Neurological complications in patients with Plasmodium vivax malaria from Karachi, Pakistan.

BACKGROUND: Malaria remains an endemic disease in Pakistan with an estimated healthcare burden of 1.6 million cases annually, with Plasmodium vivax accounting for 67% of reported cases. P. vivax is the most common species causing malaria outside of Africa, with approximately 13.8 million reported cases worldwide. METHOD: We report a series of P. vivax cases with cerebral involvement that presented at Aga Khan University Hospital, Karachi, Pakistan. RESULTS: The majority of the patients presented with high-grade fever accompanied by projectile vomiting and abnormal behaviour, seizures, shock and unconsciousness. Seven of 801 patients with P. vivax monoinfection presented or developed cerebral complications. P. vivax infections were diagnosed based on peripheral smears and rapid diagnostic testing. CONCLUSION: P. vivax infection can lead to severe complications, although not with the frequency of Plasmodium falciparum infection. Current cases highlight an increasing trend of cerebral complications caused by P. vivax.

Isolation frequency and susceptibility pattern of non-O1 and non-O139 Vibrio cholerae in a tertiary health care laboratory, 1999-2012.

In the past decade the importance of non-O1 and non-O139 strains of Vibrio cholerae has been highlighted globally. This study aimed to evaluate the frequency and antimicrobial susceptibility profile of non-O1 and non-O139 V. cholerae in Pakistan. Data of stool specimens yielding growth of non-O1 and non-O139 V. cholerae isolated at a national referral laboratory from 1999 to 2012 were retrospectively analysed and evaluated for resistance to ampicillin, tetracycline, chloramphenicol, co-trimoxazole and ofloxacin. A total of 95 800 stool samples submitted over 1999-2012 yielded 3668 strains of V. cholerae, of which 6% were non-O1 and non-O139 V. cholerae. A high isolation rate was found in the summer season, with a peak in the year 2003. Antimicrobial susceptibility data revealed increasing resistance to co-trimoxazole and ampicillin, but strains remained highly susceptible to ofloxacin. Active surveillance of serotypes and antimicrobial susceptibility is essential to predict future epidemics and define measures to curtail the disease.

Current situation and challenges in implementing Malaria control strategies in Pakistan.

Malaria transmission is unstable in Pakistan with the highest number of cases reported during the monsoon season. Despite its high incidence, malaria is still a poorly resourced, poorly funded and an uncontrolled disease especially in far-flung areas. Pakistan's National Malaria Control Program (NMCP), although operational since its inception in 1947, has suffered due to the unstable political, socioeconomic and financial situation prevalent in the country. In Pakistan, more than 300 000 cases of malaria are reported every year with 68% of the cases caused by Plasmodium vivax. It is estimated that about 70-80% of the population accesses the private sector for treatment. As the private sector does not routinely report data to the government, the actual malaria burden could be 4-5 times higher than reported. P. vivax now accounts for more than 85% of all cases requiring hospital admission compared to 54% in 2000. In this review, we have described the saga of poor control of malaria in Pakistan over several years in context of restructuring of the Malaria Control Program, challenges to improvement, and way forward.