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1.
Rev Bras Epidemiol ; 23: e200018, 2020.
Artigo em Português, Inglês | MEDLINE | ID: mdl-32159628

RESUMO

INTRODUCTION: Malaria is an infectious disease of high transmission in the Amazon region, but its dynamics and spatial distribution may vary depending on the interaction of environmental, socio-cultural, economic, political and health services factors. OBJECTIVE: To verify the existence of malaria case patterns in consonance with the fluviometric regimes in Amazon basin. METHOD: Methods of descriptive and inferential statistics were used in malaria and water level data for 35 municipalities in the Amazonas State, in the period from 2003 to 2014. RESULTS: The existence of a tendency to modulate the seasonality of malaria cases due to distinct periods of rivers flooding has been demonstrated. Differences were observed in the annual hydrological variability accompanied by different patterns of malaria cases, showing a trend of remodeling of the epidemiological profile as a function of the flood pulse. CONCLUSION: The study suggests the implementation of regional and local strategies considering the hydrological regimes of the Amazon basin, enabling municipal actions to attenuate the malaria in the Amazonas State.


Assuntos
Hidrologia , Malária/epidemiologia , Estações do Ano , Brasil/epidemiologia , Humanos , Incidência , Malária/diagnóstico , Características de Residência , Rios , Movimentos da Água
2.
BMC Med ; 18(1): 17, 2020 Jan 30.
Artigo em Inglês | MEDLINE | ID: mdl-31996199

RESUMO

BACKGROUND: There has been a successful push towards parasitological diagnosis of malaria in Africa, mainly with rapid diagnostic tests (mRDTs), which has reduced over-prescribing of artemisinin-based combination therapies (ACT) to malaria test-negative patients. The effect on prescribing for test-positive patients has received much less attention. Malaria infection in endemic Africa is often most dangerous for young children and those in low-transmission settings. This study examined non-prescription of antimalarials for patients with malaria infection demonstrated by positive mRDT results, and in particular these groups who are most vulnerable to poor outcomes if antimalarials are not given. METHODS: Analysis of data from 562,762 patients in 8 studies co-designed as part of the ACT Consortium, conducted 2007-2013 in children and adults, in Cameroon, Ghana, Nigeria, Tanzania, and Uganda, in a variety of public and private health care sector settings, and across a range of malaria endemic zones. RESULTS: Of 106,039 patients with positive mRDT results (median age 6 years), 7426 (7.0%) were not prescribed an ACT antimalarial. The proportion of mRDT-positive patients not prescribed ACT ranged across sites from 1.3 to 37.1%. For patients under age 5 years, 3473/44,539 (7.8%) were not prescribed an ACT, compared with 3833/60,043 (6.4%) of those aged ≥ 5 years. The proportion of < 5-year-olds not prescribed ACT ranged up to 41.8% across sites. The odds of not being prescribed an ACT were 2-32 times higher for patients in settings with lower-transmission intensity (using test positivity as a proxy) compared to areas of higher transmission. mRDT-positive children in low-transmission settings were especially likely not to be prescribed ACT, with proportions untreated up to 70%. Of the 7426 mRDT-positive patients not prescribed an ACT, 4121 (55.5%) were prescribed other, non-recommended non-ACT antimalarial medications, and the remainder (44.5%) were prescribed no antimalarial. CONCLUSIONS: In eight studies of mRDT implementation in five African countries, substantial proportions of patients testing mRDT-positive were not prescribed an ACT antimalarial, and many were not prescribed an antimalarial at all. Patients most vulnerable to serious outcomes, children < 5 years and those in low-transmission settings, were most likely to not be prescribed antimalarials, and young children in low-transmission settings were least likely to be treated for malaria. This major public health risk must be addressed in training and practice. TRIAL REGISTRATION: Reported in individual primary studies.


Assuntos
Antimaláricos/uso terapêutico , Artemisininas/uso terapêutico , Malária/tratamento farmacológico , Padrões de Prática Médica , Adolescente , Adulto , Criança , Pré-Escolar , Assistência à Saúde/normas , Feminino , Gana , Humanos , Malária/diagnóstico , Masculino , Pessoa de Meia-Idade , Nigéria , Prescrições , Setor Privado , Tanzânia , Uganda , Adulto Jovem
3.
Mikrobiyol Bul ; 53(4): 472-479, 2019 Oct.
Artigo em Turco | MEDLINE | ID: mdl-31709945

RESUMO

In spite of the fact that Plasmodium vivax is the leading causative agent of malaria in our country, imported malaria cases have been reported, recently. In this report, two malaria cases originated from sub-Saharan Africa, and their diagnostic and therapeutic approaches were aimed to be presented. First case, 45-year-old male, who has been working in Republic of Ghana, was admitted to Hacettepe University Hospitals Emergency Service with complaints of fever, sweating and shivering, after returning to Turkey. On admission, his general condition was fine and his physical examination revealed no pathological finding. After his admission, a fever episode occured and his blood tests revealed anemia, trombocytopenia and increased alkaline phosphatase level. Second case, 39-year-old-male admitted to the emergency service with the complaints of fever, shivering and myalgia. His physical examination revealed decreased breath sounds and splenomegaly, his laboratory tests resulted in pansitopenia and elevated liver enzymes. In the thick blood smears of the patients ring formed young trophozoites are detected and in the thin films multiple ring forms demonstrated in one erythrocyte with the absence of mature trophozoites and schizont forms, which were compatible with falciparum malaria. The rapid antigen test (Digamed, Belgium) of the second case found to be positive for both Plasmodium falciparum and P.vivax and this patient followed-up in intensive care unit due to his deterioration of general condition, respiratory distress, hematuria and change of consciousness. Neither cases were commenced on malaria prophylaxis. Both patients have been in countries which chloroquine resistance is commonly seen, they were treated with artemether/lumefantrine as current World Health Organization recommended. Targeting hypnozoites of P.vivax, primaquine was added to the therapy of the second patient. Both patients resulted in cure. In conclusion, while travelling to endemic countries, people should be informed about the importance of malaria prophylaxis and prophylaxis should be commenced immediately and continued appropriately. Additionally, malaria should always be considered in the differential diagnosis of high fever for the patients who admitted to the hospital with a travelling history to these countries.


Assuntos
Antimaláricos , Combinação Arteméter e Lumefantrina , Malária , Primaquina , Adulto , África ao Sul do Saara , Antimaláricos/uso terapêutico , Combinação Arteméter e Lumefantrina/uso terapêutico , Doenças Transmissíveis Importadas/diagnóstico , Doenças Transmissíveis Importadas/tratamento farmacológico , Doenças Transmissíveis Importadas/parasitologia , Doenças Transmissíveis Importadas/prevenção & controle , Humanos , Malária/diagnóstico , Malária/tratamento farmacológico , Malária/parasitologia , Malária/prevenção & controle , Masculino , Pessoa de Meia-Idade , Plasmodium falciparum , Plasmodium vivax , Primaquina/uso terapêutico , Viagem , Resultado do Tratamento , Turquia
4.
Georgian Med News ; (294): 109-113, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31687960

RESUMO

Malaria is a parasitic disease. It is one of blood infections caused by malaria plasmodia. The disease is transmitted to a human by a bite of a female mosquito of Anopheles genus. Local malaria transmission in Ukraine has not been registered since 1956, however, every year some imported cases occur. In 2017, 45 cases of malaria were imported to Ukraine: 80% of them were caused by P. falciparum. The aim of the research is to present a case of imported tropical malaria in a pregnant woman with the development of malaria coma. An unusual course of the illness made diagnoses difficult due to partial immunity of the patient caused by multiple previous invasions of malaria plasmodia. The diagnosis was confirmed by blood microscopy. A literature on epidemiology, clinical findings and current tropical malaria course has been scanned as well. In the presence of an appropriate epidemiological anamnesis, the patients with fever of unknown genesis should first of all be examined for malaria, the most socially significant tropical disease. It is necessary to define the type of malarial plasmodium by repeated blood parasitoscopy by a thick-blood film and blood smear coloured by Gimza-Romanovsky method. Doctors' vigilance against malaria allows preventing complicated forms and late relapses of this malignant invasion. The countries free of malaria can also face this problem and therefore they should be ready to diagnose and treat this disease effectively. The infectious diseases hospitals of Ukraine should be supplied with antimalarial drugs.


Assuntos
Coma/parasitologia , Malária/diagnóstico , Plasmodium/isolamento & purificação , Animais , Antimaláricos/uso terapêutico , Coma/etiologia , Feminino , Humanos , Malária/tratamento farmacológico , Gravidez , Gestantes , Viagem , Ucrânia
5.
BMC Infect Dis ; 19(1): 970, 2019 Nov 13.
Artigo em Inglês | MEDLINE | ID: mdl-31722678

RESUMO

BACKGROUND: Acute febrile illness (AFI) is characterized by malaise, myalgia and a raised temperature that is a nonspecific manifestation of infectious diseases in the tropics. The lack of appropriate diagnostics for the evaluation of AFI leads to increased morbidity and mortality in resource-limited settings, specifically low-income countries like India. The review aimed to identify the number, type and quality of diagnostics used for AFI evaluation during passive case detection at health care centres in South India. METHODS: A scoping review of peer-reviewed English language original research articles published between 1946-July 2018 from four databases was undertaken to assess the type and number of diagnostics used in AFI evaluation in South India. Results were stratified according to types of pathogen-specific tests used in AFI management. RESULTS: The review included a total of 40 studies, all conducted in tertiary care centres (80% in private settings). The studies demonstrated the use of 5-22 tests per patient for the evaluation of AFI. Among 25 studies evaluating possible causes of AFI, 96% tested for malaria followed by 80% for dengue, 72% for scrub typhus, 68% for typhoid and 60% for leptospirosis identifying these as commonly suspected causes of AFI. 54% studies diagnosed malaria with smear microscopy while others diagnosed dengue, scrub typhus, typhoid and leptospirosis using antibody or antigen detection assays. 39% studies used the Weil-Felix test (WFT) for scrub typhus diagnosis and 82% studies used the Widal test for diagnosing typhoid. CONCLUSIONS: The review demonstrated the use of five or more pathogen-specific tests in evaluating AFI as well as described the widespread use of suboptimal tests like the WFT and Widal in fever evaluation. It identified the need for the development of better-quality tests for aetiological diagnosis and improved standardised testing guidelines for AFI.


Assuntos
Doenças Transmissíveis/diagnóstico , Anticorpos/sangue , Antígenos/análise , Dengue/diagnóstico , Humanos , Índia , Leptospirose/diagnóstico , Malária/diagnóstico , Tifo por Ácaros/diagnóstico , Centros de Atenção Terciária
6.
Zhongguo Xue Xi Chong Bing Fang Zhi Za Zhi ; 31(5): 543-545, 2019 Jan 05.
Artigo em Chinês | MEDLINE | ID: mdl-31713391

RESUMO

OBJECTIVE: To understand the laboratory technicians' abilities in blood slide making and reading in 10 prefectures of Yunnan Province which have passed the provincial malaria elimination evaluation, so as to provide the evidence for improving the malaria elimination surveillance and parasite examination. METHODS: Thirty negative blood slides were randomly sampled to evaluate coating, dyeing and clean quality and reading results, and 4 laboratory technicians were sampled to evaluate their reading abilities from each prefecture level and its 2 subordinate counties (districts) respectively, and then the results were analyzed. RESULTS: A total of 869 negative blood samples were evaluated. The coincidence rate was 100%. The proportions of good coating, dyeing and clean quality were 96.09%, 91.71% and 96.89%, respectively. Totally 576 blood slides were used to evaluate the reading ability. The number of correct reading was 505, and the correct rate was 87.67%. Among them, the Plasmodium vivax correct reading rate was 87.76%, the P. falciparum correct reading rate was 87.50%, and the correct reading rate of mixed infections was 47.62%. The laboratory technicians' ability to the mixed infections was significantly lower than the ability to the others (χ2 = 37.169, P < 0.05), however, in the laboratory technicians' abilities, there was no significant difference among the center (s) for disease control and prevention, general hospitals and township hospitals (χ2 = 2.782, P > 0.05), and the prefecture, county and township levels (χ2 = 0.358, P > 0.05) . CONCLUSIONS: The 10 prefectures have passed the provincial evaluation in blood slide making and microscopic examination skill indicators requested, but the medical and public health institutions at all levels still should further improve their laboratory technicians' abilities in blood slide making and microscopic examination skills.


Assuntos
Técnicas e Procedimentos Diagnósticos , Erradicação de Doenças , Malária , China/epidemiologia , Técnicas e Procedimentos Diagnósticos/normas , Erradicação de Doenças/métodos , Humanos , Malária/sangue , Malária/diagnóstico , Malária/epidemiologia , Microscopia , Reprodutibilidade dos Testes
7.
PLoS Negl Trop Dis ; 13(10): e0007773, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31658252

RESUMO

In 2012, the U.S. Defense Threat Reduction Agency Joint Science and Technology Office initiated a program to develop novel point-of-need diagnostic devices for surveillance of emerging infectious diseases including dengue, malaria, plague, and melioidosis. Prior to distribution of devices to observe their correct use among community members in Iquitos, Peru, and Phnom Penh, Cambodia, research was conducted to: 1) assess acceptability of use, including the motivation to use a rapid diagnostic test (RDT) before or instead of seeking care at a health facility, 2) explore comprehension of RDT use instructions, and 3) examine possible strategies for large scale RDT distribution and use at each site. In February 2014, 9 focus group discussions (FGD) with community members and 5 FGD with health professionals were conducted in Iquitos, and 9 FGD with community members and 9 in-depth interviews with health professionals in Phnom Penh. In both places, participants agreed to use the device themselves (involving finger prick) or could identify someone who could do so in their home or neighborhood. The main incentive to RDT use in both sites was the ability for device results to be used for care facilitation (post confirmatory tests), specifically reduced wait times to be seen or obtain a diagnosis. Comprehension of RDT use instructions was assessed in Iquitos by asking some participants to apply the device to research team members; after watching a short video, most steps were done correctly. In Phnom Penh, participants were asked to describe each step after reading the instructions; they struggled with comprehension. Health professionals' main concerns in both sites were their community's ability to accurately use the test, handle complicated instructions, and safety (i.e., disposal of lancets). Health system structure and ability to use home diagnostic devices varied in the two disease endemic sites, with substantial challenges in each, suggesting the need for different strategies for RDT large scale community use, and illustrating the value of formative research before deployment of novel technologies.


Assuntos
Testes Diagnósticos de Rotina/métodos , Testes Diagnósticos de Rotina/normas , Pessoal de Saúde/educação , Adolescente , Adulto , Camboja , Dengue/diagnóstico , Educação/métodos , Feminino , Grupos Focais , Instalações de Saúde , Conhecimentos, Atitudes e Prática em Saúde , Pesquisa sobre Serviços de Saúde , Humanos , Malária/diagnóstico , Masculino , Melioidose/diagnóstico , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde , Peru , Peste/diagnóstico , Manejo de Espécimes/métodos , Adulto Jovem
8.
Artigo em Inglês | MEDLINE | ID: mdl-31590340

RESUMO

Fever is one of the most common symptoms of pediatric illnesses; it is an important early symptom of malaria. Fever had served as the entry point for presumptive treatment of malaria among children in Nigerian. Appropriate HSB is important when seeking treatment for fever among under-five children; this will help for better prognosis because treatment will be initiated early. This study attempted to identify caregiver's HSB for under-five children with fever. A cross-sectional study was conducted in Imo-State, Nigeria. Appropriate HSB was operationally defined as seeking treatment from health facility within 24 h of fever. Data were obtained using pretested self-administered questionnaire. Data were analyzed using SPSS version 22. Simple and multiple logistic regression were used to determine predictors of appropriate HSB. A total of 559 eligible respondents were recruited; 103 (18.6%) caregivers had appropriate HSB. The predictors of HSB are being male child (aOR = 2.760; 95% CI:1.536-4.958), the age of child younger than 27 months (aOR = 2.804; 95% CI:1.485-5.295), employed caregivers (aOR = 1.882; 95% CI:1.014-3.493), number of household members (aOR = 2.504; 95% CI:1.464-4.283), and caregivers who decided to seek treatment at early stage (aOR = 7.060; 95% CI:1.616-30.852). Only 18.6% caregivers practiced appropriate HSB for fever cases among under-five children. It is essential to educate caregivers and emphasise on early treatment of fever and appropriate use of health facilities for fever. The findings will be used to improve intervention at the community level and will be compared with follow-up data to evaluate their effectiveness.


Assuntos
Cuidadores/estatística & dados numéricos , Tomada de Decisões , Febre/etiologia , Malária/diagnóstico , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Adulto , Fatores Etários , Pré-Escolar , Estudos Transversais , Feminino , Comportamentos Relacionados com a Saúde , Humanos , Lactente , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Nigéria , Fatores Sexuais , Fatores Socioeconômicos , Inquéritos e Questionários , Adulto Jovem
9.
BMC Health Serv Res ; 19(1): 735, 2019 Oct 22.
Artigo em Inglês | MEDLINE | ID: mdl-31640676

RESUMO

BACKGROUND: Reducing the burden of malaria highly depends on access to prompt and effective malaria diagnosis and treatment. The aim of this study was to identify challenges affecting prompt access to effective uncomplicated malaria case management in children below 10 years old in rural primary health care facilities in Malawi. METHODS: A cross sectional health facility survey was conducted in six primary health facilities in Chikhwawa district, Malawi. Officers-in-charge of health facilities were interviewed on availability of staff, supplies and drugs. All consecutive children presenting at the facility with fever or suspected malaria, aged 6 months to 10 years old, were eligible to participate in exit interviews. Exit interviews with participants' guardians assessed duration of illness, demographic information and distance travelled. Adherence to recommended malaria case management guidelines included performing malaria rapid diagnostic tests (mRDTs) in children with fever or suspected malaria and prescribing recommended weight-based dose of artemether-lumefantrine (AL) when mRDT was positive. Multivariate logistic regression was used to determine factors associated with prompt care seeking within 24 h of onset of illness. RESULTS: Health facilities were staffed by at least two health workers. Of 265 children screened, nine were excluded due to severe illness. Twenty-one percent of children presenting at a health facility with fever were not tested for malaria. Adherence to positive and negative mRDT results for those tested was 99.4, 95% CI [98.1-100] and 97, 95% CI [88.9-100], respectively. AL was prescribed as recommended by weight in 152 children (92.2%). Temporary stock outs of AL occurred in five of six facilities. In total, 146 (57, 95% CI [52.7-64.1]) guardians of patients sought care within 24 h after fever onset. Children aged 5 to 10 years were less likely to present within 24 h of fever onset than children below 5 years of age (unadjusted odds ratio 0.40, 95% CI [0.2-0.7]). CONCLUSION: Adherence to malaria diagnosis and treatment guidelines was high. However, delayed care seeking and stock outs may affect prompt and effective malaria case management. Further qualitative work is required to determine, and address factors associated with delay in care seeking for fever.


Assuntos
Febre/diagnóstico , Malária/diagnóstico , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Antimaláricos/uso terapêutico , Administração de Caso , Criança , Pré-Escolar , Estudos Transversais , Feminino , Febre/tratamento farmacológico , Humanos , Lactente , Malária/tratamento farmacológico , Malaui , Masculino , População Rural , Fatores de Tempo
10.
BMC Infect Dis ; 19(1): 849, 2019 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-31615428

RESUMO

BACKGROUND: Leishmaniasis and malaria are tropical diseases with more than half of the world population at risk of infection resulting in significant morbidity and mortality. Co-infection of Leishmaniasis and malaria pose a great challenge in the diagnosis as well as overall management. CASE PRESENTATION: In this case report, we present a rare case of a 5 years old child hailing from non-endemic region of Nepal with history of fever for a period of 3 months who was diagnosed as co-infection of malaria due to Plasmodium vivax and visceral Leishmaniasis with pancytopenia that subsequently improved after a course of treatment. CONCLUSIONS: A high index of suspicion for a possibility of co-infection with Leishmaniasis and malaria should be borne in mind when an individual hailing from or having history of travel to endemic countries presents with prolonged fever.


Assuntos
Coinfecção/diagnóstico , Leishmaniose Visceral/diagnóstico , Malária/diagnóstico , Pancitopenia/diagnóstico , Esplenomegalia/diagnóstico , Pré-Escolar , Diagnóstico Diferencial , Humanos , Leishmania donovani/isolamento & purificação , Leishmaniose Visceral/complicações , Malária/complicações , Malária/parasitologia , Masculino , Nepal , Pancitopenia/etiologia , Plasmodium vivax/isolamento & purificação , Esplenomegalia/etiologia
11.
Malar J ; 18(1): 348, 2019 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-31619246

RESUMO

BACKGROUND: Widespread elimination of malaria requires an ultra-sensitive detection method that can detect low parasitaemia levels seen in asymptomatic carriers who act as reservoirs for further transmission of the disease, but is inexpensive and easy to deploy in the field in low income settings. It was hypothesized that a new method of malaria detection based on infrared spectroscopy, shown in the laboratory to have similar sensitivity to PCR based detection, could prove effective in detecting malaria in a field setting using cheap portable units with data management systems allowing them to be used by users inexpert in spectroscopy. This study was designed to determine whether the methodology developed in the laboratory could be translated to the field to diagnose the presence of Plasmodium in the blood of patients presenting at hospital with symptoms of malaria, as a precursor to trials testing the sensitivity of to detect asymptomatic carriers. METHODS: The field study tested 318 patients presenting with suspected malaria at four regional clinics in Thailand. Two portable infrared spectrometers were employed, operated from a laptop computer or a mobile telephone with in-built software that guided the user through the simple measurement steps. Diagnostic modelling and validation testing using linear and machine learning approaches was performed against the gold standard qPCR. Sample spectra from 318 patients were used for building calibration models (112 positive and 110 negative samples according to PCR testing) and independent validation testing (39 positive and 57 negatives samples by PCR). RESULTS: The machine learning classification (support vector machines; SVM) performed with 92% sensitivity (3 false negatives) and 97% specificity (2 false positives). The Area Under the Receiver Operation Curve (AUROC) for the SVM classification was 0.98. These results may be better than as stated as one of the spectroscopy false positives was infected by a Plasmodium species other than Plasmodium falciparum or Plasmodium vivax, not detected by the PCR primers employed. CONCLUSIONS: In conclusion, it was demonstrated that ATR-FTIR spectroscopy could be used as an efficient and reliable malaria diagnostic tool and has the potential to be developed for use at point of care under tropical field conditions with spectra able to be analysed via a Cloud-based system, and the diagnostic results returned to the user's mobile telephone or computer. The combination of accessibility to mass screening, high sensitivity and selectivity, low logistics requirements and portability, makes this new approach a potentially outstanding tool in the context of malaria elimination programmes. The next step in the experimental programme now underway is to reduce the sample requirements to fingerprick volumes.


Assuntos
Computação em Nuvem , Testes Diagnósticos de Rotina/métodos , Gerenciamento Clínico , Malária/diagnóstico , Espectrofotometria Infravermelho/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Tailândia , Adulto Jovem
13.
Pak J Pharm Sci ; 32(4): 1545-1554, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31608873

RESUMO

Malaria, dengue and chikungunya are the most rampant mosquito-borne infections predominantly in Pakistan. They pose a serious threat and cause a havoc for the victims owing to the life threatening signs and symptoms marked with elevated morbidity and mortality rate. It seems hard to discriminate due to common indications, consequently, deserves appropriate diagnosis prior elevated toll of death. Present article encompasses depth insights about their prevalence, diagnosis and clinical manifestation if erupt in the pandemic. However, host-vector-host cycle is the root cause of transmission and diverse mosquito species confer dissimilar infections. Indeed these infections are seasonal but other factors like flood, open irrigation channels, immense agricultural land, rich fauna and water reservoirs can't be overlooked. Dire need was felt to acknowledge and aware the public about local transmission, vector control, entomologic, research resources, diagnosis and advancement in healthcare system to alleviate them absolutely in future.


Assuntos
Febre de Chikungunya/diagnóstico , Febre de Chikungunya/epidemiologia , Dengue/diagnóstico , Dengue/epidemiologia , Malária/tratamento farmacológico , Malária/epidemiologia , Antimaláricos/uso terapêutico , Febre de Chikungunya/tratamento farmacológico , Dengue/complicações , Dengue/tratamento farmacológico , Humanos , Malária/diagnóstico , Paquistão/epidemiologia , Prevalência , Fatores Socioeconômicos
14.
Malar J ; 18(1): 313, 2019 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-31533756

RESUMO

BACKGROUND: Malaria continues to impose a tremendous burden in terms of global morbidity and mortality, yet even today, a large number of diagnoses are presumptive resulting in lack of or inappropriate treatment. METHODS: In this work, a two-colour lateral flow immunoassay (LFA) system was developed to identify infections by Plasmodium spp. and differentiate Plasmodium falciparum infection from the other three human malaria species (Plasmodium vivax, Plasmodium ovale, Plasmodium malariae). To achieve this goal, red and blue colours were encoded to two markers on a single test line of strips, for simultaneous detection of PfHRP2 (red), a marker specific for P. falciparum infection, and pLDH (blue), a pan-specific marker for infections by all species of Plasmodium. The assay performance was first optimized and evaluated with recombinant malarial proteins spiked in washing buffer at various concentrations from 0 to 1000 ng mL-1. The colour profiles developed on the single test line were discriminated and quantified: colour types corresponded to malaria protein species; colour intensities represented protein concentration levels. RESULTS: The limit of detection (the lowest concentrations of malaria antigens that can be distinguished from blank samples) and the limit of colour discrimination (the limit to differentiate pLDH from PfHRP2) were defined for the two-colour assay from the spiked buffer test, and the two limits were 31.2 ng mL-1 and 7.8 ng mL-1, respectively. To further validate the efficacy of the assay, 25 human whole blood frozen samples were tested and successfully validated against ELISA and microscopy results: 15 samples showed malaria negative; 5 samples showed P. falciparum positive; 5 samples showed P. falciparum negative, but contained other malaria species. CONCLUSIONS: The assay provides a simple method to quickly identify and differentiate infection by different malarial parasites at the point-of-need and overcome the physical limitations of traditional LFAs, improving the multiplexing potential for simultaneous detection of various biomarkers.


Assuntos
Testes Diagnósticos de Rotina/métodos , Imunoensaio/métodos , Malária/diagnóstico , Plasmodium/isolamento & purificação , Humanos , Malária/classificação
15.
BMC Public Health ; 19(1): 1148, 2019 Sep 16.
Artigo em Inglês | MEDLINE | ID: mdl-31522680

RESUMO

BACKGROUND: A clear understanding of the epidemiology of malaria and dengue co-infection is essential for informed decisions on appropriate control strategies for dengue and malaria. This systematic review synthesized evidence on the relationship of malaria and dengue co-infection and related it to alterations in platelet, hemoglobin, hematocrit, aspartate aminotransferase (AST), and alanine aminotransferase (ALT) levels when compared to malaria mono-infection. METHODS: A systematic review in accordance with PRISMA guidelines was conducted. All published articles available in PubMed and Web of Science (ISI) databases before October 21, 2017 were recruited. All epidemiological studies except case reports on the prevalence or incidence of malaria and dengue co-infection among patients visiting hospitals with febrile illness were included. Studies that involved conference abstracts, protocols, systematic reviews, only mono-dengue or mono-malaria infections, and only animal or in vitro studies were excluded after screening the titles, abstracts, and body texts. Studies were additionally excluded after full text review when they lacked epidemiologic data on malaria and dengue co-infection. Two reviewers independently screened, reviewed, and assessed all the studies. Cochrane Q (Chi-square) and Moran's I2 were used to assess heterogeneity, and the funnel plot was used to examine publication bias. The summary odds ratio (OR) and 95% confidence intervals (CI) were estimated using a fixed-effects model. Thirteen cross-sectional and two retrospective studies were eligible to be included in the systematic review and meta-analysis. RESULTS: Out of the 2269 citations screened, 15 articles were eligible to be included in the systematic review and meta-analysis. The 15 studies involved 13,798 (10,373 cases with malaria and 3425 with dengue) patients in 9 countries. Thirteen studies compared the incidence and odds of Plasmodium sp. infection, five studies compared the odds of mean platelet, three studies compared Plasmodium parasite density, and four studies compared the odds of hemoglobin, hematocrit, AST, and ALT levels among co-infected groups and single-malaria-infected groups. CONCLUSIONS: This study showed that dengue and malaria co-infection was associated with decreased odds of malaria infection, malaria parasitemia, AST, and ALT levels when compared to malaria mono-infection. However, malaria and dengue co-infection was associated with increased odds of platelet and hemoglobin levels when compared to malaria mono-infection.


Assuntos
Coinfecção , Dengue , Malária , Animais , Coinfecção/epidemiologia , Estudos Transversais , Dengue/diagnóstico , Dengue/epidemiologia , Hematócrito , Hospitais , Humanos , Laboratórios , Malária/diagnóstico , Malária/epidemiologia , Razão de Chances , Parasitemia , Prevalência , Estudos Retrospectivos
16.
PLoS Negl Trop Dis ; 13(9): e0007047, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31487279

RESUMO

BACKGROUND: Pathogens causing acute fever, with the exception of malaria, remain largely unidentified in sub-Saharan Africa, given the local unavailability of diagnostic tests and the broad differential diagnosis. METHODOLOGY: We conducted a cross-sectional study including outpatient acute undifferentiated fever in both children and adults, between November 2015 and June 2016 in Kinshasa, Democratic Republic of Congo. Serological and molecular diagnostic tests for selected arboviral infections were performed on blood, including PCR, NS1-RDT, ELISA and IFA for acute, and ELISA and IFA for past infections. RESULTS: Investigation among 342 patients, aged 2 to 68 years (mean age of 21 years), with acute undifferentiated fever (having no clear focus of infection) revealed 19 (8.1%) acute dengue-caused by DENV-1 and/or DENV-2 -and 2 (0.9%) acute chikungunya infections. Furthermore, 30.2% and 26.4% of participants had been infected in the past with dengue and chikungunya, respectively. We found no evidence of acute Zika nor yellow fever virus infections. 45.3% of patients tested positive on malaria Rapid Diagnostic Test, 87.7% received antimalarial treatment and 64.3% received antibacterial treatment. DISCUSSION: Chikungunya outbreaks have been reported in the study area in the past, so the high seroprevalence is not surprising. However, scarce evidence exists on dengue transmission in Kinshasa and based on our data, circulation is more important than previously reported. Furthermore, our study shows that the prescription of antibiotics, both antibacterial and antimalarial drugs, is rampant. Studies like this one, elucidating the causes of acute fever, may lead to a more considerate and rigorous use of antibiotics. This will not only stem the ever-increasing problem of antimicrobial resistance, but will-ultimately and hopefully-improve the clinical care of outpatients in low-resource settings. TRIAL REGISTRATION: ClinicalTrials.gov NCT02656862.


Assuntos
Febre de Chikungunya/diagnóstico , Dengue/diagnóstico , Febre/diagnóstico , Adolescente , Adulto , Idoso , Febre de Chikungunya/epidemiologia , Febre de Chikungunya/virologia , Vírus Chikungunya/genética , Vírus Chikungunya/isolamento & purificação , Vírus Chikungunya/fisiologia , Criança , Pré-Escolar , Estudos Transversais , República Democrática do Congo/epidemiologia , Dengue/epidemiologia , Dengue/virologia , Vírus da Dengue/genética , Vírus da Dengue/isolamento & purificação , Vírus da Dengue/fisiologia , Feminino , Febre/epidemiologia , Febre/virologia , Humanos , Malária/diagnóstico , Malária/epidemiologia , Masculino , Pessoa de Meia-Idade , Pacientes Ambulatoriais/estatística & dados numéricos , Adulto Jovem
17.
Malar J ; 18(1): 309, 2019 Sep 12.
Artigo em Inglês | MEDLINE | ID: mdl-31514740

RESUMO

BACKGROUND: Intensive malaria transmission along international borders is a significant impediment to malaria elimination in the Greater Mekong Subregion (GMS) of Southeast Asia. Passive case detection (PCD) was used to study the dynamics and trends of malaria transmission at the China-Myanmar border to provide epidemiologic information for improved malaria control. METHODS: PCD was conducted in one hospital and 12 clinics near the Laiza town in northeast Myanmar from 2011 to 2016. Clinical malaria was diagnosed by microscopy and demographic information was captured using a structured questionnaire at the time of the patient's presentation for care. RESULTS: Over the study period, 6175 (19.7%) malaria cases were confirmed by microscopy from 31,326 suspected cases. The four human malaria parasite species were all identified, with Plasmodium vivax and Plasmodium falciparum accounting for 5607 (90.8%) and 481 (7.8%) of the confirmed cases, respectively. In contrast to the steady decline of malaria in the general GMS, the study site had an upward trend of malaria incidence with vivax malaria outbreaks in 2013 and 2016. Adult males, children under the age of 15, and those with occupations such as farming, being a soldier or student, had significantly higher risks of clinical malaria compared to having fevers from other aetiologies. A self-reported history of clinical malaria was also associated with a higher risk of confirmed malaria. CONCLUSIONS: The China-Myanmar border area has experienced an overall upward trend of malaria incidence in recent years with P. vivax becoming the predominant species. Evidence-based control strategies need to focus on high-risk populations.


Assuntos
Malária/epidemiologia , Plasmodium/isolamento & purificação , Fatores Socioeconômicos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Malária/diagnóstico , Masculino , Pessoa de Meia-Idade , Mianmar/epidemiologia , Plasmodium/classificação , Adulto Jovem
18.
Acta Trop ; 200: 105125, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31394079

RESUMO

Highly-sensitive and field-friendly diagnostic tools are needed for accurate detection of low-density malaria infections. Although loop-mediated isothermal amplification (LAMP) fulfills these conditions, operational challenges are still encountered during pilot population screenings in remote settings when employing Loopamp™ MALARIA Pan/Pf detection kit (Eiken Chemical Co.). This study evaluates different procedures for the simplification of sample preparation and result reading steps of current LAMP protocols. The reference 'Boil & Spin' (B&S) pre-amplification procedure was compared to three alternative methods, along with a colorimetric staining protocol based on malachite green. Results suggested that the B&S supernatant transference step may be omitted without an impact on test performance, even when colorimetry was incorporated to facilitate results visualization. Procedures skipping centrifugation and/or heat-incubation were proved to be compatible with LAMP-based malaria DNA detection, but resulted in a low-to-moderate decrease in sensitivity and ambiguous result interpretation for the most straightforward protocol. Nevertheless, all simplified LAMP methods could still reach lower limits of detection than the currently used tools for malaria mass-screening (i.e. microscopy and rapid tests), indicating that these alternative strategies may deserve further consideration. This evaluation, therefore, demonstrates the feasibility of skipping some of the main procedural bottlenecks of LAMP-malaria protocols, a much-needed achievement to make point-of-care implementation of molecular diagnostics a reality.


Assuntos
Testes Diagnósticos de Rotina/métodos , Malária/diagnóstico , Programas de Rastreamento/métodos , Técnicas de Amplificação de Ácido Nucleico/métodos , Plasmodium/isolamento & purificação , Sistemas Automatizados de Assistência Junto ao Leito , Humanos , Projetos Piloto , Sensibilidade e Especificidade
19.
Malar J ; 18(1): 272, 2019 Aug 09.
Artigo em Inglês | MEDLINE | ID: mdl-31399031

RESUMO

BACKGROUND: To assess the occurrence of Plasmodium ovale wallikeri and Plasmodium ovale curtisi species in travellers returning to Germany, two real-time PCR protocols for the detection and differentiation of the two P. ovale species were compared. Results of parasite differentiation were correlated with patient data. METHODS: Residual nucleic acid extractions from EDTA blood samples of patients with P. ovale spp. malaria, collected between 2010 and 2019 at the National Reference Centre for Tropical Pathogens in Germany, were subjected to further parasite discrimination in a retrospective assessment. All samples had been analysed by microscopy and by P. ovale spp.-specific real-time PCR without discrimination on species level. Two different real-time PCR protocols for species discrimination of P. o. curtisi and P. o. wallikeri were carried out. Results were correlated with patient data on gender, age, travel destination, thrombocyte count, and duration of parasite latency. RESULTS: Samples from 77 P. ovale spp. malaria patients were assessed, with a male:female ratio of about 2:1 and a median age of 30 years. Parasitaemia was low, ranging from few visible parasites up to 1% infected erythrocytes. Discriminative real-time PCRs revealed 41 cases of P. o. curtisi and 36 cases of P. o. wallikeri infections. Concordance of results by the two PCR approaches was 100%. Assessment of travel destinations confirmed co-existence of P. o. curtisi and P. o. wallikeri over a wide range of countries in sub-Saharan Africa. Latency periods for the two P. ovale species were similar, with median values of 56.0 days for P. o. curtisi and 58.0 days for P. o. wallikeri; likewise, there was no statistically significant difference in thrombocyte count with median values of 138.5/µL for patients with P. o. curtisi and 152.0/µL for P. o. wallikeri-infected patients. CONCLUSIONS: Two different real-time PCR protocols were found to be suitable for the discrimination of P. o. curtisi and P. o. wallikeri with only minor differences in sensitivity. Due to the overall low parasitaemia and the lack of differences in severity-related aspects like parasite latency periods or thrombocyte counts, this study supports the use of P. ovale spp. PCR without discrimination on species level to confirm the diagnosis and to inform clinical management of malaria in these patients.


Assuntos
Doenças Transmissíveis Importadas/diagnóstico , Malária/diagnóstico , Plasmodium ovale/isolamento & purificação , Reação em Cadeia da Polimerase em Tempo Real/métodos , Adolescente , Adulto , Criança , Pré-Escolar , Doenças Transmissíveis Importadas/classificação , Doenças Transmissíveis Importadas/prevenção & controle , Estudos Transversais , Feminino , Alemanha , Humanos , Malária/classificação , Malária/prevenção & controle , Masculino , Pessoa de Meia-Idade , Plasmodium ovale/classificação , Plasmodium ovale/genética , Estudos Retrospectivos , Viagem , Adulto Jovem
20.
Med Sante Trop ; 29(2): 159-163, 2019 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-31379341

RESUMO

Morocco does not record any indigenous malaria case since 2004 and is certified by the World Health Organization as malaria-free since 2010. However, the country continues to record a significant number of imported malaria cases from endemic areas, especially from West Africa. The purpose of our work is to determine the epidemiological and diagnostic characteristics of malaria cases diagnosed at Ibn Sina Hospital Center in Rabat, Morocco. This work is a retrospective study of a series of malaria cases diagnosed between January 2012 and December 2016 at the Central Laboratory of Parasitology and Mycology of Ibn Sina Hospital Center. The methods used for the parasitological diagnosis are the search for the parasite at direct examination on thin blood film and thick drop and the search for parasite antigens by a rapid diagnostic immunochromatographic test (OptiMAL-IT® kit). Of 192 patients in whom malaria was sought, we recorded 54 positive cases (average of 10.8 cases per year). The prevalence was 28.12%. The age ranged from 4 to 76 years (average of 29.5 years). The sex ratio was 2.6. All cases had in their antecedents a notion of recent travel in an endemic area. The most common travel area was West Africa: Ivory Coast, with 31.43% of cases, followed by Guinea, with 14.29% of cases. The symptomatology was dominated by fever in 52 patients (96.3% of cases), followed by headache in 22 cases (40.74%). Anemia was present in 7 and thrombocytopenia in 12 patients. The most isolated species was Plasmodium falciparum (84.21% of cases), followed by P. vivax (10.53% of cases) and P. ovale (5.26% of cases). One case involved two species: P. falciparum and P. vivax. Parasitaemia was between less than 0.1 and 20%. Despite the local eradication of malaria, the persistence of imported cases, mainly due to the lack of chemoprophylaxis, should call for the strengthening of health education of travelers, especially in endemic areas.


Assuntos
Doenças Transmissíveis Importadas/diagnóstico , Doenças Transmissíveis Importadas/epidemiologia , Malária/diagnóstico , Malária/epidemiologia , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Hospitais , Humanos , Masculino , Pessoa de Meia-Idade , Marrocos/epidemiologia , Estudos Retrospectivos , Adulto Jovem
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