Seroprevalence of viral and bacterial pathogens among malaria patients in an endemic area of southern Venezuela.

BACKGROUND: Malaria remains a leading public health problem worldwide. Co-infections with other pathogens complicate its diagnosis and may modify the disease's clinical course and management. Similarities in malaria clinical presentation with other infections and overlapping endemicity result in underdiagnosis of co-infections and increased mortality. Thus, the aim of this study was to determine the seroprevalence of viral and bacterial pathogens among diagnosed malaria patients in malaria-endemic areas in Venezuela. METHODS: A cross-sectional study was conducted on malaria patients attending three reference medical centres in Ciudad Bolivar, Venezuela. Clinical evaluation and laboratory tests for dengue virus (DENV), chikungunya virus (CHIKV), viral hepatitis [hepatitis A virus (HAV), hepatitis B virus (HBV), and hepatitis C virus (HCV)], and leptospirosis (LEP) were performed by enzyme-linked immunosorbent assays. Previous exposure to these pathogens was defined by the presence of specific immunoglobulin (Ig) G, and co-infection or recent exposure (CoRE) was determined by the presence of specific IgM alone or IgM + IgG. Data analysis considered descriptive statistics. Parameter distribution was statistically evaluated using Kolmogorov-Smirnov test and the necessary comparison tests. Odds ratio (OR) for complications was determined according to CoRE presence with a 95% confidence interval (CI). RESULTS: A total of 161 malaria patients were studied, 66% infected with Plasmodium vivax, 27% with P. falciparum, and 7.5% harboured P. vivax/P. falciparum mixed infection. Previous exposure to DENV (60%) and CHIKV (25%) was frequent. CoRE was confirmed in 55 of the 161 malaria patients (34%) and were more frequent in P. falciparum (49%) than in P. vivax (29%) and mixed malaria patients (25%) (OR = 2.43, 95% CI: 1.39-4.25, P = 0.018). The most frequent CoRE was DENV (15%), followed by HAV (12%), HBV (6.2%), CHIKV (5.5%), and LEP (3.7%); HCV CoRE was absent. Complicated malaria was significantly more frequent in patients with CoRE (56%) than those without CoRE (36%; OR = 2.31, 95% CI: 1.18-4.92, P = 0.013). CONCLUSIONS: We found high CoRE prevalence in malaria patients as determined by serology in the study region; cases were associated with a worse clinical outcome. Further prospective studies with samples from different infection sites and the use of molecular tools are needed to determine the clinical significance of these findings.

The clinical-epidemiological profile of malaria patients from Southern Venezuela, a critical hotspot in Latin America.

BACKGROUND: Venezuela accounted for 55% of the cases and 73% of the malaria deaths in the Americas in 2019. Bolivar state, in the southeast, contributes > 60% of the country's Plasmodium vivax and Plasmodium falciparum cases every year. This study describes the clinical-epidemiological characteristics of clinical malaria patients in this high-transmission area. METHODS: A prospective study was conducted on patients seeking medical attention in three medical centres in the state capital, Ciudad Bolivar, between June and October 2018. Malaria diagnosis was carried out using microscopy following national standards. Malaria-positive patients were examined for clinical symptoms, and haematological tests were performed at the time of diagnosis. Patients were followed up by telephone to evaluate malaria recurrences. RESULTS: Out of 287 patients, 200 (69.7%) were positive for P. vivax, 69 (24%) for P. falciparum, and 18 (6.3%) had mixed (P. vivax/P. falciparum) infections. Patients' median age was 33 years (IQR 20), 168 (69%) were men, and 40% practiced gold mining as the main occupation. Fever (96.5%), chills (91.3%), and headaches (90.6%) were the most frequent symptoms. At least one symptom associated with severe malaria was observed in 69 out of 161 patients with complete clinical evaluation (42.9%). Plasmodium vivax infections were found in 42 out of 69 (60.9%) severe cases; by contrast, P. falciparum and mixed malaria caused 34.8% (24/69) and 4.4% (3/69) of infections, respectively. Two patients died of cerebral malaria. Mean hemoglobin was lower in the patients infected with P. falciparum than those infected with P. vivax. Regardless of the parasite causing the infection, patients presented high levels of total bilirubin, aminotransferases (AST, ALT), and lactate dehydrogenase (LDH). Out of the 142 patients followed up by phone for three months (49.5% of the 287 patients), 35 (24.7%) reported recurrences. CONCLUSIONS: The high malaria prevalence among young male adults practicing gold mining suggests that this occupation is a significant risk factor. The unexpected high prevalence of P. vivax patients with at least one criteria of severe clinical disease is a matter of concern. Whether it is the result of a lack of timely diagnosis and effective treatment should be explored.

Knowledge, Attitudes, and Practices Regarding COVID-19 Among Healthcare Workers in Venezuela: An Online Cross-Sectional Survey.

Background: The deterioration of Venezuela's health system in recent years undoubtedly contributes to an increased impact of the COVID-19 pandemic. Understanding healthcare workers' (HCWs) knowledge, attitudes, and practices (KAPs) toward COVID-19 in the early stages of the pandemic could inform their medical training and improve their preparedness. Methods: A online national cross-sectional survey was conducted between May 26th and May 30th, 2020, to assess KAPs among HCWs in Venezuela. Results: A total of 1,441 HCWs from all 24 regions of the country responded to the survey. The mean age of the HCWs was 44 (SD [standard deviation] 14) years; most were women (66.4%). Most HCWs were specialized doctors (48%), followed by nurses (13%) and resident doctors (12.3%). The majority of HCWs had good knowledge (76.3%), obtained information mainly from scientific literature (85.4%); had negative attitudes (53.6%), felt uncomfortable with their work during the current pandemic (59.8%); and reported appropriate practices (76.9%). However, participation in COVID-19 related training was absent in more than half of the HCWs. Positive attitudes were significantly more frequent in frontline workers than in non-frontline workers (p = 0.001). Bioanalysts, students, and doctors were more likely to have good knowledge; participating in training was a predictor for positive attitudes and older age was an appropriate practice predictor. Conclusions: HCWs, knowledge in Venezuela could be improved by strengthening education and training programs. Strategies should focus on reducing fear and improving attitudes toward the care of COVID-19 patients, as well as the promotion of preventive practices.

Malaria in pregnancy complications in Southern Venezuela.

BACKGROUND: Pregnant women are particularly vulnerable to malaria infections, increasing the risk of maternal-fetal complications, mainly in high-endemicity areas. However, few studies of malaria in pregnancy (MiP) have been carried out in Latin America, a region with low endemicity and transmission of both, Plasmodium falciparum and Plasmodium vivax. Despite the high malaria burden in Venezuela in the last years, no recent studies of MiP have been conducted. Hence, epidemiological and clinical characteristics of pregnant women with malaria in southern Venezuela are described herein. METHODS: A retrospective study in pregnant women attending at the "Ruíz y Páez" University Hospital Complex, Bolivar state, Venezuela, was carried out between February and October, 2019. Epidemiological, clinical, and laboratory information was analysed. RESULTS: Thirty-seven out of 52 pregnant women analysed were infected with P. vivax. Age ranged between 15 and 39 years, and adolescent pregnancies were common. Malaria infection was diagnosed mainly during the third trimester of pregnancy (63.4%). The distribution of symptoms and signs as well as clinical laboratory values was similar among Plasmodium spp. Although uncomplicated malaria was most frequent, 30% (13/52) had severe anaemia. A high proportion of studied women (44%) presented at least one complication during the pregnancy or delivery. Spontaneous abortion was recorded in four women, and three fetal deaths were observed. Six women had preterm delivery without any further complication. CONCLUSIONS: A high prevalence of maternal-fetal complications was found in the studied population, highlighting the requirement for a careful medical follow up during the prenatal check-ups, which should include routinary malaria tests. Preventive measures as distribution of insecticide-treated mosquito net for pregnant women at risk should also be implemented. Those measures can help to reduce the negative impact of malaria on the newborn and mother.

Malaria in Venezuela: changes in the complexity of infection reflects the increment in transmission intensity.

BACKGROUND: Malaria incidence has reached staggering numbers in Venezuela. Commonly, Bolívar State accounted for approximately 70% of the country cases every year. Most cases cluster in the Sifontes municipality, a region characterized by an extractive economy, including gold mining. An increase in migration to Sifontes, driven by gold mining, fueled a malaria spillover to the rest of the country and the region. Here samples collected in 2018 were compared with a previous study of 2003/2004 to describe changes in the parasites population structures and the frequency of point mutations linked to anti-malarial drugs. METHODS: A total of 88 Plasmodium falciparum and 94 Plasmodium vivax isolates were collected in 2018 and compared with samples from 2003/2004 (106 P. falciparum and 104 P. vivax). For P. falciparum, mutations linked to drug resistance (Pfdhfr, Pfdhps, and Pfcrt) and the Pfk13 gene associated with artemisinin delayed parasite clearance, were analysed. To estimate the multiplicity of infection (MOI), and perform P. falciparum and P. vivax population genetic analyses, the parasites were genotyped by using eight standardized microsatellite loci. RESULTS: The P. falciparum parasites are still harbouring drug-resistant mutations in Pfdhfr, Pfdhps, and Pfcrt. However, there was a decrease in the frequency of highly resistant Pfdhps alleles. Mutations associated with artemisinin delayed parasite clearance in the Pfk13 gene were not found. Consistent with the increase in transmission, polyclonal infections raised from 1.9% in 2003/2004 to 39% in 2018 in P. falciparum and from 16.3 to 68% in P. vivax. There is also a decrease in linkage disequilibrium. Bayesian clustering yields two populations linked to the time of sampling, showing that the parasite populations temporarily changed. However, the samples from 2003/2004 and 2018 have several alleles per locus in common without sharing multi-locus genotypes. CONCLUSIONS: The frequency of mutations linked with drug resistance in P. falciparum shows only changes in Pfdhps. Observations presented here are consistent with an increase in transmission from the previously circulating parasites. Following populations longitudinally, using molecular surveillance, provides valuable information in cases such as Venezuela with a fluid malaria situation that is affecting the regional goals toward elimination.

Malaria y coinfecciones en una región endémica de Venezuela

Introducción: La malaria continúa siendo un importante problema de salud pública en todo el mundo. Las coinfecciones son un factor de riesgo que incrementa la mortalidad de esta enfermedad. En Venezuela no existen estudios que describan la presencia de coinfecciones en pacientes con malaria. Nosotros determinamos las características clínicas y epidemiológicas de los pacientes con malaria y la presencia de coinfecciones en Ciudad Bolívar, Estado Bolívar, Venezuela. Metodología: Se realizó un estudio descriptivo, correlacional y transversal, que incluyó pacientes diagnosticados con malaria por prueba rápida y/o gota gruesa y extendido de sangre periférica que consultaron en tres centros médicos de Ciudad Bolívar, estado Bolívar, entre junio y noviembre de 2018. Se realizó una evaluación clínica y de laboratorio de cada paciente, las coinfecciones con Dengue (VD), Hepatitis viral (HV) (A, B y C), Leptospirosis (LP), y Chikungunya (VCHIK) fueron evaluadas mediante la técnica de ELISA. Resultados: Un total de 161 pacientes fueron estudiados, 106 (65,8 %) presentaron infección por P. vivax, 43 (26,7 %) por P. falciparum y 12 (7,4 %) tenían malaria mixta (Pf/Pv). La media de edad fue 33,8 (±13,43) años; 103 (63,9 %) fueron hombres, la raza más frecuente fue mestiza (94,4 %); la mayoría de los pacientes (37,3 %) practicaban la minería ilegal. Los síntomas más frecuentes fueron fiebre, escalofríos y cefalea. Anemia leve, trombocitopenia moderada, y compromiso de la función hepática fueron los hallazgos de laboratorio más relevantes en todas las especies parasitarias. Se encontró coinfección en 55/161 (34,2 %) pacientes, siendo más frecuente entre los pacientes con P. falciparum (48,8 %). La coinfección más frecuente fue con VD (14,9 %), seguida de VHA (11,8 %)VHB (6,2 %), VCHIK (5,5 %) y LP (3,7 %). En el grupo de coinfectados fue más frecuente la malaria complicada (56,36 %) que la no complicada (43,63 %) con una diferencia estadísticamente significativa (P=0,018). Conclusión: Se encontró una alta prevalencia de coinfecciones en los pacientes con malaria, y su asociación con la severidad de la Malaria, estos datos epidemiológicos influyen de manera directa en el curso clínico, así como en la mortalidad de la enfermedad. Estos hallazgos deben darse a conocer al personal de salud para la identificación oportuna de coinfecciones en estos pacientes.

Introduction: Malaria continues to be a major public health problem worldwide. Co-infections are a risk factor that increases the mortality of this disease. In Venezuela there are no studies describing the presence of coinfections in patients with malaria. We determine the clinical and epidemiological characteristics of patients with malaria and the presence of coinfections in Ciudad Bolívar, Bolívar state, Venezuela. Methodology: A descriptive, correlational and cross-sectional study was carried out, which included patients diagnosed with malaria by rapid test and / or thick and extended peripheral blood drop that they consulted in three medical centers in Ciudad Bolívar, Bolívar state, between June and November 2018 A clinical and laboratory evaluation of each patient was performed, coinfections with Dengue (DV), viral hepatitis (HV) (A, B and C), Leptospirosis (LP), and Chikungunya (VCHIK) were evaluated using the technique of ELISA Results: A total of 161 patients were studied, 106 (65.8 %) had P. vivax infection, 43 (26.7 %) due to P. falciparum and 12 (7.4 %) had mixed malaria (Pf / Pv ). The mean age was 33.8 (± 13.43) years; 103 (63.9 %) were men, the most frequent race was mestizo (94.4 %); the majority of patients (37.3 %) practiced illegal mining. The most frequent symptoms were fever, chills and headache. Mild anemia, moderate thrombocytopenia, and hepatic function impairment were the most relevant laboratory findings in all parasitic species. Coinfection was found in 55/161 (34.2 %) patients, being more frequent among patients with P. falciparum (48.8 %). The most frequent coinfection was with RV (14.9 %), followed by HAV (11.8 %) HBV (6.2 %), HCV (5.5 %) and LP (3.7 %). Complicated malaria (56.36 %) was more frequent than uncomplicated (43.63 %) with a statistically significant difference (P = 0.018). Conclusion: A high prevalence of coinfections was found in patients with malaria, and its association with the severity of Malaria, these epidemiological data directly influence the clinical course, as well as the mortality of the disease. These findings should be made known to health personnel for the timely identification of coinfections in these patients.