[Tropical malaria in children in the Republic of Tajikistan].

The complications of tropical malaria were noted in 25 (9.4%) of 196 pediatric patients followed up. These included cerebral malaria in 8 (3%), severe hemolytic anemia in 15 (5.7%), hemoglobinuric fever in 1 (0.37%), and malarial hepatitis in 1 (0.37%). The occurrence of complications was associated with the late referral of patients to a health care facility and untimely treatment, as well as with preliminary misdiagnoses (acute respiratory viral infection, typhoid-parathyphoid fever, meningitis, acute enteric infection, viral hepatitis, sepsis). The main reasons for late diagnosis were the absence of malarial paroxysm at the onset of disease in infants and the wrong type of a temperature curve.

[Role of cytokines in the clinical course of tropical malaria in children].

The paper gives data on impaired cytokine status in children with tropical malaria. There have been heterodirectional changes in the level ofcytokines during the infectious process and in relation to the severity of the pathological process, which allow prediction of the course of tropical malaria. Correlations were found between the clinical and laboratory parameters and the level of proinflammatory cytokines, which provide evidence for an important role of inflammatory mediators in the clinical course of the disease. The findings suggest that it is expedient to correct immune disorders in the early stages of tropical malaria.

[Age-related cytokine regulation in children with malaria].

The paper presents data on age-related cytokine dysregulation in children with tertian or tropical malaria infection. Immunological changes depended on the dynamics of the infectious process and the severity of the pathological one. The most pronounced changes were observed in a group of infants probably due to the functional immaturity of immunoregulatory mechanisms appearing as elevated levels of proinflammatory cytokines with a reduction in IFN-gamma, which suggest that Th-1 lymphocyte reactions are inhibited. With age, there is a shift from Th2 towards Th1 immune response, which testifies that the disease runs a favorable course. These findings may be useful in assessing the prognosis of the course and outcome of malaria in children.

[Time course of cytochemical changes in the microbicidal system of neutrophilic granulocytes in children with tropical malaria].

The functional metabolic activity of neutrophilic leukocytes underwent clinical laboratory assessment in tropical malaria. A significant inhibited activity of myeloperoxidase and decreased levels of cationic protein, glycogen, and lipids were revealed while the activities of alkaline and acid phosphatase were increased. The degree of changes in the enzymatic activity of leukocytes and the level of intraleukocytic components depended on both the stage of the disease and the degree of the pathological process and the presence of mixed infections. The maximum changes in the content of all components of the neutrophilic microbicidal system were noted in patients with tropic malaria concurrent with typhoid fever. The values of the peripheral neutrophilic microbicidal system may be used as additional criteria for evaluating the severity and prognosis of tropical malaria.

[Efficiency of a package of therapeutic and preventive measures in the Republic of Tajikistan in the malaria postepidemic period (2000-2007)].

In 2005, Tajikistan joined the Move of Elimination of Tropical Malaria in 2010 and Tertian Malaria to 2015 (Tashkent Declaration, WHO European Office for European). To achieve the targets and goals, it is necessary to evaluate the efficiency of therapeutic and preventive measures in 2000-2007, i.e. in the postepidemic period preceding elimination (pre-elimination according to the WHO terminology). Investigations were conducted in the Gorno-Badakhstan Autonomous Region, Khatlon and Sogdiysk Regions, in the districts under the Republic's jurisdiction, and in the city of Dushanbe. The results of the investigations has shown that a small proportion of the population has red blood cell glucose-6-phosphate dehydrogenase deficiency, which does not preclude mass preventive treatment with primaquine that is responsible for a 2.5-fold reduction in the number of foci (783 foci of different types). Foci should be typified for the rational use of a package of therapeutic and preventive measures in the endemic areas. Differentiated packages of therapeutic and preventive measures correspondingly to the National Malaria Strategy of the Republic of Tajikistan should be implemented depending on the type of a focus.

[The epidemiological and clinical characteristics of malaria under the present conditions of Tajikistan].

The highest malaria morbidity rates have been observed in the Tajikistan's Khatlon Region that is contiguous with Afghanistan. This area is notorious for its high malariogenicity ("susceptibility" according to the WHO terminology), caused by natural climatic factors, as well as a significant vulnerability associated with socioeconomic conditions (intensive migration of populations among which there are many infected subjects). In children, tropical malaria is generally characterized by an acute onset, abnormal fever, and its polymorphism of clinical manifestations that are exemplified by the lack of typical malaria paroxysms, as well as a gradual progression of parasitemia during the first malaria attacks. Recurrences are induced by ineffective treatment and chloroquine resistance in the tropical malaria pathogen. The reduction in malaria morbidity has resulted from a package of large-scale malaria-controlling measures implemented with the support of the Global Fund to Fight AIDS, Tuberculosis, and Malaria.