Re-emergence of Plasmodium malariae In Trinidad, West Indies

A focus of Plasmodium malariae infection has recently occurred on the island of Trinidad, some 30 years after a successful eradiction programme. Examination of bloodsmears revealed 22 cases of P. malariae in the Nariva-Mayaro area of Trinidad between August 1994 and September 1995. Most (77 percent) of the cases were male and, as seven were aged >25 years of age, it appeared that transmission had been renewed, probably by the vector Anopheles bellator. However, none of the 3000 mosquitoes tested by ELISA for circumsporozoite protein of P. malariae proved positive. Use of IFAT to check blood samples for P. malariae appeared more sensitive than direct examination of bloodsmears, indicating that 42 (13 percent) of the 325 samples tested were seropositive (at titres of 1:256 or greater). The levels of transmission of the parasite may therefore be even higher than indicated by examination of blood smears. The surveillance measurers adopted to understand the epidemiology of this outbreak of P. malariae in Trinidad are described. The need to maintain malaria surveillance in all the countries where P. malariae parasites once existed (prior to eradication) is emphasised. (AU)

A focus of plasmodium malariae in Trinidad, West Indies

This report describes a focus of Plasmodium malariae on the island of Trinidad, some 30 years after a successful eradication programme. A total of 22 cases of P. malariae was detected using blood smears in the Nariva-Mayaro area of Trinidad from August 1994 to September 1995, with 77.3 percent of the cases being males and 22.7 percent being females. Seven of the 22 cases were individuals < 25 years of age suggesting that malaria transmission was renewed by the anopheline vectors Anopheles bellator and Anopheles homunculus. None of the three thousand mosquitoes tested by ELISA for cirumsporozoite protein of P. malariae proved positive. Blood samples tested using polymerase chain reaction (PCR) proved negative for P. malariae, while indirect fluorescent antibody (IFA) serology proved more sensitive. For example, from 325 IFA samples tested, 42 (12.9 percent) had titres of 1:256 for higher. These results suggest that malaria transmission levels were higher than those reported by blood smears and PCR. The surveillance measures adopted to understand the epidemiology of this outbreak of P. malariae from Trinidad are described. The need of maintain malaria surveillance in all countries where P. malariae parasites existed prior to eradication is emphasized.(AU)

Imported cerebral malaria complicated with glucose 6 phosphate dehydrogenase deficiency

Two cases of cerebral malaria imported from Guyana and Ghana are reported. These are the first cases of cerebral malaria diagnosed and treated in Trinidad and Tobago since malaria was eradicated. The management of both these cases was complicated because the patients' erythrocytes were glucose-6-phosphate dehydrogenase-deficient, and by the occurrence of blackwater fever, cerebral manifestations, renal impairment, hyperglycaemia and thrombocytopenia. The symptoms of cerebral malaria resolved following treatment with quinidine and doxycycline and quinidine and clindamycin. (AU)

Imported cerebral malaria complicated with glucose 6 phosphate dehydrogenase deficiency

Two cases of cerebral malaria imported from Guyana and Ghana are reported. These are the first cases of cerebral malaria diagnosed and treated in Trinidad and Tobago since malaria was eradicated. The management of both these cases was complicated because the patients' erythrocytes were glucose-6-phosphate dehydrogenase-deficient, and by the occurrence of blackwater fever, cerebral manifestations, renal impairment, hyperglycaemia and thrombocytopenia. The symptoms of cerebral malaria resolved following treatment with quinidine and doxycycline and quinidine and clindamycin.

A case of vivax malaria presenting with psyhosis

The first case of psychosis due to Plasmodium vivax malaria, imported from India is reported. A 44-year-old Trinidadian male presented with fever, and psychotic episodes in association with vivax malaria. The symptoms of both malaria and psychosis were resolved following the standard chloroquine-primaquine therapy (AU)

A case of vivax malaria presenting with psyhosis

The first case of psychosis due to Plasmodium vivax malaria, imported from India is reported. A 44-year-old Trinidadian male presented with fever, and psychotic episodes in association with vivax malaria. The symptoms of both malaria and psychosis were resolved following the standard chloroquine-primaquine therapy

Ivermectin treatment of mansonellosis in Blanchisseuse, Trinidad, West Indies - abstract

The first double-blind-placebo field trial, using the drug ivermectin to control M. ozzardi microfilariae, was conducted in Blanchisseuse, North Trinidad. A preliminary trial indicated that there were no major constraints in administering the drug ivermectin within the community. In 16 patients before treatment, the microfilariae density ranged from 1 to 5,679 mf/ml, and the geometric mean was 697 mf/ml compared to 4 to 2,042 mf/ml and 362 mf/ml in the 14 patients given the placebo. Following treatment 87.5 percent (14/16) experienced side effects including fever and arthralgia (12 cases), myalgia (3 cases), headaches (11 cases) and chills (8 cases). All symptoms disappeared after 24 hours. Twenty-four hours after the ivermectin treatment the M. ozzardi microfilariae densities significantly (p < 0.001) declined to zero in 11 out of 16 cases (68.8 percent) while in 5 cases densities declined by > 95 percent. One week post-treatment there were no microfilariae observed in 93.8 percent (15/16) of cases, with one patient not attending the clinic. Blood samples collected 1 and 5 months after ivermectin treatment revealed M. ozzardi microfilariae in 3 patients. These 3 patients were re-treated with 6 mg of ivermectin, but two patients demonstrated persistent parasitaemias in subsequent blood samples. Within the placebo group, fluctuating levels of microfilariae were observed (AU)

Mass chemotherapy with diethylcarbamazine for the control of bancroftian filariasis: a twelve-year follow-up in Northern Trinidad, including observations on mansonella ozzardi

A microfilaria survey was conducted in Trinidad in 1992, 12 years after mass treatment with spaced doses of diethylcarbamazine citrate (DEC-C) for the control of Bancroftian filariasis; 348 persons were examined using thick blood smears and a membrane filtration technique. They included 104 who had participated in the mass chemotherapy campaign in 1980. No Wuchereria bancrofti microfilariae were detected among 66 percent of the population examined. In 1980, 86 of 592 persons examined were found to be infected with W. bancrofti, 140 with Mansonella ozzardi and 44 with mixed infections, while in 1992, only M. ozzardi infections persisted despite treatment with DEC-C. Of the 104 persons reexamined 12 years later, 46 had M. ozzardi, of which five were new cases, but none had W. bancrofti. During both the 1980 and 1992 surveys, low microfilariae rates for M. ozzardi were observed among those 19 years of age or younger. Of the 302 persons newly examined in 1992, 29 were infected with significantly (P<0.001) more males (79.3 percent) than females (20.9 percent) being microfilaremic. The combined results showed similar prevalence rates for M. ozzardi from 23.3 percent to 21.6 percent in 1980 and 1992. Nuclepore membrane filtration and thick blood films were very efficient in demonstrating the presence of microfilariae. The usefulness of these methods and spaced treatment using DEC-C are also discussed (AU)

Mass chemotherapy with diethylcarbamazine for the control of bancroftian filariasis: a 12-year follow-up in North Trinidad including observations on mansonella ozzardi microfilaraemia - abstract

A microfilaria survey was conducted in Blanchisseuse, North Trinidad in 1992 twelve years after mass treatment with spaced doses of diethylcarbamazine citrate (DEC-C) for the control of Bancroftian filariasis; 348 persons were examined, including 104 who had participated in the mass-chemotherapy campaign in 1980. No W. bancrofti microfilarie were detected among 66 percent of the population examined. In 1980, 86 persons were found with W. bancrofti, 140 with M. ozzardi and 44 with mixed infections while in 1992 only Mansonella ozzardi infections persisted despite DEC-C treatment. From the 104 persons re-examined, 46 persons had M.ozzardi, of which 5 were new cases but none had W. bancrofti infections in 1992. During both the 1980 and 1992 surveys, low microfilariae rates of M.ozzardi were observed among the 1-4, 5-9 and 10-19-year age groups. From the 302 persons examined in 1992, 29 were infected, with significantly (p<0.001) more males (79.3 percent) than females (20.7 percent) being microfilaraemic. The combined results showed similar prevalence rates of M.ozzardi from 23.3 percent to 21.6 percent in 1980 and 1992, respectively. A good correlation was found between the results observed from Nucleopore membrane filtration and thick blood films. The usefulness of thes methods and spaced treatment using DEC-C is also discussed (AU)

Falciparum malaria treated with a chloroquine suspension administered rectally in Trinidad

A new mode of administering malaria chemotherapy to patients unable to tolerate oral medication is described. A patient with Plasmodium falciparum malaria, severe hyponatraemia and hypokalaemia who regurgitated oral treatment of chloroquine phosphate and pyrimethamine and sulfadoxine (Fansidar) is presented. But neither chloroquine nor quinine intravenous formulations were available locally. As the patient was deteriorating, a suspension of chloroquine phosphate was prepared and administered rectally, resulting in a decline in the level of parasitaemia from ++++ to ++ within 48 hours. The patient improved, and further clinical management was uncomplicated (AU)

Falciparum malaria treated with a chloroquine suspension administered rectally in Trinidad

A new mode of administering malaria chemotherapy to patients unable to tolerate oral medication is described. A patient with Plasmodium falciparum malaria, severe hyponatraemia and hypokalaemia who regurgitated oral treatment of chloroquine phosphate and pyrimethamine and sulfadoxine (Fansidar) is presented. But neither chloroquine nor quinine intravenous formulations were available locally. As the patient was deteriorating, a suspension of chloroquine phosphate was prepared and administered rectally, resulting in a decline in the level of parasitaemia from ++++ to ++ within 48 hours. The patient improved, and further clinical management was uncomplicated.

Gastroenteritis in Kingston and St. Andrew as seen at Bustamante Children's Hospital, 1973 - 1977

Gastroenteritis is a major cause of mortality and morbidity in Kingston and St. Andrew. It was the single most important cause of death in 1968 to 1970 with a mortality rate of 216.1 per 100,000 population. At Children's Hospital it ranked second to respiratory diseases as the major cause of death with a steady decline over the past three years. The case fatality rate showed a remarkable decline over the past four years at the Institution. The under two year age group is the most affected accounting for about 90 per cent of the morbidity and mortality. The seasonal trends during 1973 to 1977 demonstrated a peak in the cooler months of the year. The bacterial pathogens isolated from the gastroenteritis cases being the salmonellae, shigellaE, and pathogenic E. coli with the Salmonellae being most predominant, although an increase in the isolates of shigellae was seen in 1977. Weaning before the sixth month of life was associated with increasing incidence of gastroenteritis. Also more cases of gastroenteritis were noted in the economically depressed areas of Kingston and St. Andrew. (AU)