Malaria grave en mujeres gestantes hospitalizadas entre el 2010 y el 2014 en el departamento de Antioquia, Colombia / Severe malaria in pregnant women hospitalized between 2010 and 2014 in the Department of Antioquia (Colombia)

Resumen Introducción. La malaria (o paludismo) durante la gestación impacta negativamente la salud de la madre y del neonato, con alto riesgo de complicaciones clínicas y mortalidad. En las regiones de alta endemia se han caracterizado, especialmente, la anemia materna y el bajo peso al nacer, pero es poco conocido el espectro clínico en las zonas de baja endemia. Objetivo. Caracterizar clínica y epidemiológicamente los episodios de malaria en mujeres gestantes hospitalizadas en el departamento de Antioquia entre el 2010 y el 2014. Materiales y métodos. Se hizo un estudio descriptivo, transversal y retrospectivo, con historias clínicas de mujeres gestantes con malaria por Plasmodium falciparum y P. vivax. Se utilizaron los criterios diagnósticos de malaria complicada de la Organización Mundial de la Salud (OMS) y de la Guía para la atención clínica integral del paciente con malaria vigente en Colombia. Resultados. Se analizaron 111 casos; el 13,5 % se clasificó como complicación grave según los criterios de la OMS, porcentaje que ascendió a 23,4 % según los criterios de la guía colombiana. Las complicaciones detectadas fueron disfunción hepática, anemia, acidosis y trombocitopenia grave. No se observó diferencia en la frecuencia de las complicaciones según la especie de plasmodio. El 39,4 % de los casos presentó signos generales de peligro; la palidez y la ictericia fueron los más frecuentes. El 40,5 % presentó signos de peligro para la gestación como la cefalea persistente, el dolor abdominal y el sangrado vaginal. Conclusiones. La malaria grave se presenta con gran frecuencia en las mujeres gestantes, sin diferencia según la especie de plasmodio, y se manifiesta con signos de peligro precozmente reconocibles. Se encontró un subregistro hospitalario del 88 % de los casos graves y falta de exámenes de laboratorio para un diagnóstico más completo. Se requiere un protocolo para el diagnóstico clínico de las mujeres gestantes con malaria.

Abstract Introduction: Malaria during pregnancy has a negative impact on maternal-neonatal health, with a high risk of clinic complications and mortality. High endemic areas are specially characterized by maternal anaemia and low birth weight. The clinical spectrum is little known in low endemic areas. Objective: To clinically and epidemiologically characterize malaria episodes in hospitalized pregnant women in the Department of Antioquia (Colombia) in the period 2010-2014. Materials and methods: Retrospective, cross-sectional, descriptive study with medical records of pregnant women with P. falciparum and P. vivax malaria. The WHO severe malaria diagnostic criteria and the Colombian Guía para la atención clínica integral del paciente con malaria (guidelines for comprehensive malaria treatment) were used. Results: We analyzed 111 cases, out of which 13.5% were classified as severe malaria according to the WHO criteria. Following the Colombian Guidelines, the proportion increased to 23.4%. Identified complications included hepatic dysfunction, anaemia, acidosis, and severe thrombocytopenia. No difference in the frequency of complications by Plasmodium species was observed; 39.4% of the cases presented general danger signs, pallor and jaundice being the most frequent; 40.5% showed danger signs for pregnancy, such as persistent headache, abdominal pain, and vaginal bleeding. Conclusions: Severe malaria is a highly frequent event in pregnant women, without differences by Plasmodium species. It shows early recognizable dangers signs. Hospital under-reporting was identified in 88% of severe cases as well as a lack of laboratory tests for a more comprehensive diagnosis. A protocol for the clinical diagnosis of pregnant women with malaria is required.

Basic sanitation, socioeconomic conditions, and degree of risk for the presence and maintenance of malaria in a low-transmission area in the Brazilian Amazon

ABSTRACTINTRODUCTION:This study aimed to evaluate basic sanitation and socioeconomic indicators, reported cases of malaria, and risk of contracting malaria in the Ananindeua municipality, State of Pará.METHODS:Data on basic sanitation and socioeconomic dimensions were taken from the Brazilian Institute of Geography and Statistics [ Instituto Brasileiro de Geografia e Estatística (IBGE)] 2010 census. Epidemiological malaria information was taken from the Epidemiological Malaria Surveillance Information System [ Sistema de Informação de Vigilância Epidemiológica de Malária (SIVEP/Malaria)], between 2003 and 2013 of the Ministry of Health and from the SIVEP/Malaria forms of the municipality's Endemic Diseases Unit for 2,013 cases.RESULTS:Our data do not confirm the correlation among indicators of basic sanitation, socioeconomic conditions, and water supply with malaria cases. Of the 1,557 cases evaluated, most were caused by Plasmodium vivax , with rare cases of Plasmodium falciparum and mixed infections. There were 756 notifications in 2003. The number of reported cases was sharply reduced between 2006 and 2012, but a 142-case outbreak occurred in 2013. Ananindeua municipality's Annual Parasite Index indicated low risk in 2003 and no risk in other years, and the 2,013 cases were predominantly male individuals aged ≥40 years.CONCLUSIONS:Our data confirm the non-endemicity of malaria in the Ananindeua municipality, as the Annual Parasite Indices described for the years 2004-2013 classify it as a risk-free area. However, the 2013 outbreak indicates the need to strengthen prevention, surveillance, and control activities to reduce the risk of new outbreaks and consequent economic and social impacts on the population.

Malaria in the state of Rio de Janeiro, Brazil, an Atlantic Forest area: an assessment using the health surveillance service

The lethality of malaria in the extra-Amazonian region is more than 70 times higher than in Amazonia itself. Recently, several studies have shown that autochthonous malaria is not a rare event in the Brazilian southeastern states in the Atlantic Forest biome. Information about autochthonous malaria in the state of Rio de Janeiro (RJ) is scarce. This study aims to assess malaria cases reported to the Health Surveillance System of the State of Rio de Janeiro between 2000-2010. An average of 90 cases per year had parasitological malaria confirmation by thick smear. The number of malaria notifications due to Plasmodium falciparum increased over time. Imported cases reported during the period studied were spread among 51% of the municipalities (counties) of the state. Only 35 cases (4.3%) were autochthonous, which represents an average of 3.8 new cases per year. Eleven municipalities reported autochthonous cases; within these, six could be characterised as areas of residual or new foci of malaria from the Atlantic Forest system. The other 28 municipalities could become receptive for transmission reintroduction. Cases occurred during all periods of the year, but 62.9% of cases were in the first semester of each year. Assessing vulnerability and receptivity conditions and vector ecology is imperative to establish the real risk of malaria reintroduction in RJ.

Plasmodium vivax malaria: related factors to severity in the State of Maranhão, Brazil

INTRODUCTION: Malaria caused by Plasmodium vivax species has shown signs of severity, recorded with increasing frequency in the medical literature. This study aimed to characterize the signs of severe malaria by Plasmodium vivax in the State of Maranhão, Brazil. METHODS: A descriptive cohort study of patients assisted in the field and a historical and concurrent study of a series of cases among hospitalized patients were undertaken to identify the clinical and laboratory signs of severity. RESULTS: A total of 153 patients were included in the study, 13 of whom were hospitalized. Males made up the majority, numbering 103 (67.3%). The age of the patients ranged from 10 to 70 years, 92.2% were natives of the State of Maranhão, and 65% of the patients had had malaria before. The average time elapsed between symptom onset and diagnosis among outpatients was three days, while among hospitalized patients this average reached 15.5 days, a statistically significant difference (p=0.001). The parasitemia ranged from 500 to 10,000 parasites/µl in 92.8% of cases. The clinical and laboratory manifestations of severity were vomiting and diarrhea, jaundice, drowsiness, mental confusion, seizures, loss of consciousness, agitation, bleeding, pale skin, coughing and dyspnea, thrombocytopenia, anemia, elevation of nitrogenous compounds, and elevated transaminases and bilirubin. CONCLUSIONS: The monitoring of malaria patients with Plasmodium vivax showed the possibility of aggravation, the intensity of which varied in different circumstances, especially the interval time between falling ill and diagnostic confirmation.

Expansão urbana e distribuição espacial da malária no município de Manaus, Estado do Amazonas / Urban expansion and spatial distribution of malaria in the municipality of Manaus, State of Amazonas

No município de Manaus, a intensificação do processo migratório, aliada a precária vigilância epidemiológica e entomológica, resultou na reintrodução da transmissão de malária no perímetro urbano, zona Leste, em julho de 1988, após 13 anos sem registro de autoctonia. Este estudo descreve sobre a situação epidemiológica da malária e áreas que sofreram ações antrópicas (desmatamento, assentamentos humanos, atividades de piscicultura, etc.) em Manaus, no período entre 1986 e 2005. Nesse Município, o incremento populacional em 2005 atingiu 105,2 por cento, em relação a 1986, resultado de ocupação dos espaços (invasões e conjuntos habitacionais). A partir de 2003, a doença teve incremento acima 2.000 por cento em relação a 1986. Nessas áreas ocorreu aumento da incidência da doença. O índice parasitário anual no Município oscilou de baixo a médio risco, e entre as zonas urbanas, variou de sem risco a alto risco. As zonas Leste, Oeste e Norte onde ainda existem áreas com características rurais apresentaram maior receptividade e vulnerabilidade de transmissão.

In the municipality of Manaus, intensification of the migratory process, along with precarious epidemiological and entomological surveillance, resulted in reintroduction of malaria transmission on the urban perimeter (in the eastern zone), in July 1988, after 13 years without any records of autochthonous disease. This study reports on the epidemiological situation relating to malaria and to the areas that were subjected to human actions (deforestation, human settlement, fish-rearing activity, etc) in Manaus, between 1986 and 2005. In this municipality, the population increase from 1986 to 2005 was 105.2 percent. This resulted from occupation of space, in the form of invasions and housing projects. From 2003, the increase in relation to 1986 was more than 2,000 percent. In these areas, there were increases in disease incidence. The annual parasitic index in the municipality ranged from low to medium risk and, between urban zones, it ranged from no risk to high risk. In the eastern, western and northern zones, which still contain areas with agricultural characteristics, there was greater receptivity and vulnerability to transmission.

Malária e aspectos hematológicos em moradores da área de influência dos futuros reservatórios das hidrelétricas de Santo Antônio e Jirau, Rondônia, Brasil / Malaria and hematological aspects among residents to be impacted by reservoirs for the Santo Antônio and Jirau Hydroelectric Power Stations, Rondônia State, Brazil

Em Rondônia, prevê-se a construção de mais duas usinas hidrelétricas (UHE) no rio Madeira, a montante da cidade de Porto Velho, Rondônia, Brasil (de Santo Antônio e Jirau). O objetivo deste trabalho foi analisar a prevalência da malária antes do início da implantação das obras civis e fazer considerações sobre os impactos da doença com o ingresso de milhares de trabalhadores e agregados atraídos pelas oportunidades de emprego e comércio. Os resultados obtidos mostram que a malária se faz presente em toda região, em variados graus de prevalência. Além disso, a existência de potenciais portadores assintomáticos de malária entre a população nativa pode ter relevância epidemiológica e deve ser considerada nos programas de controle da malária, vinda tanto das autoridades públicas quanto das empresas responsáveis pela instalação das UHE, visando o diagnóstico e tratamento precoce, controle vetorial, abastecimento de água e aplicação de infra-estrutura nos centros urbanos.

In Rondônia State, Brazil, two new hydroelectric plants, Santo Antônio and Jirau, are scheduled for construction on the Madeira River, upriver from the State capital, Porto Velho. The current study analyzes malaria prevalence before the construction and provides information on the possible impacts of malaria burden related to the influx of thousands of persons attracted by direct and indirect employment opportunities. According to the findings, malaria is present throughout the region, with varying prevalence rates. The existence of potential asymptomatic malaria carriers among the local population may be epidemiologically relevant and should be considered in the malaria control programs organized by public authorities and companies responsible for building the power plants, aimed at early diagnosis and treatment, vector control, water supply, and infrastructure in the urban areas.

Fatores socioambientais associados à distribuição espacial de malária no assentamento Vale do Amanhecer, Município de Juruena, Estado de Mato Grosso, 2005 / Socioenvironmental factors associated with the spatial distribution of malaria in the Vale do Amanhecer settlement, Municipality of Juruena, State of Mato Grosso, 2005

Malaria é uma doença de distribuição focal. No Brasil, áreas de assentamento e garimpos de ouro na Amazônia Legal apresentam grande concentração de casos. Este artigo analisa a distribuição espacial de casos de malária, considerando fatores ambientais e sociais, no assentamento Vale do Amanhecer, Município de Juruena, Mato Grosso, Brasil. Em 2005, notificou-se 359 casos autóctones no assentamento e pelo método de Kernel identificaram-se áreas de maior e menor intensidade de número de casos. As áreas de maior intensidade apresentaram 290 casos e na de menor intensidade 64 casos. A intensidade da distribuição variou no assentamento, indicando áreas de grande intensidade de casos favoráveis para transmissão como área de garimpos. Assim, apesar de assentamentos serem considerados como foco de malária, existem no seu interior, especificidades que, uma vez identificadas, podem contribuir para o controle da doença.

Malaria is a disease with focal distribution. In Brazil, settlement and gold mining areas in the Legal Amazon region present a great concentration of cases. This paper analyzes the spatial distribution of malaria cases taking into consideration environmental and social factors in the Vale do Amanhecer settlement in the municipality of Juruena, Mato Grosso, Brazil. In 2005, 359 autochthonous cases were notified in the settlement. Using the Kernel method, areas of greater and lesser intensities of case numbers were identified. The areas of greater intensity presented 290 cases and those of lesser intensity, 64 cases. The intensity of distribution varied within the settlement, thus indicating areas of great intensity of cases favoring transmission, like gold mining areas. Therefore, although the settlement was considered to be the main focus for malaria, there were specific factors within it that, once identified, could contribute towards the disease control.

Aspectos epidemiológicos de malária autóctone na mata atlântica, litoral norte, Estado de São Paulo, 1985 - 2006 / Epidemiological aspects of autochthonous malaria in the Atlantic forest area of the northern coast of the State of São Paulo, 1985 - 2006

Com o objetivo analisar a distribuição espacial e temporal de casos de malária autóctone, segundo: densidade parasitária, sintomas e atividade por ocasião da infecção. Foi feito estudo descritivo retrospectivo de 1985 a 2006, nos municípios de Ubatuba, Caraguatatuba, São Sebastião e Ilhabela. Os dados foram obtidos na ficha de investigação epidemiológica da Superintendência de Controle de Endemias e Sistema de Informação de Notificação de Agravos à Saúde. Dos 83 casos, 77 por cento eram do sexo masculino. São Sebastião e Caraguatatuba apresentaram maior número de casos. Os indivíduos mais acometidos encontraram-se em idade produtiva com Plasmodium vivax, e densidade parasitária de um parasita a cada dois ou mais campos microscópicos. Lazer foi a atividade mais exercida pelos pacientes por ocasião da infecção. Os principais sintomas foram febre, cefaléia, sudorese e mialgia. Foram registrados 4 indivíduos assintomáticos. Esses dados devem contribuir para a melhoria das ações de descentralização do controle da malária na região considerando-a na suspeita clínica e/ou epidemiológica, laboratório de referência e recursos humanos treinados para o diagnóstico e tratamentos adequados.

This study had the aim of analyzing the spatial and temporal distribution of autochthonous malaria cases according to parasite density, symptoms and activity at the time of infection. A retrospective descriptive study was undertaken in the municipalities of Ubatuba, Caraguatatuba, São Sebastião and Ilhabela, covering 1985 to 2006. The data were obtained from the epidemiological investigation files of the Superintendency of Endemic Disease Control and the Information System for Health Threat Notification. Out of the 83 cases notified, 77 percent were male. São Sebastião and Caraguatatuba presented the largest numbers of cases. The individuals most affected with Plasmodium vivax were at productive ages, with a parasite density of one parasite for every two or more microscope fields. At the time of becoming infected, these patients were mostly doing leisure activities. The main symptoms were fever, headache, sweating and myalgia. Four asymptomatic cases were detected. These data are expected to contribute towards improving the decentralized malaria control actions in the region, through considering malaria among the clinical and/or epidemiological suspicions, with a reference laboratory and trained personnel for adequate diagnosis and treatment.

Malaria in Colombia: retrospective glance during the past 40 years

Objective: Describe and analyze the structural configuration of malaria in Colombia since 1960 to 2004 where the phenomena of persistence, resurgence and resistance as well as the main determinants associated to these phenomena. Methods A comparative study of the history of malaria and its trend was conducted in Colombia since 1960-2004. Secondary and primary information about the frequency and spatial distribution of malaria was collected. The sub period were identified according to institutional transformation and malaria control strategies as well as the socioeconomic and sociopolitical conjuncture factors in the country. Results The structural and situational analyses of malaria in Colombia shown a steadily increase in morbidity from an average API 2,19 x 1 000 in 1960-74 to 8,92 by 1994-2004. Since the middle 70's there has been a considerable reduction of mortality. The malaria case relation P. vivax vs. P. falciparum is 3 to 5, respectively. The Annual Positive Sample Rate increased during the same study periods from 3,96 percent to 29,93 percent. Unfortunately the Annual Blood Examination Rate-ABER decreased by fewer than 5 percent, instead of increase to minimum required for detection of malaria. Conclusions During the National Eradication Malaria Service the malaria decreased steadily by the first five years, unfortunately the disease present resurgence, persistence after the reduction of financial and technical support from international health agencies in the middle seventies. Nowadays, around 85 percent of the territory, mainly rural areas are endemic for malaria. In spite of the transformation of the health system and different strategies implemented against malaria, it continues being one of the priorities in the public health services of Colombia.

Objetivo: Describir y analizar la configuración estructural de malaria en Colombia desde 1960 a 2004 considerando los fenómenos de persistencia, resurgimiento y resistencia y los principales determinantes asociados. Métodos Se realizo un estudio comparativo de la historia de malaria y su tendencia en Colombia desde 1960-2004. Se realizo una búsqueda de información primaria y secundaria sobre la frecuencia y la distribución espacial de malaria. Los periodos fueron identificados según la transformación institucional y estrategias de control/erradicación de malaria así como elementos coyunturales socio-económicos y sociopolíticos asociados al mismo periodo de estudio. Resultados El análisis estructural y situacional de la malaria en Colombia muestra un considerable aumento en la mortalidad de IPA de 2,19 x 1 000 en 1960-74 a un IPA de 8,9 entre 1994-2004. Desde mediados de los 70 ha habido una reducción considerable de mortalidad. La relación de caso de malaria de P. vivax versus P. falciparum es 3 a 5, respectivamente. El índice Anual de Muestra Positiva aumentó durante los mismos períodos del estudio de 3,96 por ciento a 29,9 por ciento. Sin embargo, el índice Anual de Muestras Examinadas disminuyó por debajo del 5 por ciento, manteniendo los valores mínimos requeridos para el control. Conclusiones Durante el Servicio de Erradicación de la Malaria la malaria disminuyó durante el primer ciclo. Desafortunadamente se presento el resurgimiento y persistencia desde mediados de los setenta después de la reducción de apoyo financiero y técnico de las agencias de salud internacionales. Actualmente, en el 85 por ciento del territorio, principalmente en áreas rurales, la malaria es endémica. A pesar de la transformación del sistema de salud y las estrategias implementadas contra la malaria, ésta continúa siendo uno de las prioridades en los servicios de salud pública de Colombia.

Malaria por Plasmodium vivax: aspectos clínicos y hematológicos / Malaria due to Plasmodium vivax. Clinical and hematological aspects

Se reportan los hallazgos clínicos, de laboratorio e histopatológicos, presentes en 20 pacientes que ingresaron al Hospital Hipólito Unanue en el año 1984, con el diagnóstico de malaria. Se revisa la fisiopatología con énfasis en los casos de malaria por Plasmodium vivax. El agente etiológico más frecuente, en esta serie, fue el Plasmodium vivax ( 19 pacientes ). Fiebre y escalofrío se presentó en el 100 por ciento, hepatomegalia en el 90 por ciento, esplenomegalia en el 70 por ciento, ictericia en el 30 por ciento, esta última fue muy severa en un caso asociada a hepatitis crónica activa. La anemia que se observó en el 85 por ciento, fue de origen multifactorial; la trombocitopenia estuvo presente en el 83.3 por ciento de casos, rara vez se acompañó de sangrado. Otros hallazgos fueron: linfopenia ( 70 por ciento ), leucopenia leve ( 45 por ciento ), neutropenia leve ( 35 por ciento ). La histopatología en médula ósea mostró: hiperplasia de las tres series y cambios reactivos inespecíficos. En hígado encontramos: depósito de pigmento malárico en el 42.8 por ciento de casos. Dada las actuales condiciones sanitarias y epidemiológicas del país, es impostergable reforzar la lucha contra esta enfermedad