations.

Epidemic situation and diagnosis and treatment of severe falciparum malaria in Nantong City / 中国血吸虫病防治杂志

Objective To retrospectively analyze the epidemic situation and diagnosis and treatment of severe falciparum malaria in Nantong City, summarize the causes of severe falciparum malaria, and evaluate the effect of diagnosis and treatment, so as to provide the evidence for formulating the practical treatment measures for this disease. Methods All the data of falciparum malaria cases in Nantong City from 2009 to 2016 were collected and analyzed for the onset time, diagnosis process and treatment of the disease. Results A total of 359 malaria cases, including 289 falciparum malaria cases, were reported in Nantong City from 2009 to 2016, including 26 severe falciparum malaria cases. All the severe falciparum malaria cases were imported from Africa, including 57.70% of cases (15/26) from Angola. All of them were male labor exporting personnel. The incidence of malaria was not obviously seasonal. The average time from onset to definite diagnosis was 5.2 days, and 11 cases were diagnosed 5 days after the onset. All the 26 cases were cured by anti-malaria treatment and symptomatic treatment, and there was no death. Conclusions Severe falciparum malaria seriously harm the people’s health and its clinical manifestations are complicated. Therefore, the training of medical staff and health education in residents, especially in labor exporting personnel, should be further strengthened.

Epidemic situation and diagnosis and treatment of severe falciparum malaria in Nantong City / 中国血吸虫病防治杂志

Objective To retrospectively analyze the epidemic situation and diagnosis and treatment of severe falciparum malaria in Nantong City, summarize the causes of severe falciparum malaria, and evaluate the effect of diagnosis and treatment, so as to provide the evidence for formulating the practical treatment measures for this disease. Methods All the data of falciparum malaria cases in Nantong City from 2009 to 2016 were collected and analyzed for the onset time, diagnosis process and treatment of the disease. Results A total of 359 malaria cases, including 289 falciparum malaria cases, were reported in Nantong City from 2009 to 2016, including 26 severe falciparum malaria cases. All the severe falciparum malaria cases were imported from Africa, including 57.70% of cases (15/26) from Angola. All of them were male labor exporting personnel. The incidence of malaria was not obviously seasonal. The average time from onset to definite diagnosis was 5.2 days, and 11 cases were diagnosed 5 days after the onset. All the 26 cases were cured by anti-malaria treatment and symptomatic treatment, and there was no death. Conclusions Severe falciparum malaria seriously harm the people’s health and its clinical manifestations are complicated. Therefore, the training of medical staff and health education in residents, especially in labor exporting personnel, should be further strengthened.

A Study on Predictive Value of Thrombocytopaenia in Cases of Malaria

Malaria is a major health problem in India. In cases of fever with thrombocytopenia, malaria should be on top of the differential diagnosis. This was a study of admitted patients in medical wards of Bhaskara Medical Colleges, Hyderabad who were diagnosed with malaria and they were assessed for thrombocytopenia using automated quantitative D3 analyser. The data were analysed using SPSS version 16.0. Viral haemorrhagic fevers can also be presented as fever with high haematocrit and leucopenia along with thrombocytopenia. In our study, the commonest cause of thrombocytopenia in malaria was vivax malaria.

Study of renal complications of malaria

Background: Plasmodium falciparum malaria is one of the major health problems in many tropical countries including India and due to increase in the drug resistance in India the incidence of complicated malaria has increased. Objectives: To study the renal complications of malaria. Materials and methods: 50 malaria positive cases with clinical renal disease were prospectively observed clinically and by laboratory investigations till the discharge. Results: Among the 50 malaria positive cases 41 (82 %) patients had p. falciparum infection, 4 (8%) had p. vivax and 5 (10%) had mixed infections. P. falciparum and mixed infection found to be responsible for ARF in 25 (89.28%), 3 (10.70%) respectively. Volume depletion was found to be the prominent cause (75%) of ARF, hyperbilirubinemia was noted in 64.28% of patients. Urinary abnormalities were noted in 24 (48%) cases, proteinuria in 20(40%), microscopic haematuria in 20 (40%), granular casts in 7 (14%). In the present study electrolyte abnormalities were noted in 46 (92%) of the patients. The overall mortality in the present study was 5 (10%). The cause of death was multi-factorial. MODS were the commonest cause of death. Conclusion: Renal complications were seen as the commonest complication of malaria. Early diagnosis, treatment specially the fluid management reduces the overall mortality

Epidemic characteristics of imported falciparum malaria in Huai'an City / 中国血吸虫病防治杂志

Objective To understand the situation and epidemic characteristics of imported falciparum malaria in Huai'an City from 2010 to 2016,so as to provide the evidence for formulating the prevention and control strategies of imported falci-parum malaria in the city. Methods The epidemic data of imported falciparum malaria in Huai'an City from 2010 to 2016 were analyzed by using the descriptive epidemiological method. Results A total of 308 malaria cases were reported in Huai'an City from 2010 to 2016 with the average annual incidence of 0.88/105. A total of 240 imported falciparum malaria cases were report-ed,of which 18 cases(7.50%)developed into severe illness,and 2 severe patients died. The cases were reported in every coun-ty(district),and the incidence rates of Qingpu District and Huai'an District were higher than the city average level. The cases occurred every month,so there was no significant seasonal variation in the reporting time of the cases. Most of the patients were young men and aged 30-49 years. The occupational distribution revealed that the patients were mainly farmers,workers and mi-grant workers. The main source of infection was from African countries. The median interval from symptom appearing to definite diagnosis was 1 day,and the longest interval was 236 days. Twenty-nine cases were diagnosed within 24 hours,accounting for 12.08%. Conclusions The epidemic situation of imported falciparum malaria in Huai'an City is grim. In order to consolidate the achievements of malaria eradication,it is necessary to further improve the multi-sectoral cooperation mechanism,strengthen the management of floating population and take effective measures to reduce the risk of imported falciparum malaria.

Investigation of a case of foreign imported falciparum malaria in Xilin County,Baise City / 中国血吸虫病防治杂志

Objective To investigate the epidemiology,diagnosis and treatment of an imported falciparum malaria patient in Xilin County,Baise City,so as to provide the reference for improving the diagnosis and treatment of falciparum malaria pa-tients in the future. Methods The epidemiological and clinical data were collected and analyzed. Results The patient had lived in Africa where the malaria was epidemic. The disease attacked him after his coming back home from abroad. The blood test for Plasmodium falciparum was positive. In Xilin County,no local Plasmodium infection was found from 2004 to 2016,and therefore,we concluded that this case was overseas imported. Conclusion The monitoring of overseas returnees in Xilin Coun-ty should be strengthened to timely diagnose and treat the imported cases of malaria.