PET-PCR reveals low parasitaemia and submicroscopic malarial infections in Honduran Moskitia.

BACKGROUND: Malaria remains a main parasitic disease of humans. Although the largest number of cases is reported in the African region, there are still endemic foci in the Americas. Central America reported 36,000 malaria cases in 2020, which represents 5.5% of cases in the Americas and 0.015% of cases globally. Most malaria infections in Central America are reported in La Moskitia, shared by Honduras and Nicaragua. In the Honduran Moskitia, less than 800 cases were registered in 2020, considering it an area of low endemicity. In low endemicity settings, the number of submicroscopic and asymptomatic infections tends to increase, leaving many cases undetected and untreated. These reservoirs challenge national malaria elimination programmes. This study aimed to assess the diagnostic performance of Light Microscopy (LM), a nested PCR test and a photoinduced electron transfer polymerase chain reaction (PET-PCR) in a population of febrile patients from La Moskitia. METHODS: A total of 309 febrile participants were recruited using a passive surveillance approach at the Puerto Lempira hospital. Blood samples were analysed by LM, nested PCR, and PET-PCR. Diagnostic performance including sensitivity, specificity, negative and positive predictive values, kappa index, accuracy, and ROC analysis was evaluated. The parasitaemia of the positive samples was quantified by both LM and PET-PCR. RESULTS: The overall prevalence of malaria was 19.1% by LM, 27.8% by nPCR, and 31.1% by PET-PCR. The sensitivity of LM was 67.4% compared to nPCR, and the sensitivity of LM and nPCR was 59.6% and 80.8%, respectively, compared to PET-PCR. LM showed a kappa index of 0.67, with a moderate level of agreement. Forty positive cases by PET-PCR were not detected by LM. CONCLUSIONS: This study demonstrated that LM is unable to detect parasitaemia at low levels and that there is a high degree of submicroscopic infections in the Honduran Moskitia.

Field Evaluation of a Hemozoin-Based Malaria Diagnostic Device in Puerto Lempira, Honduras.

The diagnosis of malaria in Honduras is based mainly on microscopic observation of the parasite in thick smears or the detection of parasite antigens through rapid diagnostic tests when microscopy is not available. The specific treatment of the disease depends exclusively on the positive result of one of these tests. Given the low sensitivity of conventional methods, new diagnostic approaches are needed. This study evaluates the in-field performance of a device (Gazelle™) based on the detection of hemozoin. This was a double-blind study evaluating symptomatic individuals with suspected malaria in the department of Gracias a Dios, Honduras, using blood samples collected from 2021 to 2022. The diagnostic performance of Gazelle™ was compared with microscopy and nested 18ssr PCR as references. The sensitivity and specificity of Gazelle™ were 59.7% and 98.6%, respectively, while microscopy had a sensitivity of 64.9% and a specificity of 100%. The kappa index between microscopy and Gazelle™ was 0.9216 using microscopy as a reference. Both methods show similar effectiveness and predictive values. No statistical differences were observed between the results of the Gazelle™ compared to light microscopy (p = 0.6831). The turnaround time was shorter for Gazelle™ than for microscopy, but the cost per sample was slightly higher for Gazelle™. Gazelle™ showed more false-negative cases when infections were caused by Plasmodium falciparum compared to P. vivax. Conclusions: The sensitivity and specificity of Gazelle™ are comparable to microscopy. The simplicity and ease of use of the Gazelle™, the ability to run on batteries, and the immediacy of its results make it a valuable tool for malaria detection in the field. However, further development is required to differentiate Plasmodium species, especially in those regions requiring differentiated treatment.

Experiencia de los hombres durante el embarazo de su esposa y nacimiento de su hijo (A) / Men experience during Pregnancy of his wife and the birth of his child

Antecedentes. Escasas investigaciones se realizan sobre las experiencias del hombre durante el embarazo y nacimiento de su hijo, y son tan diversas y variadas como en las mujeres. Objetivo: Conocer las experiencias de los hombres durante el embarazo de su esposa y el nacimiento de su hijo(a). Pacien-tes y Métodos: Estudio cualitativo realizado de marzo a mayo del año 2014 en el área de espera de la sala de Labor y Parto del Hospital Leonardo Martínez Valenzuela (HLMV), mediante entrevistas individuales a 20 hombres que esperaban el nacimiento de su hijo(a) Resultados: Las experiencias del hombre durante el embarazo de su compañera son variadas, sin embargo cuando hay deseos de ser padre se involucra más en apoyar a su esposa, el hombre apoya más en actividades del hogar y menos al asistir al control prenatal. Al existir unión sentimental, y una relación estable, son más frecuentes los signos y síntomas psicológicos o fisiológicos; con el pasar de los meses el hombre se va absteniendo de las relaciones sexuales. Discusión Conocer el sentir y pensar del hombre referente al embarazo denota la necesidad de involucrarlo en el proceso, hacerle sentir "estamos esperando un hijo" y no como, "mi mujer está embarazada". Conclusión: Los resultados destacan que los hombres tienen numerosas experiencias, cambios psicológicos, fisiológicos y adquisición de nuevos roles, desean ser parte del embarazo por lo cual deben ser educados referente al mismo...(AU)