Combating severe malaria in African children

An initiative to reduce childhood mortality due to malaria, diarrhoea and vaccine-preventable diseases, called the Africa Child Survival Initiative—Combatting Childhood Communicable Diseases (CCCD) project, was started in 1982 and is now operating in 13 African countries, 12 of which are endemic for malaria. The project''s malaria control strategy relies on the use of drugs, mainly chloroquine, to prevent severe illness and death in children less than 5 years of age; chemoprophylaxis for pregnant women is also advised to prevent low birth weight in newborns. The strategy is based on WHO recommendations which focus on improved diagnosis and treatment of cases and chemoprophylaxis for pregnant women.     

DDT residues in human milk samples from Delhi,India

Possible contamination of human milk through the excretion of DDT and its metabolites is a concern in India, where DDT is widely used as an insecticide. To assess this risk, milk samples collected from 60 lactating women admitted to hospitals in Delhi were quantitatively analyzed. 55 of the 60 milk samples showed evidence of residues of pp'DDE (mean, 0.176 + or - 0.382 ppm), op'DDT (mean, 0.046 + or - 0.011 ppm), and pp'DDT (mean, 0.122 + or - 0.434 ppm). The mean residue level in milk fat (mg/kg fat) was 7.280 + or - 23.240, 1.428 + or - 2.697, and 1.597 + or - 5.936, respectively. A large variation in individual values was observed. The finding that pp'DDE is the DDT metabolite excreted into human milk at the highest level is consistent with previous research. Daily intake of total DDT averaged 0.062 mg/kg of body weight--a value that is 12 times higher than the acceptable level of DDT (0.005 mg/kg/day) set by the World Health Organization. Although no harmful effects of DDT have been recorded to date in breastfed infants in India, preventive measures aimed at reducing the body burden of DDT in lactating women are urged.     

Clinical course of malaria in pregnancy--a prospective controlled study from India

A prospective hospital-based study was conducted from June 1984 to November 1985 in northern India to study the morbidity pattern of malaria in pregnant women. 78 pregnant and 22 non-pregnant women with malarial infection (60% Plasmodium vivax and 40% P. falciparum) were included in the study. The results were analysed according to period of gestation, parity and type of infection. Severity of clinical illness was significantly higher in pregnant patients for both P. vivax and P. falciparum infections. Some striking differences were found in our study when compared with those from African countries. Multigravidas had a slightly higher morbidity than primigravidas, though the difference was not statistically significant. Even though only a small proportion (1.4%) of our pregnant patients were affected by malaria, cerebral malaria, maternal deaths, intrauterine foetal deaths and pre-term labours were much more common.     

Predominant tuberculosis spoligotypes, Delhi, India

One hundred five Mycobacterium tuberculosis clinical isolates from the Delhi area were typed by spoligotyping; 45 patterns were identified. Comparison with an international spoligotype database showed type 26, Delhi type (22%), type 54 (12%), and type 1, Beijing type (8%), as the most common. Eighteen spoligotypes did not match any existing database pattern.     

Bacteraemia complicating severe malaria in children.

Bacteraemia associated with severe malaria in childhood is a sporadically reported phenomenon but its incidence and clinical importance are unknown. We have reviewed clinical and laboratory data from 783 Kenyan children sequentially admitted with a primary diagnosis of severe malaria. The overall incidence of bacteraemia in children with severe malaria was 7.8% (95% CI 5.5-10.0); however, in children under 30 months of age the incidence was 12.0% (95% CI 8.3-15.7). The presence of bacteraemia was associated with a 3-fold increase in mortality (33.3% vs. 10.4%, P < 0.001). We conclude that invasive bacterial disease may contribute to the pathophysiology of the clinical syndrome of severe malaria in an important subgroup of children. We recommend that young children with severe malaria be treated with broad-spectrum antibiotics in addition to antimalarial drugs.     

Ciprofloxacin-resistant Neisseria meningitidis, Delhi, India

Decreased susceptibility of Neisseria meningitidis isolates to ciprofloxacin emerged from an outbreak in Delhi, India. Results of antimicrobial susceptibility testing of the meningococcal isolates to ciprofloxacin and further sequencing of DNA gyrase A quinolone-resistance-determining region confirmed the emergence of ciprofloxacin resistance in the outbreak.     

New Clonal Strain of Candida auris,Delhi, India: New Clonal Strain of Candida auris,Delhi, India

A new clonal strain of Candida auris is an emerging etiologic agent of fungemia in Delhi, India. In 12 patients in 2 hospitals, it was resistant to fluconazole and genotypically distinct from isolates from South Korea and Japan, as revealed by M13 and amplified fragment length polymorphism typing.     

Distribution of Plasmodium falciparum genotypes in clinically mild and severe malaria cases in Orissa, India

A cross-sectional study was conducted in a malaria hyperendemic state of India to ascertain the distribution of Plasmodium falciparum genotypes in patients with mild (n=40) and severe (n=35) malaria. PCR and nested PCR were used to determine the glutamate-rich protein (GLURP), merozoite surface proteins 1 and 2 (MSP1 and MSP2) and knob-associated histidine-rich protein (KAHRP) for characterization of the parasite. The results indicate that (i) the 200bp allele of the MAD20 family of MSP1 and the 550bp allele of the 3D7 family of MSP2 show over-representation in severe malaria cases; (ii) the multiplicity of infection with respect to MSP2 alleles is significantly higher (P<0.001) in severe cases than in mild cases; and (iii) comparison with the findings of other studies leads to the conclusion that the distribution of P. falciparum genotypes between different clinical groups differs geographically.     

Artemether in moderately severe and cerebral malaria in Nigerian children

Intramuscular artemether was compared with intramuscular sulfadoxine-pyrimethamine in Nigerian children with moderately severe malaria requiring parenteral therapy. Artemether produced significantly shorter parasite and fever clearance times but a higher parasite recrudescence rate than sulfadoxine-pyrimethamine. There was no significant difference in their initial parasitological cure rates—100% for artemether, 98% for sulfadoxine-pyrimethamine. In a separate study intramuscular artemether was compared with intravenous quinine in children with cerebral malaria. There was no significant difference between the 2 drugs in parasite and fever clearance times, time to regain consciousness, or recrudescence rate. There was an overall mortality of 16·7%, with 12% in the artemether group and 21% in the quinine group. Artemether was well tolerated. There was no abnormal change in haematological and biochemical features monitored and there was no adverse clinical reaction. These results show that artemether is a potentially useful drug for moderate and severe malaria and its place in the chemotherapy of malaria deserves further study.     

62例婴幼儿重型麻疹临床及流行病学特征

目的探讨婴幼儿重型麻疹的临床及流行病学特点。方法回顾性分析62例重型麻疹婴幼儿的临床资料。结果 62例重型麻疹患儿中,年龄9月龄42例(67.74%),其中37例(88.10%)未接种麻疹疫苗;发病月份为2~5月,其中3~4月41例(66.13%)。临床表现均有发热和皮疹,口腔黏膜斑50例(80.65%),卡他症状48例(77.42%),结膜炎49例(79.03%),早期有饮水呛咳病史47例(75.81%);合并肺炎59例(95.16%),急性喉炎22例(35.48%),电解质紊乱13例(20.97%),急性呼吸窘迫综合征和肝功能损害各6例(9.68%),气胸5例(8.06%),心肌损害3例(4.84%),呼吸衰竭和中毒性脑病各2例(3.23%),麻疹脑炎和胸腔积液各1例(1.61%)。治愈41例,好转19例,死亡1例,放弃治疗1例。结论该组重型麻疹婴幼儿以9月龄且未接种麻疹疫苗的婴儿为主;早期有饮水呛咳史;发病月份多为3~4月;肺炎仍是婴幼儿麻疹的主要并发症。     

Clinical aspects and outcome of suspected severe pediatric malaria

Objective

The authors had for aim to evaluate diagnosis and treatment practices applied to children with clinically suspected severe malaria, in two referral hospitals of Kisangani.

Patients and methods

A prospective study was carried out between January 1, 2010 and February 28, 2011 including all children admitted for clinically suspected severe malaria, with at least one of the WHO severity criteria.

Results

One thousand one hundred and fifty-four children were admitted in the two hospitals, 427 (37.0%, n = 1.154) for clinically suspected severe malaria: 155 (36.3%, n = 427) had a positive thick drop examination (TDE), 198 (46.4%, n = 427) a negative one, and 74 (17.3%, n = 427) without thick blood smear examination. Prostration (48.0%) and anemia (40.3%) were the most common severity criteria, while 14.5% and 9.8% presented with convulsions and impaired consciousness respectively. The etiological treatment was quinine infusion. The case specific fatality rate was 19.4% (n = 427), 7.7% (n = 155) in confirmed cases, 9.6% (n = 198) in patients with negative thick blood smear, and 70.3% (n = 74) in patients without any TDE (P < 0.001).

Conclusion

Poor technical support and inadequate organization of the patient circuit can result in underestimating the metabolic complications of severe malaria and of other severe infections of early childhood. This is detrimental to the patients, even when effective drugs are available.     

Westernization and tobacco use among young people in Delhi,India

Few studies have explored the relationship between acculturation and health in non-immigrant populations. The purpose of this study was to investigate the relationship between “westernization” and tobacco use among adolescents living in Delhi, India. A bi-dimensional model of acculturation was adapted for use in this study to examine (a) whether young people’s identification with Western culture in this setting is related to tobacco use, and (b) whether their maintenance of more traditional Indian ways of living is related to tobacco use. Multiple types of tobacco commonly used in India (e.g., cigarettes, bidis, chewing tobacco) were considered. Socioeconomic status (SES), gender, and grade level were examined as potential effect modifiers of the relationship between “westernization” and tobacco use. The study was cross-sectional by design and included 3512 students in eighth and tenth grades who were enrolled in 14 Private (higher SES) and Government (lower SES) schools in Delhi, India. A self-report survey was used to collect information on tobacco use and “westernization.” The results suggest that young people’s identification with Western influences may increase their risk for tobacco use, while their maintenance of traditional Indian ways of living confers some protection. Importantly, these effects were independent of one another. Boys benefitted more from protective effects than girls, and tenth graders gained more consistent benefits than eighth graders in this regard, too. Negative effects associated with identification with Western ways of living were, in contrast, consistent across gender and grade level. The positive and negative effects of acculturation on adolescent tobacco use held for all tobacco products considered here. Future interventions designed to curb youth tobacco use in India may benefit by paying closer attention to cultural preferences of these young consumers.