Malaria outbreak in users of injectable drugs

An outbreak of Plasmodium vivax malaria among drug addicts in Bauru, S. Paulo State, Brazil, is reported. Until July 1989, 12 cases had been confirmed by thick smear examinations and 20 contacts were being investigated. All of them reported frequent use of intravenous cocaine and sharing of needles and syringes but deny having travelled through endemic malarial areas.     

Risk factors for HIV infection in drug addicts from the northeast of Italy

Prevalence and determinants of HIV infection were assessed in 313 parenteral drug addicts admitted to five Centers for Drug-Addict Assistance and two prisons located in the northeast of Italy (Friuli Venezia-Giulia), an area some distance from the major Italian cities first reached by the AIDS epidemic. The overall prevalence of HIV positivity was also rather high in this area, ie 30% with 24-36% confidence interval. The most important risk factors (besides syringe sharing applicable to all drug addicts), turned out to be of a geographical nature, ie living in Pordenone province (where a US military base is located) or coming from other endemic areas and having travelled long distances in the past three years. Prostitution also seemed to increase the risk of infection, but duration of drug addiction had little effect. In addition to persistent generalized lymphadenopathy (closely linked to HIV infection), reversal of helper:suppressor T-cell ratio was found in 67% of HIV positive individuals, but also in 31% of HIV negative ones. Clinical signs and symptoms strongly linked with HIV positivity were fatigue, weight loss, splenomegaly, fever and nocturnal sweats.     

靖江市2002～2004年疟疾监测结果分析

[目的]为了解灭疟后期疟疾疫情情况。[方法]对2002～2004年靖江市疟疾监测结果进行分析。[结果]2002～2004年疟疾本地感染25例,流动人口感染10例,其中间日疟34例,恶性疟1例;“三热”病人血检7472人,血检疟原虫阳性6人。IFA检测1200人,阳性33人。[结论]本地和流动人口每年均有疟疾发生,防治疟疾工作应本地和流动人口并重。     

Patient-to-patient transmission of nosocomial malaria in Italy.

OBJECTIVE: To describe nosocomial transmission of malaria from patient to patient via blood exposure. PATIENTS: A 56-year-old man was admitted to an Italian hospital with fever and Plasmodium falciparum parasitemia, but with no risk factors for malaria. Twenty days earlier, he had been admitted for bronchopulmonary disease to the hospital's intensive care unit, where a woman with P. falciparum malaria acquired abroad was present. METHODS: We reviewed both patients' medical records and searched for mosquitoes in the hospital and on the grounds. We interviewed the staff about patient care practices potentially involving contact with blood. The genetic identities of strains were determined by genotyping of the DNA extracted from blood. RESULTS: Molecular genotyping showed that the two strains were identical. The only invasive procedures performed on both patients by the same staff on the same shift were capillary blood sampling by finger stick, intravenous drug administration, and substitution of total parenteral nutrition bags and intravenous sets. The fingerstick device used was designed to prevent person-to-person transmission of blood-borne infections, and the staff interviews did not reveal any incorrect use of aseptic techniques. The likely source of infection was identified during a training course 6 months later: a nurse reported that, when collecting blood, she placed patients' fingers directly on the blood glucose meter, a practice she had learned from a poster advertising the device. CONCLUSIONS: A nosocomial case of malaria was ascertained, which was likely due to patient-to-patient transmission via a contaminated blood glucose meter. Incomplete instructions for the meter seem to have played a role in this case.     

汉川市美沙酮门诊海洛因成瘾者基本情况调查

目的了解汉川市美沙酮维持治疗门诊海洛因成瘾者的人口学及行为学特征,为制定干预措施提供依据。方法对自愿接受美沙酮维持治疗的230名海洛因成瘾者采用社区药物维持治疗评估基线调查。结果海洛因成瘾者中男性占79.57%,40岁及以下者占73.48%,未婚和离异者占55.66%,初中及以下文化程度者占70.87%,无业或待业者占80.87%。毒资花费每天50～1 500元,平均(380.78±268.14)元;过去1个月内76.52%的成瘾者有注射吸毒行为,13.91%的成瘾者共用过注射器。161人(70.00%)有过性行为,多性伴比例占13.66%,21.74%在最近1次性行为时使用了安全套。丙型肝炎病毒(HCV)阳性率62.17%,艾滋病病毒(HIV)阳性率6.52%。过去3个月内37.83%的成瘾者因为吸毒而有过偷、抢、骗等行为,71.74%与家人居住,51.31%自我感觉与家人关系较差。结论进入美沙酮门诊接受治疗的吸毒者为艾滋病的高危人群,应开展积极的健康教育和有效的行为干预措施,阻断艾滋病经吸毒传播。     

Clinical-parasitological response and in-vitro sensitivity of Plasmodium vivax to chloroquine and quinine on the western border of Thailand

This study was conducted during 2002-2004 at Mae Sot District, on the Thai-Myanmar border, an area of multidrug-resistant Plasmodium falciparum malaria. Sixty-two patients with P. vivax malaria were included in the study. All were randomized into two groups to receive a 3-day regimen of chloroquine or a 3-day regimen of quinine. Primaquine was given to patients in both groups for the elimination of hepatic stages. Results from the present study suggest that the standard regimen of chloroquine and a 3-day course of quinine at the dose regimens under investigation were very effective and well tolerated for the treatment of P. vivax malaria in this area. All patients responded well to both drug regimens; the cure rates with chloroquine or quinine, when given concurrently with the tissue schizontocidal drug primaquine, were virtually 100% within 28 days of follow-up. No significant correlations between parasite clearance time (PCT) or fever clearance time (FCT) and inhibitory concentration 50 (IC50) were found. Patients who had PCT < or = 24 h and those with PCT >24 h had comparable IC50 to chloroquine (alone and plus primaquine) and quinine, as well as similar concentrations of chloroquine/desethylchloroquine (in blood) or quinine (in plasma) at the investigated time points.     

Clinical and epidemiological profiles of severe malaria in children from Delhi, India

Plasmodium vivax is traditionally known to cause benign tertian malaria, although recent reports suggest that P. vivax can also cause severe life-threatening disease analogous to severe infection due to P. falciparum. There are limited published data on the clinical and epidemiological profiles of children suffering from 'severe malaria' in an urban setting of India. To assess the clinical and epidemiological profiles of children with severe malaria, a prospective study was carried out during June 2008-December 2008 in the Department of Pediatrics, Guru Teg Bahadur Hospital, a tertiary hospital located in East Delhi, India. Data on children aged < or = 12 years, diagnosed with severe malaria, were analyzed for their demographic, clinical and laboratory parameters. All patients were categorized and treated as per the guidelines of the World Health Organization. In total, 1,680 children were screened for malaria at the paediatric outpatient and casualty facilities of the hospital. Thirty-eight children tested positive for malaria on peripheral smear examination (2.26% slide positivity rate). Of these, 27 (71%) were admitted and categorized as severe malaria as per the definition of the WHO while another 11 (29%) received treatment on outpatient basis. Most (24/27; 88.8%) cases of severe malaria (n=27) were infected with P. vivax. Among the cases of severe malaria caused by Plasmodium vivax (n=24), 12 (50%) presented with altered sensorium (cerebral malaria), seven (29.1%) had severe anaemia (haemoglobin <5 g/dL), and 17 (70.8%) had thrombocytopaenia, of which two had spontaneous bleeding (epistaxis). Cases of severe vivax malaria are clinically indistinguishable from severe falciparum malaria. Our study demonstrated that majority (88.8%) of severe malaria cases in children from Delhi and adjoining districts of Uttar Pradesh were due to P. vivax-associated infection. P. vivax should, thus, be regarded as an important causative agent for severe malaria in children.     

A case of intravenous and oral mefenamic acid poisoning

A 22 year old heroin addict was admitted with tonic-clonic seizures, confusion and agitation 10 hours after taking mefenamic acid 5 grams orally and 2.25 grams intravenously. This appears to be the first recorded case of intravenous mefenamic acid abuse and, although not fatal, is a cause of concern. This is a commonly used drug and its seizure inducing potential is well recognised. It may therefore be worthwhile considering the possibility of intravenous abuse of mefenamic acid in heroin addicts admitted with confusion or seizures.     

湖南郴州市疟疾流行及基本消灭疟疾后的防治效果分析

目的　分析疟疾流行及基本消灭疟疾后的防治效果 ,为进一步巩固灭疟成果提供依据。方法　收集历年疟疾防治资料 ,进行疟疾病原学、免疫学和昆虫学监测 ,处理疟疾疫点。结果　 2 0世纪 5 0年代居民原虫率最高达83 .8% ,发病率达 82 98.92 /10万。经过几十年的反复查治 ,疟疾年发病率逐年下降 ,1977年降至 6.3 6/10万。 1987年经湖南省卫生厅考核 ,确认达到基本消灭疟疾标准。 1987～ 2 0 0 2年发热病人血检 5 742 6例 ,查出疟原虫阳性 15 63例 ,其中间日疟 15 3 8例 ,恶性疟 2 3例 ,间日疟与恶性疟混合感染 1例 ,三日疟 1例。 1987～ 2 0 0 2年疟疾年发病率 0 .0 4/10万～6.72 /10万 ,并呈逐年下降趋势 ,输入性疟疾占总病例数的 94.2 8% (15 15 /160 7)。通过对现症病人根治 ,结合流行季节周围人群预防服药和灭蚊工作 ,未发现二代病例和健康带虫者。结论　郴州市基本消灭疟疾后病例以输入性为主 ,但不能排除本地还有疟疾传播。在今后的疟疾防治工作中 ,应加强对进入高疟区回归人群的监测 ,巩固灭疟成果。     

2004-2016年龙岩市疟疾流行病学监测结果分析

目的 分析2004-2016年龙岩市疟疾监测资料,为消除疟疾后防控略制定提供依据。方法 收集并分析2004-2016年疟疾病例、“三热”病人血检、媒介和人群知晓率调查资料。结果 2004-2016年报告疟疾病例40例,均为输入性病例,东南亚及非洲国家感染34例占85.00%(34/40),间日疟24例占60.00%(24/40),恶性疟6例占15.00%(6/40),间日疟恶性疟复合感染8例占20.00%(8/40),“三热病人”血检阳性者均为主动求诊疑似疟疾病例,中华按蚊种群构成1.52％,未发现嗜人按蚊和微小按蚊,人群防治知识知晓率为35.47%。结论 龙岩市2004年以来疟疾病例均为输入性,东南亚及非洲国家归国人员是病例侦查发现传染源主要对象,提高医疗机构“三热病人”血检效率及时发现治疗病例和加强大众人群的健康宣教,是巩固消除疟疾成果的关键。     

海洛因依赖者肝功能损害因素分析

目的调查温州市海洛因依赖者肝功能水平及其影响因素。方法对温州市戒毒所684例海洛因依赖者的ALT、AST等指标进行测定．并与同期在温州市体检中心健康体检的717名正常人群进行比较。结果海洛因依赖者戒毒期ALT和AST水平、肝功能异常率显著高于正常人群（P〈0．001）,静脉吸毒组的ALT和AST水平、肝功能异常率均显著高于烫吸组（P〈0．001）;单因素分析显示吸毒时间、每天吸毒剂量与ALT呈正相关（P〈0．05）,血糖与ALT呈负相关（P〈0．001）,TG、TC、LDL-C与ALT、AST呈负相关（P〈0．05,P〈0．001）,HDL-C与ALT、AST呈正相关（P〈0．05）;多因素非条件Logistic回归分析显示ALT异常与吸毒时间、吸毒方式、血糖有关,AST异常与吸毒方式、血脂有关。结论温州市海洛因依赖者转氨酶水平、肝功能异常患病率均显著高于正常人群,可能与长时间吸毒、静脉吸毒方式、低血糖、低甘油三酯等有关。     

Drug czar seeks new emphasis on methadone treatment

Barry McCaffrey, the White House drug policy director, called for improved methadone maintenance treatment programs for heroin addicts. McCaffrey referred to the incarceration of heroin addicts as a failed social policy. Speaking at a heroin addiction conference sponsored by the National Institute of Drug Abuse, McCaffrey told participants that heroin addicts who are not enrolled in methadone treatment programs are exposed to HIV infection through shared drug needles and unprotected sexual relations.     

Malaria surveillance--United States, 1998.

PROBLEM/CONDITION: Human malaria is caused by one or more of four species of intraerythrocytic protozoa of the genus Plasmodium (i.e., P. falciparum, P. vivax, P. ovale, or P. malariae). The protozoa are transmitted by the bite of an infective female Anopheles species mosquito. The majority of malaria infections in the United States occur among persons who have traveled to areas with endemic transmission. Cases occasionally occur that are acquired through exposure to infected blood products, by congenital transmission, or by local mosquitoborne transmission. Malaria surveillance is conducted to identify episodes of local transmission and to guide prevention recommendations for travelers. REPORTING PERIOD: Cases with an onset of symptoms during 1998. DESCRIPTION OF SYSTEM: Malaria cases confirmed by blood smear are reported to local and state health departments by health-care providers and laboratory staff members. Case investigations are conducted by local and state health departments, and reports are sent to CDC through the National Malaria Surveillance System (NMSS). This report uses NMSS data. RESULTS: CDC received reports of 1,227 cases of malaria with onsets of symptoms in 1998, among persons in the United States and its territories. This number represents a decrease of 20.5% from the 1,544 cases reported during 1997. P. falciparum, P. vivax, P. malariae, and P. ovale were identified in 42.8%, 37.8%, 3.5%, and 2.1% of cases, respectively. More than one species was present in seven patients (0.6% of total). The infecting species was not determined in 162 (13.2%) cases. Compared with reported cases in 1997, reported malaria cases acquired in Africa increased by 1.3% (n = 706); those acquired in Asia decreased by 52.1% (n = 239); and those acquired in the Americas decreased by 6.5% (n = 229). Of 636 U.S. civilians who acquired malaria abroad, 126 (19.8%) reportedly had followed a chemoprophylactic drug regimen recommended by CDC for the area to which they had traveled. Five persons became infected in the United States. One case was congenitally acquired; one was acquired by blood transfusion; and three were isolated cases that could not be epidemiologically linked to another case. Four deaths were attributed to malaria. INTERPRETATION: The 20.5% decrease in malaria cases during 1998 compared with 1997 resulted primarily from decreases in P. vivax cases acquired in Asia among non-U.S. civilians. This decrease could have resulted from local changes in disease transmission, decreased immigration from the region, decreased travel to the region, incomplete reporting from state and local health departments, or increased use of effective antimalarial chemoprophylaxis. In a majority of reported cases, U.S. civilians who acquired infection abroad had not taken an appropriate chemoprophylaxis regimen for the country where they acquired malaria. PUBLIC HEALTH ACTIONS TAKEN: Additional information was obtained from state and local health departments and clinics concerning the four fatal cases and the five infections acquired in the United States. Persons traveling to a malarious area should take a recommended chemoprophylaxis regimen and use personal protection measures to prevent mosquito bites. Any person who has been to a malarious area and subsequently develops fever or influenza-like symptoms should seek medical care immediately; the investigation should include a blood smear for malaria. Malaria infections can be fatal if not diagnosed and treated promptly. Current recommendations concerning prevention and treatment of malaria can be obtained from CDC.     

Concurrent dengue and malaria due to Plasmodium falciparum and P. vivax

Concurrent infections of dengue and malaria are rare. We report a case of dengue fever with acute malaria due to Plasmodium falciparum and P. vivax in which the presence of mixed infection with P. vivax was overlooked and confirmed later on during recurrence of the fever that had initially responded to conventional antimalarial treatment and symptomatic treatment for dengue fever. We suggest that in concurrent infections of dengue and malaria, possibility of mixed infection with various Plasmodium species should be excluded to ensure a better treatment outcome.     

海洛因依赖者尿检转阴时间的监测研究

〔目的〕追踪监测海洛因依赖者尿检转阴时间,为在出入境人群中开展药物瘾检测,评判海洛因依赖者近期吸食状况提供依据。〔方法〕根据酶放大免疫分析技术（EMIT）原理,利用德灵公司Urine Opiates Screen Flex TM试剂盒和全自动生化分析仪进行检测。〔结果〕连续检测60例被强制戒毒者每日尿吗啡含量,测定在不继续吸食的情况下尿检转阴时间为（3.833±2）×0.218d。〔结论〕根据尿检追踪监测结果可判断海洛因依赖者近期吸食状况,同时对在出入境人群中开展药物瘾检测和临床戒毒治疗具有指导意义。     

AIDS in Manipur

Manipur, located in northeastern India, shares a 357 kilometer long border with Myanmar. The state is landlocked and connected with the rest of India by air and road. Injected heroin addiction among young people has been a problem in the state since the early 1980s, with an estimated 40,000 addicts in the state. The addicts are 13-40 years old and at least half inject their heroin. The Manipur Voluntary Health Association (MVHA) was the first nongovernmental organization (NGO) to establish drug de-addiction and counseling centers in the state. There are now 25 de-addiction and counseling centers in Manipur run by NGOs, and 4 other centers run by the government or government institutions. IV drug users who share unsterile drug injecting equipment among themselves are at risk of HIV transmission and infection. As of February 28, 1997, 5121 of 44,669 blood samples screened in the state were found to be infected with HIV, an HIV seropositivity rate almost 10 times higher than the overall rate for India. Tuberculosis and sexually transmitted diseases (STDs) in Manipur, HIV/AIDS, the state AIDS policy, blood safety, and measures required for HIV and STD control are discussed.     

Plasmodium vivax circumsporozoite variants and Duffy blood group genotypes in the Brazilian Amazon region

The circumsporozoite protein (CSP) of the Plasmodium vivax infective sporozoite is considered to be a major target for the development of recombinant malaria vaccines. The Duffy blood group molecule acts as the red blood cell receptor for P. vivax. We review the frequency of P. vivax CSP variants and report their association with the Duffy blood group genotypes from Brazilian Amazon patients carrying P. vivax malaria. Peripheral blood samples were collected from 155 P. vivax-infected individuals from five Brazilian malaria-endemic areas. The P. vivax CSP variants and the Duffy blood group genotypes were assessed using PCR/RFLP. In single infections, the VK210 variant was the commonest followed by the P. vivax-like variant. The typing of P. vivax indicated that the frequency of variants among the study areas was significantly different from one to another. This is the first detection of the VK247 and P. vivax-like variant in single infections in endemic areas of Brazil. Association of the CSP P. vivax variants with the heterozygous Duffy blood group system genotype was significant for VK210 single infection. These observations provide additional data on the Plasmodium-host interactions concerning the Duffy blood group and P. vivax capability of causing human malaria.     

武汉市116例境外输入性恶性疟临床治疗效果分析

目的分析和评价境外输入性恶性疟患者临床特点及青蒿素类药物治疗效果,促进合理规范用药,提高临床治愈率。方法收集武汉市省级疟疾定点医院收治的116例输入性恶性疟病例,对患者临床症状及体征、青蒿素药物使用情况及用药效果等进行回顾性分析。结果输入性恶性疟临床表现复杂多样且并发症较多,主要为发热、纳差、贫血、黄疸等;使用青蒿素治疗后症状均减轻或消失,无明显药物不良反应,退热中位数为2d,疟原虫转阴中位数为3d,临床症状缓解中位数为3d;109例普通型恶性疟采用青蒿素复方口服或青蒿琥酯针剂联合青蒿素复方口服治疗,其中30例口服青蒿素复方治疗1~4d, 1例复燃;79例青蒿琥酯针剂联合青蒿素复方口服治疗4~6d, 4例出现复燃。7例重症病例采用青蒿琥酯针剂联合口服多种青蒿素复方长疗程大剂量后均治愈,总治愈率95.69%(111/116)。结论患者以口服和注射青蒿素杀灭疟原虫治疗恶性疟安全有效,治愈率高,但部分患者停用青蒿素类药物后出现疟原虫复燃,为遏制患者重症和抗药风险,应"规范、全程、足量"使用青蒿素类药品。     

Absence of nucleotide polymorphism in a Plasmodium vivax multidrug resistance gene after failure of mefloquine prophylaxis in French Guyana

Vivax malaria is widespread and resistance has been described for chloroquine and sulfadoxine-pyrimethamine. We report on evidence of failure of mefloquine prophylaxis in a French soldier who contracted Plasmodium vivax in French Guyana, South America. Despite regular weekly mefloquine prophylaxis (250 mg/d), the patient presented with a first episode of vivax malaria, which was treated by chloroquine alone, then experienced a second crisis in France. The reappearance of the parasites occurred one day after the end of prophylaxis, confirming parasitological and clinical resistance in a non-immune patient. Mefloquine was detected by a liquid chromatography assay in plasma at a level of 1062 ng/ml, which was higher than the expected concentration after five months of weekly prophylaxis. This isolate had no single nucleotide polymorphisms of the pvmdr1 gene at seven allele positions: pvmdr1 N91, Y189, Y976, S1071, F1076, N1079 and D1291, corresponding to codons 86, 184, 939, 1034, 1039, 1042 and 1246 in P. falciparum. This observation of failure of mefloquine prophylaxis against P. vivax, when added to previously reported chloroquine and atovaquone-proguanil failure, strengthens the case for re-evaluating drug policies for vivax malaria and the need for continuous research on molecular markers of drug resistance.     

Vivax malaria: preliminary observations following a shorter course of treatment with artesunate plus primaquine

The standard adult treatment regimen for Plasmodium vivax malaria is chloroquine (1500 mg over 3 d) plus primaquine (15 or 30 mg daily for 14 d), but patient compliance tends to be poor with the lengthy course. Preliminary observations are reported on the efficacy of a shorter treatment course - artesunate (200mg twice a day for 2 d) plus primaquine (22.5mg base twice a day for 7 d) - given to 28 adult patients infected with P. vivax in Viet Nam. All patients responded quickly to treatment with mean (SD) parasite and fever clearance times of 14.2 (4.0) and 18.6 (8.4) h, respectively. The high dose of primaquine was generally well tolerated, and only one patient (3.6%) had a recurrence of parasitaemia during 28 d of follow-up. As most patients infected with Southeast Asian strains of P. vivax have their first relapse within 28 d after treatment with rapidly eliminated blood schizonticides, the absence of parasitaemia in the remaining 27 patients suggests that this drug regimen was active against both blood and liver stages. Further studies are needed to confirm that this rapidly acting, short artesunate-primaquine regimen can result in better patient compliance and treatment outcomes than the chloroquine-primaquine regimen.