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.

Targeted and whole-genome sequencing reveal a north-south divide in P. falciparum drug resistance markers and genetic structure in Mozambique

Mozambique is one of the four African countries which account for over half of all malaria deaths worldwide, yet little is known about the parasite genetic structure in that country. We performed P. falciparum amplicon and whole genome sequencing on 2251 malaria-infected blood samples collected in 2015 and 2018 in seven provinces of Mozambique to genotype antimalarial resistance markers and interrogate parasite population structure using genome-wide microhaplotyes. Here we show that the only resistance-associated markers observed at frequencies above 5% were pfmdr1-184F (59%), pfdhfr-51I/59 R/108 N (99%) and pfdhps-437G/540E (89%). The frequency of pfdhfr/pfdhps quintuple mutants associated with sulfadoxine-pyrimethamine resistance increased from 80% in 2015 to 89% in 2018 (p < 0.001), with a lower expected heterozygosity and higher relatedness of microhaplotypes surrounding pfdhps mutants than wild-type parasites suggestive of recent selection. pfdhfr/pfdhps quintuple mutants also increased from 72% in the north to 95% in the south (2018; p < 0.001). This resistance gradient was accompanied by a concentration of mutations at pfdhps-436 (17%) in the north, a south-to-north increase in the genetic complexity of P. falciparum infections (p = 0.001) and a microhaplotype signature of regional differentiation. The parasite population structure identified here offers insights to guide antimalarial interventions and epidemiological surveys.

Impact of COVID-19 pandemic on the management of imported malaria in China / 中国血吸虫病防治杂志

OBJECTIVE@#To examine the impact of COVID-19 pandemic on the epidemic status of imported malaria and national malaria control program in China, so as to provide insights into post-elimination malaria surveillance.@*METHODS@#All data pertaining to imported malaria cases were collected from Anhui Province, Hubei Province, Henan Province, Zhejiang Province and Guangxi Zhuang Autonomous Region during the period from January 1, 2018 through December 31, 2021. The number of malaria cases, species of malaria parasites, country where malaria parasite were infected, diagnosis and treatment after returning to China, and response were compared before (from January 1, 2018 to January 22, 2020) and after the COVID-19 pandemic (from January 23, 2020 to December 31, 2021).@*RESULTS@#A total of 2 054 imported malaria cases were reported in Anhui Province, Hubei Province, Henan Province, Zhejiang Province and Guangxi Zhuang Autonomous Region during the period from January 1, 2018 to December 31, 2021, and there were 1 722 cases and 332 cases reported before and after the COVID-19 pandemic, respectively. All cases were reported within one day after definitive diagnosis. The annual mean number of reported malaria cases reduced by 79.30% in Anhui Province, Hubei Province, Henan Province, Zhejiang Province and Guangxi Zhuang Autonomous Region after the COVID-19 pandemic (171 cases) than before the pandemic (826 cases), and the number of monthly reported malaria cases significantly reduced in Anhui Province, Hubei Province, Henan Province, Zhejiang Province and Guangxi Zhuang Autonomous Region since February 2020. There was a significant difference in the constituent ratio of species of malaria parasites among the imported malaria cases in Anhui Province, Hubei Province, Henan Province, Zhejiang Province and Guangxi Zhuang Autonomous Region before and after the COVID-19 pandemic (χ2 = 146.70, P < 0.05), and P. falciparum malaria was predominant before the COVID-19 pandemic (72.30%), while P. ovale malaria (44.28%) was predominant after the COVID-19 pandemic, followed by P. falciparum malaria (37.65%). There was a significant difference in the constituent ratio of country where malaria parasites were infected among imported malaria cases in Anhui Province, Hubei Province, Henan Province, Zhejiang Province and Guangxi Zhuang Autonomous Region before and after the COVID-19 pandemic (χ2 = 13.83, P < 0.05), and the proportion of malaria cases that acquired Plasmodium infections in western Africa reduced after the COVID-19 pandemic that before the pandemic (44.13% vs. 37.95%; χ2 = 4.34, P < 0.05), while the proportion of malaria cases that acquired Plasmodium infections in eastern Africa increased after the COVID-19 pandemic that before the pandemic (9.58% vs. 15.36%; χ2 = 9.88, P = 0.02). The proportion of completing case investigation within 3 days was significantly lower after the COVID-19 pandemic than before the pandemic (96.69% vs. 98.32%; χ2= 3.87, P < 0.05), while the proportion of finishing foci investigation and response within 7 days was significantly higher after the COVID-19 pandemic than before the pandemic (100.00% vs. 98.43%; χ2 = 3.95, P < 0.05).@*CONCLUSIONS@#The number of imported malaria cases remarkably reduced in Anhui Province, Hubei Province, Henan Province, Zhejiang Province and Guangxi Zhuang Autonomous Region of China during the COVID-19 pandemic, with a decreased proportion of completing case investigations within 3 days. The sensitivity of the malaria surveillance-response system requires to be improved to prevent the risk of secondary transmission of malaria due to the sharp increase in the number of imported malaria cases following the change of the COVID-19 containment policy.

Molecular Epidemiology of Plasmodium species in Conflicted Federally Administered Tribal Area (FATA) Pakistan / Epidemiologia molecular de espécies de plasmódio em área tribal sob administração federal em conflito do Paquistão

Military conflicts have been significant obstacles in detecting and treating infectious disease diseases due to the diminished public health infrastructure, resulting in malaria endemicity. A variety of violent and destructive incidents were experienced by FATA (Federally Administered Tribal Areas). It was a struggle to pursue an epidemiological analysis due to continuing conflict and Talibanization. Clinical isolates were collected from Bajaur, Mohmand, Khyber, Orakzai agencies from May 2017 to May 2018. For Giemsa staining, full blood EDTA blood samples have been collected from symptomatic participants. Malaria-positive microscopy isolates were spotted on filter papers for future Plasmodial molecular detection by nested polymerase chain reaction (nPCR) of small subunit ribosomal ribonucleic acid (ssrRNA) genes specific primers. Since reconfirming the nPCR, a malariometric study of 762 patients found 679 positive malaria cases. Plasmodium vivax was 523 (77%), Plasmodium falciparum 121 (18%), 35 (5%) were with mixed-species infection (P. vivax plus P. falciparum), and 83 were declared negative by PCR. Among the five agencies of FATA, Khyber agency has the highest malaria incidence (19%) with followed by P. vivax (19%) and P. falciparum (4.1%). In contrast, Kurram has about (14%), including (10.8%) P. vivax and (2.7%) P. falciparum cases, the lowest malaria epidemiology. Surprisingly, no significant differences in the distribution of mixed-species infection among all five agencies. P. falciparum and P. vivax were two prevalent FATA malaria species in Pakistan's war-torn area. To overcome this rising incidence of malaria, this study recommends that initiating malaria awareness campaigns in school should be supported by public health agencies and malaria related education locally, targeting children and parents alike.

Os conflitos militares têm sido obstáculos significativos na detecção e tratamento de doenças infecciosas devido à diminuição da infraestrutura de saúde pública, resultando na endemicidade da malária. Uma variedade de incidentes violentos e destrutivos foi vivida pelas FATA (áreas tribais administradas pelo governo federal). Foi uma luta busca ruma análise epidemiológica devido ao conflito contínuo e à talibanização. Isolados clínicos foram coletados de agências Bajaur, Mohmand, Khyber e Orakzai, de maio de 2017 a maio de 2018. Para a coloração de Giemsa, amostras de sangue completo com EDTA foram coletadas de participantes sintomáticos. Isolados de microscopia positivos para malária foram colocados em papéis de filtro para futura detecção molecular plasmódica por reação em cadeia da polimerase aninhada (nPCR) de primers específicos de genes de subunidade ribossômica de ácido ribonucleico (ssrRNA). Desde a reconfirmação do nPCR, um estudo malariométrico de 762 pacientes encontrou 679 casos positivos de malária. Plasmodium vivax foi 523 (77%), Plasmodium falciparum 121 (18%), 35 (5%) eram com infecção de espécies mistas (P. vivax mais P. falciparum) e 83 foram declarados negativos por PCR. Entre as cinco agências da FATA, a agência Khyber tem a maior incidência de malária (19%), seguida por P. vivax (19%) e P. falciparum (4,1%). Em contraste, Kurram tem cerca de 14%, incluindo 10,8% casos de P. vivax e 2,7% P. falciparum, a epidemiologia de malária mais baixa. Surpreendentemente, não há diferenças significativas na distribuição da infecção de espécies mistas entre todas as cinco agências. P. falciparum e P. vivax foram duas espécies prevalentes de malária FATA na área devastada pela guerra no Paquistão. Para superar essa incidência crescente de malária, este estudo recomenda que o início de campanhas de conscientização sobre a malária na escola deve ser apoiado por agências de saúde pública e educação relacionada com a malária localmente, visando crianças e pais.

Les perturbations des enzymes ASAT, ALAT et LDH au cours du paludisme de l'adulte au Nord-est de la RDC / NA

Introduction : la présente étude avait pour objectif de ressortir certaines anomalies des enzymes hépatiques portant sur l'ASAT, l'ALAT et la LDH chez les patients impaludés en vue de contribuer à la prise en charge diagnostique du paludisme dans la ville de Butembo. Méthodes. Cette étude est descriptive. Elle a été réalisée dans le service de Médecine Interne et de Parasitologie de l'Hôpital Matanda du 1er juillet 2020 au 2 novembre 2020 soit pendant une période de 4 mois. Elle a porté sur une série de 100 patients impaludés avec goutte épaisse positive. Les paramètres d'intérêt étaient les caractéristiques sociodémographiques, les anomalies des enzymes hépatiques (ASAT, ALAT, LDH) et la densité parasitaire. Résultats : 100 patients ont été sélectionnés au cours de notre étude parmi lesquels 54 sujets de sexe féminin et 46 de sexe masculin. Le taux de LDH était élevé dans 73% des cas. Les transaminases ASAT et ALAT étaient élevées dans 28% et 31% des cas respectivement. Aucune corrélation significative n'a été retrouvée entre la densité parasitaire et les anomalies enzymatiques observées dans notre étude. Conclusion. Des variations notables des paramètres biologiques portant sur les anomalies de enzymes hépatiques dont l'ASAT, l'ALAT et la LDH ont été enregistrés au cours de l'accès palustre à Plasmodium falciparum chez l'adulte de la ville de Butembo. Ces paramètres pourraient avoir une utilité dans le diagnostic du paludisme et /ou constituer un indicateur de la sévérité de la maladie, spécialement lorsque les résultats parasitologiques ne sont pas disponibles ou sont incertains.

Caregivers' perception and determinants of delayed presentation of children with severe malaria in an emergency room in Benin City, Nigeria

Introduction: Severe malaria is a leading cause of mortality due to late presentation to health facilities. Hence, there is a need to identify and mitigate factors promoting delayed presentation with severe malaria. Objective: This study aimed to evaluate determinants of delayed presentation of children with severe malaria in a tertiary referral hospital. Methods: This study adopted a descriptive, cross-sectional design. The participants were children with a diagnosis of severe malaria, based on WHO diagnostic criteria. Delayed presentation was defined as presentation at the referral centre at >3 days of illness. Inferential analyses were done to identify factors associated with delayed presentation. P < 0.05 was considered statistically significant. Results: A total of 126 children with severe malaria participated in the study; their mean (standard deviation) age was 4.2 (5.3) years. The prevalence of delayed presentation in this study is 37.3%. Socio-economic class (P = 0.003); marital status (P = 0.015) and the number of health facilities visited before admission in the referral centre (P = 0.008) were significantly associated with delayed presentation. Children from upper socio-economic class were thrice more likely to present late, compared to those from lower social class (odds ratio [OR] = 3.728, 95% confidence interval [CI]: 1.694­8.208; P = 0.001). Likewise, the Yorubas were more delayed than the Binis (OR = 0.408, 95% CI: 0.180­0.928; P = 0.033). There was a negative correlation between caregivers' perception of treatment (r = −0.113, P = 0.21) of convulsion in severe malaria and timing of presentation. Conclusions: Delayed presentation is common with multifactorial determinants in the setting. Health education of caregivers on the consequences of delayed presentation in severe malaria is desirable.

Factores de riesgo asociados a la transmisión de malaria en zona endemica de Córdoba, Colombia / Risk factors associated with the transmission of malaria in the endemic zone of Córdoba, Colombia

El objetivo del trabajo fue determinar factores de riesgo asociados a la transmisión de la malaria en el municipio de Puerto Libertador, Córdoba. Se realizó un estudio observacional analítico transversal, retrospectivo, con enfoque cuantitativo de casos de malaria de zonas rurales del municipio. La información se organizó en Excel, se describieron variables sociodemográficas, aspectos clínicos de los pacientes, de vivienda y ambientales y se realizó un análisis de riesgo para establecer asociación entre las variables y la malaria, además se clasificaron especies de anofelinos vectores y se utilizaron los softwares SatScan y QGis para identificar puntos calientes de malaria en la zona de estudio. Se incluyeron 170 casos de malaria, se identificó que 92% de los individuos carecen de servicio de recolección de basuras, 86,5% sin acueducto, más del 90% no utilizan angeos, repelentes, insecticidas o fumigaciones, se encontró asociación estadística significativa (OR>1) con las aguas estancadas, la falta de acueducto y agua continua como factores de riesgo de malaria; además se clasificaron cinco especies de mosquitos que estarían involucradas en la transmisión y se identificó un punto caliente compuesto por seis veredas del municipio. La malaria en el municipio de Puerto Libertador está asociada principalmente a problemáticas sociales, que se constituyen en factores de riesgo que favorecen la incidencia de esta enfermedad. En la zona de estudio la identificación de los mosquitos Anopheles y del punto caliente, permitirán orientar las medidas de control del vector y dirigir las intervenciones a las localidades focalizadas con mayor riesgo de malaria(AU)

The objective of the work was to determine risk factors associated with the transmission of malaria in the municipality of Puerto Libertador, Córdoba. A retrospective, cross-sectional analytical observational study was carried out, with a quantitative approach to malaria cases in rural areas of the municipality. The information was organized in Excel, sociodemographic variables, clinical aspects of the patients, housing and environmental variables were described, and a risk analysis was carried out to establish an association between the variables and malaria.In addition, vector anopheline species were classified and the SatScan and QGis software to identify malaria hot spots in the study area. 170 cases of malaria were included, it was identified that 92% of the individuals lack garbage collection service, 86.5% without aqueduct, more than 90% do not use angeos, repellents, insecticides or fumigations, a significant statistical association was found ( OR> 1) with stagnant water, lack of aqueduct and continuous water as risk factors for malaria; In addition, five species of mosquitoes that would be involved in the transmission were classified and a hotspot made up of six villages in the municipality was identified. Malaria in the municipality of Puerto Libertador is mainly associated with social problems, which constitute risk factors that favor the incidence of this disease. In the study area, the identification of Anopheles mosquitoes and the hotspot will make it possible to orient vector control measures and direct interventions to targeted localities with the highest risk of malaria(AU)

Hacia un mundo libre de malaria: Utopía o realidad / Towards a malaria-free world: Utopia or reality

La Malaria es una enfermedad causada por un parásito que se transmite a los humanos a través de la picadura de mosquito hembra Anophele. Reportando la WHO en el 2019, 229 millones de casos y 409.000 muertes por la enfermedad en 87 paises del mundo, Existen seis especies de este párasito: Plasmodium falciparum, Plasmodium vivax, Plasmodium ovale wallickeri, Plasmodium ovale curtisi, Plasmodium malariae y Plasmodium knowlesi. Siendo la especie P. falciparum la causante de mayor morbilidad, con tasa entre 10 y 50% de mortalidad por malaria complicada. Alrededor de 108 países han declarado la malaria como enfermedad endémica, pudiendo padecer la enfermedad en cualquier época del año. Sin embargo, en el caso de América Latina hoy en día se vive un estancamiento de la enfermedad, reportándose en países menos de 100 casos autóctonos entre el 2000 y 2019, con algunas excepciones. Esta situación de vulnerabilidad de países como Brasil, Colombia, la frontera Perú-Ecuador, Venezuela, se incrementan ante la presencia activa de la pandemia producto del Covid -19 aunado a restricciones económicas, incremento de la actividad minera, o políticas públicas que ponen en riesgo la sostenibilidad del programa de control de la enfermedad. Para el 2021 la OMS corrobora que existen 87 países con malaria a nivel mundial, de los cuales 24 de ellos habían interrumpido su transmisión autóctona por 3 años. Realidad que consolidad la propuesta tras la experiencia adquirida, que cualquiera que sea la situación epidemiológica de entrada, el trabajo hacia la erradicación de la malaria debe entenderse y atenderse como un proceso continuo donde los propios Estados deben desde su realidad y estrategias propias se articulen con el Plan Estratégico Técnico Mundial Contra la Malaria 2016-2030 propuesto por la OMS(AU)

Malaria is a disease caused by a parasite that is transmitted to humans through the bite of the female Anophele mosquito. Reporting the WHO in 2019, 229 million cases and 409,000 deaths from the disease in 87 countries of the world, There are six species of this parasite: Plasmodium falciparum, Plasmodium vivax, Plasmodium ovale wallickeri, Plasmodium ovale curtisi, Plasmodium malariae and Plasmodium knowlesi. The species P. falciparum is the cause of greatest morbidity, with a rate between 10 and 50% of mortality from complicated malaria. About 108 countries have declared malaria as an endemic disease, and the disease can occur at any time of the year. However, in the case of Latin America today there is a stagnation of the disease, with fewer than 100 indigenous cases reported in countries between 2000 and 2019, with some exceptions. This situation of vulnerability of countries such as Brazil, Colombia, the Peru-Ecuador border, Venezuela, increases in the face of the active presence of the pandemic product of the Covid -19 coupled with economic restrictions, increased mining activity, or public policies that put at risk the sustainability of the disease control programme. By 2021, WHO confirms that there are 87 countries with malaria worldwide, of which 24 had interrupted their indigenous transmission for 3 years. Reality that consolidates the proposal after the experience acquired, that whatever the epidemiological situation of entry, The work towards the eradication of malaria must be understood and addressed as a continuous process where the States themselves must from their own reality and strategies articulate with the Global Technical Strategic Plan Against Malaria 2016-2030 proposed by the WHO(AU)

Detection of antimalarial drug resistance polymorphisms in Plasmodium falciparum chloroquine resistance transporter and Plasmodium falciparum multidrug resistance 1 genes of Plasmodium falciparum found in Kano State, Nigeria

Objectives: In 2018, malaria claimed an estimated 380,000 lives in African region, with Nigeria accounting for 24.0% (91,368) of malaria deaths from the region. Mutations in Plasmodium falciparum chloroquine resistance transporter (Pfcrt) and P. falciparum multidrug resistance 1 (Pfmdr-1) genes had reduced the effective use of artemisinin combination therapy through the development of resistance to these antimalarial agents. Our study set out to determine the antimalarial drug resistance polymorphisms in Pfcrt and Pfmdr-1 genes of P. falciparum isolates among patients in Kano State, Nigeria. Material and Methods: Malaria positive samples were collected across the three senatorial districts of Kano State. The samples were amplified using nested polymerase chain reaction to detect the Pfcrt and Pfmdr-1 genes. The amplicons were sequenced and bioinformatic analysis was done using CLC Sequence viewer 8.0 and BioEdit sequence alignment editor to detect the single-nucleotide polymorphisms. Results: In the Pfcrt gene, CVIET haplotype was seen in 26.2% of the samples while only two samples showed the 86Y mutation in the Pfmdr-1 gene. All the 86Y mutations and majority of the CVIET haplotypes were detected in the patients from rural settings where some of them noted that they consumed modern and traditional (herbs) antimalarial agents. One sample was observed to have the CVIET haplotype and N86Y mutation while the other five CVIET haplotypes were seen in five separate samples. A new mutation V62A was found in the Pfmdr-1 gene as observed in one of the sample. Conclusion: It is imperative to ensure the rational use of the right antimalarial agents and employ continuous resistance surveillance/mapping to ensure synergy in malaria containment and elimination strategies.

Electrocardiographic effect of artemisinin-piperaquine, dihydroartemisinin-piperaquine, and artemether-lumefantrine treatment in falciparum malaria patients

Abstract INTRODUCTION: Artemisinin-based combination therapy (ACT), such as artemisinin-piperaquine (AP), dihydroartemisinin-piperaquine (DP), and artemether-lumefantrine (AL), is the first-line treatment for malaria in many malaria-endemic areas. However, we lack a detailed evaluation of the cardiotoxicity of these ACTs. This study aimed to analyze the electrocardiographic effects of these three ACTs in malaria patients. METHODS: We analyzed the clinical data of 89 hospitalized patients with falciparum malaria who had received oral doses of three different ACTs. According to the ACTs administered, these patients were divided into three treatment groups: 27 treated with AP (Artequick), 31 with DP (Artekin), and 31 with AL (Coartem). Electrocardiograms and other indicators were recorded before and after the treatment. The QT interval was calculated using Fridericia's formula (QTcF) and Bazett's formula (QTcB). RESULTS: Both QTcF and QTcB interval prolongation occurred in all three groups. The incidence of such prolongation between the three groups was not significantly different. The incidence of both moderate and severe prolongation was not significantly different between the three groups. The ΔQTcF and ΔQTcB of the three groups were not significantly different. The intra-group comparison showed significant prolongation of QTcF after AL treatment. CONCLUSIONS: Clinically recommended doses of DP, AL, and AP may cause QT prolongation in some malaria patients but do not cause torsades de pointes ventricular tachycardia or other arrhythmias.

Malaria congénita por Plasmodium falciparum / Congenital malaria by Plasmodium falciparum

INTRODUCCIÓN: La malaria congénita (MC) es la infección por Plasmodium spp adquirida in útero o durante el parto y sus manifestaciones clínicas son inespecíficas. Puede causar enfermedad grave en la embaraza da y en el recién nacido. OBJETIVO: describir dos casos de MC causados por Plasmodium falciparum, diagnóstico diferencial de sepsis en recién nacidos de gestantes que hayan visitado o residan en áreas endémicas para malaria. CASOS CLÍNICOS: Neonatos de sexo femenino, nacidos en área no endémica para malaria, diagnosticados con sepsis neonatal y tratados con antibióticos sin respuesta clínica. Después de la primera semana de vida la gota gruesa identificó trofozoítos de Plasmodium falciparum y los neonatos recibieron tratamiento con quinina intravenosa con mejoría. Las madres de las recién nacidas tuvieron malaria en el embarazo, una de ellas recibió tratamiento y estaba asintomática y otra tenía malaria complicada al momento del parto. CONCLUSIONES: La MC puede causar enfermedad neonatal grave con manifestaciones clínicas inespecíficas y similares a la sepsis, el tratamiento oportuno disminuye el riesgo de malaria complicada. Es un diagnóstico diferencial en recién nacidos de mujeres con malaria durante el embarazo o gestantes que visiten o residan en áreas endémicas.

INTRODUCTION: Congenital malaria (CM) is a Plasmodium spp infection acquired in utero or during delivery with nonspecific clinical manifestations. Plasmodium falciparum can cause severe illness in pregnant wo men and newborns. OBJECTIVE: to describe two cases of CM caused by Plasmodium falciparum, di fferential diagnosis of sepsis in newborns of pregnant women who live in or have visited endemic malaria zones. CLINICAL CASES: Female neonates born in a non-endemic malaria area, diagnosed with neonatal sepsis and treated with antibiotics without clinical response. After the first week of life, the peripheral blood smear identified trophozoites of Plasmodium falciparum thus the newborns were treated with intravenous quinine, improving their condition. The mothers of the two newborns who had malaria in pregnancy, one of them received treatment and she was asymptomatic, and the other one had severe malaria at the time of delivery. CONCLUSIONS: CM can cause severe neonatal disease with non-specific, sepsis-like clinical manifestations in which early treatment decreases the risk of complicated malaria. It is a differential diagnosis in newborns of women with a history of malaria during pregnancy or pregnant women visiting or living in endemic malaria areas.

Caracterización clínica del paludismo importado / Clinical characterization of imported malaria

Introducción: El paludismo es una enfermedad febril aguda potencialmente mortal causada por parásitos que se transmiten al ser humano por la picadura de mosquitos del género Anopheles. Cuba logró eliminar la transmisión de esta enfermedad gracias a grandes esfuerzos encaminados a conseguirlo, por lo que es necesario adoptar una serie de medidas para evitar su reaparición, mediante la vigilancia y el Programa de Control Sanitario Internacional. Objetivo: Caracterizar clínicamente un grupo de pacientes con paludismo importado. Métodos: Se realizó un estudio descriptivo de corte transversal de 46 pacientes adultos con paludismo importado, ingresados en el Instituto de Medicina Tropical Pedro Kourí desde enero 2015 a diciembre 2016. Los datos fueron tomados de las historias clínicas. El análisis de las variables cualitativas fue expresado en tablas de frecuencias absolutas y relativas. Resultados: Predominaron los pacientes del sexo masculino, con una edad media de 37,4 años. Entre los pacientes, 38 (82,6 por ciento) arribaron del continente africano, la mayoría de ellos de Angola (26,1 por ciento del total de casos). Fue significativa la relación existente entre el supuesto estado no inmune de los pacientes con la severidad del cuadro clínico y presencia de comorbilidades; así como la severidad del cuadro clínico con mayor parasitemia y la especie Plasmodium falciparum. La respuesta al tratamiento resultó excelente con los esquemas combinados utilizados a base de quinina y cloroquina según la especie. Conclusiones: La demora desde el arribo al ingreso hospitalario de los pacientes constituye un riesgo extraordinario para la reintroducción del paludismo en Cuba y para la vida de estos(AU)

Introduction: Malaria is an acute potentially fatal febrile disease caused by parasites transmitted to humans through the bite of mosquitoes from the genus Anopheles. Cuba succeeded in eliminating transmission of this disease thanks to great efforts geared to such an end. It is therefore necessary to take a number of measures aimed at preventing its re-emergence via surveillance and the International Health Control Program. Objective: Clinically characterize a group of patients with imported malaria. Methods: A descriptive cross-sectional study was conducted of 46 adult patients with imported malaria admitted to Pedro Kourí Tropical Medicine Institute from January 2015 to December 2016. The data were collected from the patients' medical records. Results of the analysis of qualitative variables were transferred onto absolute and relative frequency tables. Results: Male patients prevailed, with a mean age of 37.4 years. Of the patients studied, 38 (82.6 percent) were from the African continent, most of them from Angola (26.1 percent of the total cases). A significant relationship was found between the supposed non-immune status of patients and the severity of the clinical status and the presence of comorbidities, as well as between the severity of the clinical status and greater parasitemia and the presence of the species Plasmodium falciparum. An excellent response was obtained to treatment with combined schemes based on quinine and chloroquine, depending on the species. Conclusions: Delay between arrival and hospital admittance of patients is an extraordinary risk for the reintroduction of malaria in Cuba and to the patients' lives(AU)

Malaria placentaria submicroscópica: histopatología y expresión de mediadores de procesos fisiológicos / Submicroscopic placental malaria: histopathology and expression of physiological process mediators

RESUMEN Objetivos: Relacionar entre sí los eventos histopatológicos de malaria placentaria (MP), el comportamiento de células inmunitarias y la expresión de genes asociados a citoquinas, hipoxia, inflamación y angiogénesis en placentas con o sin infección plasmodial. Materiales y métodos: Diseño transversal, con tres grupos independientes. Las mujeres y sus placentas fueron captadas en 2009-2016, en los hospitales de Puerto Libertador y Tierralta, noroccidente de Colombia. El tamaño muestral se definió por conveniencia. El diagnóstico malárico se basó en PCR cuantitativa en tiempo real. Resultados: Se estudiaron 20 casos con MP por P. vivax (MP-V), 20 casos de MP por P. falciparum (MP-F) y 19 sin MP; 95% de los casos de MP son infección plasmodial placentaria submicroscópica (IPPS). Los tres grupos difieren en frecuencia y cantidad de eventos histopatológicos. Los mediadores de procesos fisiológicos presentaron diferencia significativa entre grupos, excepto IL-2, VEGF, VEGFR-1 y C5a. Conclusiones: Las placentas con infección difieren claramente de las no infectadas. P. vivax se comporta tan patógeno como P. falciparum. Se resalta la aproximación al abordaje integral del problema de MP. La infección plasmodial placentaria submicroscópica causa alteraciones tisulares y en mediadores fisiológicos como lo hace la infección microscópica, aunque probablemente en menor grado.

ABSTRACT Objetives: To relate histopathological events of placental malaria (PM), immune cell behavior and gene expression associated with cytokines, hypoxia, inflammation and angiogenesis in placentas with or without plasmodial infection. Materials and methods: Transversal design, with three independent groups. Women were recruited, and their placentas were collected in 2009-2016, in the hospitals of Puerto Libertador and Tierralta, northwestern Colombia. The sample size was defined by convenience. The malaria diagnosis was based on real-time quantitative PCR. Results: We studied 20 cases of PM by P. vivax (PM-V), 20 cases of PM by P. falciparum (PM-F) and 19 without PM; 95% of the cases of PM are submicroscopic placental plasmodial infection (SPPI). The three groups differ in frequency and number of histopathological events. Physiological process mediators showed significant difference between groups, except IL-2, VEGF, VEGFR-1 and C5a. Conclusions: Infected placentas are clearly different from uninfected ones. P. vivax behaves as pathogenic as P. falciparum. The approximation to the integral approach of the problem of PM is underlined. Submicroscopic placental plasmodial infection causes tissue and physiological mediator alterations as does microscopic infection, although probably to a lesser degree.

Malaria en pacientes con infección por VIH: serie de casos en un hospital peruano / Malaria in HIV-Infected patients: a series of cases in a peruvian hospital

RESUMEN Las manifestaciones clínicas de la malaria en pacientes con VIH pueden ser variables dependiendo del estado inmunológico del paciente. La evidencia en relación a la coinfección es escasa a nivel nacional. Se describen cuatro casos procedentes de un hospital de Iquitos-Perú con diagnóstico de infección por VIH y examen de sangre positivo para malaria. De estos pacientes, dos tenían infección por Plasmodium falciparum y dos por Plasmodium vivax. Un paciente se encontraba en estadio sida con mala adherencia a la terapia antirretroviral combinada (TARVc) y el resto se encontraba en estadios tempranos sin recibir TARVc.

ABSTRACT The clinical signs of malaria in HIV patients may vary depending on the immunological status of the patient. Nationally, evidence regarding co-infection is scarce. This research describes four cases from a hospital in Iquitos, Peru, of patients diagnosed with HIV infection and a positive blood test for malaria. Two of these patients had Plasmodium falciparum infection, and two had Plasmodium vivax infection. One of the patients was in the AIDS stage with poor adherence to combination antiretroviral therapy (cART), and the other three were in the early stages and not receiving cART.

Evaluación de la calidad del diagnóstico de malaria en la red local de laboratorios y en los laboratorios intermedios en el contexto de la eliminación de la enfermedad en Ecuador / Quality evaluation of malaria diagnosis in the local laboratories network and in intermediate laboratories in a setting towards the disease elimination in Ecuador

Resumen Introducción. El cumplimiento de la meta de eliminación de la malaria en Ecuador en el 2020 exige contar con la capacidad requerida para el diagnóstico microscópico ajustado a los estándares de calidad de la Organización Mundial de la Salud (OMS) y de la Organización Panamericana de la Salud (OPS) y proveer el tratamiento adecuado a los pacientes. Objetivo. Conocer la idoneidad o competencia de los microscopistas de la red pública local para el diagnóstico parasitológico de la malaria y el desempeño de los laboratorios intermedios de referencia. Materiales y métodos. Se hizo un estudio descriptivo de corte transversal a partir de la información obtenida en los talleres de evaluación de idoneidad en el diagnóstico microscópico de la red de laboratorios en las coordinaciones zonales de salud utilizando un panel de láminas para evaluar la concordancia del diagnóstico. Además, se calificó el desempeño de los laboratorios intermedios en el diagnóstico en el marco del programa de evaluación externa del desempeño. Los resultados se compararon con los obtenidos por el laboratorio supranacional de Perú. Resultados. En los 11 talleres realizados, se evaluó la idoneidad de 191 microscopistas, de los cuales 153 (80,1 %) aprobaron las pruebas. Las medianas de los indicadores fueron las siguientes: concordancia entre la detección y el resultado, 100 % (Q1- Q3: 96-100); concordancia en la especie, 100 % (Q1- Q3: 93-100); concordancia en el estadio, 93,0 % (Q1- Q3: 86-95) y concordancia en el recuento, 77 % (Q1- Q3: 71-82). En el programa de evaluación externa de desempeño, los tres laboratorios intermedios obtuvieron una concordancia del 100 % en el resultado y una del 96 % en la especie. Conclusiones. Los indicadores de competencia de la red local y de desempeño de los laboratorios intermedios alcanzaron altos estándares de calidad acordes con el proceso de entrenamiento implementado en el país.

Abstract Introduction: To reach the goal of malaria elimination in Ecuador for the year 2020, it is necessary to have a laboratory network with the capacity to perform microscopic diagnosis according to the WHO/PAHO quality standards and to provide the adequate treatment of cases. Objective: To determine the level of competence for parasitological diagnosis of the microscopists from the local public network and the performance of intermediate reference laboratories. Materials and methods: We conducted a cross-sectional study based on the information collected in workshops carried out to appraise the competence for microscopic diagnosis of the local laboratory network (zonal health coordinating offices 1 to 8) using a slide panel to evaluate diagnosis agreement, as well as the diagnostic performance of the intermediate laboratories using an external quality assessment program. The results were compared against the reference standards of the supranational laboratory in Perú. Results: We evaluated the competencies of 191 microscopists in 11 workshops and 153 (80.1%) of them were approved. The medians of the indicators were the following: concordance for parasite detection, 100% (Q1- Q3: 96-100), concordance for species identification, 100% (Q1- Q3: 93-100), and concordances for stage identification, 93.0% (Q1- Q3: 86-95) and parasite counting, 77.0% (Q1- Q3: 71-82). In the external quality assessment, the three intermediate laboratories obtained 100% in parasite detection concordance and 96% for species detection concordance. Conclusions: The results for the primary network and the performance indicators for the intermediate laboratories showed the high-quality standards of the training program implemented in the country.

Malaria grave en mujeres gestantes hospitalizadas entre el 2010 y el 2014 en el departamento de Antioquia, Colombia / Severe malaria in pregnant women hospitalized between 2010 and 2014 in the Department of Antioquia (Colombia)

Resumen Introducción. La malaria (o paludismo) durante la gestación impacta negativamente la salud de la madre y del neonato, con alto riesgo de complicaciones clínicas y mortalidad. En las regiones de alta endemia se han caracterizado, especialmente, la anemia materna y el bajo peso al nacer, pero es poco conocido el espectro clínico en las zonas de baja endemia. Objetivo. Caracterizar clínica y epidemiológicamente los episodios de malaria en mujeres gestantes hospitalizadas en el departamento de Antioquia entre el 2010 y el 2014. Materiales y métodos. Se hizo un estudio descriptivo, transversal y retrospectivo, con historias clínicas de mujeres gestantes con malaria por Plasmodium falciparum y P. vivax. Se utilizaron los criterios diagnósticos de malaria complicada de la Organización Mundial de la Salud (OMS) y de la Guía para la atención clínica integral del paciente con malaria vigente en Colombia. Resultados. Se analizaron 111 casos; el 13,5 % se clasificó como complicación grave según los criterios de la OMS, porcentaje que ascendió a 23,4 % según los criterios de la guía colombiana. Las complicaciones detectadas fueron disfunción hepática, anemia, acidosis y trombocitopenia grave. No se observó diferencia en la frecuencia de las complicaciones según la especie de plasmodio. El 39,4 % de los casos presentó signos generales de peligro; la palidez y la ictericia fueron los más frecuentes. El 40,5 % presentó signos de peligro para la gestación como la cefalea persistente, el dolor abdominal y el sangrado vaginal. Conclusiones. La malaria grave se presenta con gran frecuencia en las mujeres gestantes, sin diferencia según la especie de plasmodio, y se manifiesta con signos de peligro precozmente reconocibles. Se encontró un subregistro hospitalario del 88 % de los casos graves y falta de exámenes de laboratorio para un diagnóstico más completo. Se requiere un protocolo para el diagnóstico clínico de las mujeres gestantes con malaria.

Abstract Introduction: Malaria during pregnancy has a negative impact on maternal-neonatal health, with a high risk of clinic complications and mortality. High endemic areas are specially characterized by maternal anaemia and low birth weight. The clinical spectrum is little known in low endemic areas. Objective: To clinically and epidemiologically characterize malaria episodes in hospitalized pregnant women in the Department of Antioquia (Colombia) in the period 2010-2014. Materials and methods: Retrospective, cross-sectional, descriptive study with medical records of pregnant women with P. falciparum and P. vivax malaria. The WHO severe malaria diagnostic criteria and the Colombian Guía para la atención clínica integral del paciente con malaria (guidelines for comprehensive malaria treatment) were used. Results: We analyzed 111 cases, out of which 13.5% were classified as severe malaria according to the WHO criteria. Following the Colombian Guidelines, the proportion increased to 23.4%. Identified complications included hepatic dysfunction, anaemia, acidosis, and severe thrombocytopenia. No difference in the frequency of complications by Plasmodium species was observed; 39.4% of the cases presented general danger signs, pallor and jaundice being the most frequent; 40.5% showed danger signs for pregnancy, such as persistent headache, abdominal pain, and vaginal bleeding. Conclusions: Severe malaria is a highly frequent event in pregnant women, without differences by Plasmodium species. It shows early recognizable dangers signs. Hospital under-reporting was identified in 88% of severe cases as well as a lack of laboratory tests for a more comprehensive diagnosis. A protocol for the clinical diagnosis of pregnant women with malaria is required.

Ruptura esplénica espontánea como complicación en la malaria aguda grave por plasmodium falciparum / Spontaneous splenic rupture as a complication in plasmodium falciparum acute severe malaria

Se presenta el caso clínico de un paciente con rotura espontánea del bazo, como complicación grave y poco frecuente de la malaria aguda. Esta complicación puede acontecer desde la primera semana de enfermedad y su diagnóstico tardío es potencialmente fatal. Debe sospecharse en todo paciente con malaria grave, que evolutivamente presente un abdomen agudo y signos de shock hipovolémico. El manejo médico o quirúrgico dependerá de la magnitud de la ruptura y del estado hemodinámico del paciente. Se presenta el caso por la gravedad y escasa frecuencia de esta complicación(AU)

We present a clinical case of a patient with spontaneous rupture of the spleen, as a serious and uncommon complication of acute malaria. This complication can occur from the first week of illness and its late diagnosis is potentially fatal. It should be suspected in all patients with severe malaria, who evolutionarily present an acute abdomen and signs of hypovolemic shock. Medical or surgical management will depend on the extent of the rupture and hemodynamic status of the patient. The case is presented due to the severity and low frequency of this complication(AU)

Plasmodium falciparum malarial parasites from Brazil lack artemisinin resistance-associated mutations in the kelch13 gene

Abstract INTRODUCTION Mutations in the propeller domain of the Plasmodium falciparum kelch13 (k13) gene are associated with artemisinin resistance. METHODS: We developed a PCR protocol to sequence the pfk13 gene and determined its sequence in a batch of 50 samples collected from 2003 to 2016 in Brazil. RESULTS: We identified 1 K189T substitution located outside the propeller domain of the PfK13 protein in 36% of samples. CONCLUSIONS: Although the sample size is relatively small, these results suggest that P. falciparum artemisinin-resistant mutants do not exist in Brazil, thereby supporting the continuation of current treatment programs based on artemisinin-based combination therapy.

Performance of an immuno-rapid malaria Pf/Pv rapid diagnostic test for malaria diagnosis in the Western Brazilian Amazon

Abstract INTRODUCTION: Rapid diagnostic tests (RDTs) for detecting Plasmodium antigens have become increasingly common worldwide. We aimed to evaluate the accuracy of the Immuno-Rapid Malaria Pf/Pv RDT in detecting Plasmodium vivax infection compared to standard thick blood smear (TBS) under microscopy. METHODS: Hundred and eighty-one febrile patients from the hospital's regular admissions were assessed using TBS and RDT in a blinded experiment. RESULTS: RDT showed a sensitivity of 98.9%, specificity of 100%, and accuracy of 99.5% for P. vivax infection when compared to TBS. CONCLUSIONS: The RDT is highly accurate, making it a valuable diagnostic tool for P. vivax infection.