Malaria in Turkey: a review of 33 cases

Aim: To evaluate epidemiologic and clinical features of the patients with malaria followed in our clinic, and to review current status of malaria in our country. Patients and methods: Epidemiologic, clinical, diagnostic, and therapeutic features of 33 patients with malaria (4 female, 29 male, mean age: 28 ± 11 years, range: 15–60) followed in our clinic between 1981 and 2000 were evaluated retrospectively. Malaria data of our country for 1926–2000 were obtained from Health Ministry. Results: Diagnosis was established by thin smears of blood preparations obtained in the febrile period in all cases. Plasmodium vivax was detected in 26 patients (25 domestic and one imported), and P. falciparum in seven (two domestic and five imported). Sixty-one percent of the patients had the prodromal symptoms of the disease and used various antibiotics. All cases demonstrated the typical pattern of fever with chills. Fever (100%), splenomegaly (91%), hepatomegaly (55%), anemia (70%), leukopenia (48%), thrombocytopenia (48%), a rise in sedimentation rate (100%), and abnormalities in hepatic enzymes (30%) were determined in the patients. Chloroquine+primaquine were given to all patients with P. vivax, chloroquin (for three) or mefloquin (for four) alone were given to the patients with P. falciparum. One patient with P. falciparum died soon after admission, all the remaining recovered. Data from Health Ministry revealed that the most common (100%) species in our country is P. vivax. Although an eradication program against malaria initiated in 1926 achieved success, it still remains as an important health problem. Conclusion: Every febrile patient with a history of travel to the regions where malaria is endemic (tropical regions for the world, southeast regions for our country) should raise the suspicion of malaria. Every country should fight against malaria and global cooperation is essential.     

Malaria epidemiological trends in Italy

Based on the official reports received from local health laboratories, an epidemiological analysis of malaria cases reported in Italy from 1989 to 1992 is presented. A total of 1,941 cases were reported, 1,287 among Italians and 654 among foreigners. The incidence of cases was on average 500 per year with a maximum in 1990. A slight, but constant decrease of incidence of malaria cases was recorded in this period among Italian citizens (–21.5%), while the incidence among foreigners increased (+80%).Plasmodium falciparum accounted for 74.2% of total infections, followed byP. vivax (19%). The highest number of cases was imported from Africa (86.5%), followed by Asia, South America, and Oceania. 11 cases were contracted in Europe (transfusion, airport and cryptic malaria). 26 people died from malaria during the four years, with a fatality rate of 2.3% among Italians. Other epidemiological features concerning incidence in the different categories of travellers, countries of infection, clinical and therapeutic aspects of cases, are also discussed.     

Molecular Detection of Malaria in South Punjab with Higher Proportion of Mixed Infections

Background

Malaria is well known for its fatalities worldwide, Plasmodium vivax and the Plasmodium falciparum are the two important species of malaria reported from Pakistan and creating lots of morbidities across the country.

Method

Study was conducted to determine the Surveillance of malaria in South Punjab by microscopy and Polymerase chain reaction (PCR).

Result

samples out of 100 patients were found positive for malarial parasites. One patient was found with mixed infection, whereas P. falciparum and P. vivax infections were detected in 17 and 22 patients, respectively. In nested PCR, genus-specific primers for Plasmodium species. in round 1 and species-specific primers for P. falciparum and P. vivax in round 2 were used. By the application of PCR 41% were found to be infected by Plasmodium spp. Among Plasmodium positive patients: mixed, P. falciparum and P. vivax infection were detected in 10, 15 and 16 patients, respectively. Thirty nine microscopically positive patients confirmed to have Plasmodium spp. One negative by PCR, 2 microscopically negative patients had shown Plasmodium spp. infection (P. falciparum and P. vivax) by PCR. In total samples, P. falciparum, P. vivax and mixed infection accounted for 36.6%, 39.0% and 24.3%, respectively.

Conclusion

Microscopy was found deficient for interpretation of mixed infections, low parasitaemia, and species specific diagnosis. The sensitivity, specificity and efficacy of nested PCR was calculated 95%, 98% and 97%, respectively, showing PCR as a more effective and efficient diagnostic tool for malaria.     

Severe Plasmodium vivax Malaria in Pakistan

To compare the severity of Plasmodium vivax malaria with that of P. falciparum malaria, we conducted a retrospective cross-sectional study of 356 adults hospitalized with malaria (2009–2011) in Pakistan. P. vivax and P. falciparum accounted for 83% and 13% of cases, respectively; 79.9% of patients with severe malaria were infected with P. vivax.     

Congenital malaria due to Plasmodium vivax: a case report from Sri Lanka

A case of Plasmodium vivax malaria in an eight-week-old infant in Colombo is documented, with epidemiological and circumstantial evidence which strongly supports a transplacental route of infection. The malarial antibody levels detected by the indirect fluorescent antibody technique in both mother and child are discussed in terms of the present epidemiological pattern of malaria in the country. We also comment on the species incidence of congenital malaria, this case being the first caused by P. vivax in Sri Lanka, despite this species being more prevalent than P. falciparum which has been reported in six previous cases of congenital malaria in Sri Lanka.     

应用间接荧光抗体技术进行疟疾纵向调查

应用恶性疟原虫与食蟹猴疟原虫两种抗原作间接荧光抗体试验,1983~1984年间对安徽省三个采取不同抗疟措施的间日疟与恶性疟混合流行区进行了两年的纵向调查,血清学结果与疟原虫率调查结果在反映疟疾不同的流行水平上显示平行的关系。三个地区每年疟疾传播季节的寄生虫学接种率(疟原虫血症发生率)与恢复率,食蟹猴疟原虫与恶性疟原虫抗原检测的疟疾抗体阳性发生率与恢复率,其数值大小与变动分别与该地间日疟与恶性疟的传播强度及采取的抗疟惜施相关。     

Comparison of Parascreen Pan/Pf, Paracheck Pf and light microscopy for detection of malaria among febrile patients, Northwest Ethiopia

Two malaria rapid diagnostic tests (RDT), Parascreen Pan/Pf^® and Paracheck Pf^®, were tested in rural health centres in Ethiopia against independent expert microscopy (the gold standard). Participants (n =1997) presented with presumptive malaria to ten health centers in Amhara Regional State during the 2007 peak malaria season (October to December). By microscopy, 475 (23.8%) suspected malaria cases were positive, of which 57.7% were P. falciparum; 24.6% P. vivax and 17.7% mixed infections. Parascreen and Paracheck were positive for 442 (22.1%) and 277 (13.9%) febrile patients, respectively. For Parascreen, P. falciparum sensitivity was 79.6%, specificity 97.4%, positive predictive value (PPV) 86.9%, and negative predictive value (NPV) 95.6%. For Parascreen, P. vivax sensitivity was 74.4%, specificity 98.6%, PPV 76.3% and NPV 98.4%. For Paracheck, P. falciparum sensitivity was 73.7%, specificity 99.2%, PPV 95.3%, NPV 94.5%. Sensitivity was significantly higher for both tests (P < 0.05) when parasite density was >100/μl of blood; in these cases Parascreen was 90.7% and 91.5% sensitive for P. falciparum and P. vivax, respectively, while Paracheck was 87.9% sensitive for P. falciparum. Parascreen thus performed adequately for both P. falciparum and P. vivax compared to expert microscopy and is more useful than Paracheck where microscopy is unavailable.     

Clinical Malaria along the China–Myanmar Border,Yunnan Province,China, January 2011–August 2012

Passive surveillance for malaria cases was conducted in Yunnan Province, China, along the China–Myanmar border. Infection with Plasmodium vivax and P. falciparum protozoa accounted for 69% and 28% of the cases, respectively. Most patients were adult men. Cross-border travel into Myanmar was a key risk factor for P. falciparum malaria in China.     

Indirect ELISA test for malaria in blood donors

To determine the potential risk of transfusion malaria at the Hospital Militar Central in Bogota, Colombia, sera from 3114 blood donors were tested for malaria antibodies by the indirect ELISA technique. Positive results were found in 8·6 per thousand of the serum samples using P. falciparum antigen containing more than 60% mature forms as substrate. Three cases of transfusion-induced malaria were confirmed during the study. The first patient developed a P. vivax infection one week after the administration of one unit of infected blood. The other two patients received a red blood cell concentrate and a platelet preparation, respectively, derived from a single donor and developed a P. falciparum infection eight days after transfusion. The application of the ELISA technique would be of use in attempts to control transfusion-induced malaria.     

Augmentation du paludisme d’importation à Rennes : étude épidémiologique et analyse de la chimioprophylaxie et des traitements curatifs

Objective – In 2000, we observed a sharp increase of imported malaria in the Rennes university hospital, with 80 documented cases compared to a maximum of 43 cases per year over the previous 35 years. We carried out a retrospective study of these cases and evaluated the adequation of chemoprophylaxis and curative treatment according to current recommendations. Results – The 80 episodes occurred in 73 patients (58 males, 15 females) with a mean age of 30 years. The median duration of stay in tropical area was 60 days, sub-Saharian Africa in 80% of the cases and for professional purposes in 40% of the cases. According to current French recommendations, chemoprophylaxis was inadequate for 58 patients (83%). Mean diagnosis delay was 6 days (0–60), four cases (5.5%) were considered as severe malaria according to the WHO definition, but no complicated malaria was observed. Mean parasitemia was 0.9 % erythrocytes (0.001–7.5); mean platelet count 130 000/mm³ (24–335). The 80 cases included: 50 P. falciparum (62.5%), 14 P. vivax (17.5%), 11 P. ovale (14%), two P. malariae (2.5%) and four mixed strains. An infectious disease specialist was consulted 53 times (66%). Curative treatment included mefloquine (41%), quinine IV (22%), chloroquine (23%), halofantrine (13%). It was inadequate (by excess) for five patients (mefloquine for Plasmodium vivax or P. ovale). All patients completely recovered. Conclusion – The increase in imported malaria was associated with inadequate chemoprophylaxis in more than 80% of cases. When no infectious disease specialist was consulted, over medication of chloroquine-sensitive plasmodium species was observed.     

Management of severe imported malaria in adults

Severe malaria accounts for approximately 10% of all cases of imported malaria in France; cases are mainly due to Plasmodium falciparum, while other Plasmodium species are possible but uncommon (P. vivax, P. knowlesi, P. malariae, and P. ovale). On the basis of WHO criteria for endemic areas, the French criteria defining severe imported malaria in adults have been progressively adapted to the European healthcare level. Management of severe imported malaria is a diagnostic and treatment emergency and must be initially conducted in the intensive care unit. Anti-infective treatment is now based on intravenous artesunate, which must be available in every hospital of the country likely to receive severe imported malaria patients. Intravenous quinine is thus used as a second-line treatment and is restricted to limited indications. Critical care management of organ failure is essential, particularly in patients presenting with very severe malaria. To date, no adjunctive therapy (including exchange transfusion) has demonstrated clear beneficial effects.     

Malaria eradication in Portugal

Research on malaria, which was endemic in several parts of Portugal at the beginning of this century, was intensified in the 1940's and led to the development of better control methods, especially in the rice-growing areas of the country. In the 1950's residual DDT spraying was introduced and followed by extensive detection of cases of malaria and their treatment. Plans for eradication of the disease were made, and by 1958 the transmission of the infection was interrupted in nearly all areas of European Portugal. The country was placed in the maintenance phase of malaria eradication and the certification of malaria eradication was confirmed by the WHO in 1973.The political and military events of the past five years greatly increased the number of cases of malaria imported into Portugal from tropical Africa and indicated the need for much vigilance to prevent the resumption of transmission by the local vectors. It appears that the measures put into action have succeeded in this respect. This was due to the high degree of effective surveillance and also to the fact that Anopheles atroparvus does not readily transmit the exotic strains of Plasmodium falciparum and P. vivax. However, further vigilance must be maintained and intensified.     

Plasmodium cynomolgi Co-infections among Symptomatic Malaria Patients,Thailand

Among 1,180 symptomatic malaria patients, 9 (0.76%) infected with Plasmodium cynomolgi were co-infected with P. vivax (n = 7), P. falciparum (n = 1), or P. vivax and P. knowlesi (n = 1). Patients were from Tak, Chanthaburi, Ubon Ratchathani, Yala, and Narathiwat Provinces, suggesting P. cynomolgi is widespread in this country.     

Serologic Markers for Detecting Malaria in Areas of Low Endemicity,Somalia, 2008

Areas in which malaria is not highly endemic are suitable for malaria elimination, but assessing transmission is difficult because of lack of sensitivity of commonly used methods. We evaluated serologic markers for detecting variation in malaria exposure in Somalia. Plasmodium falciparum or P. vivax was not detected by microscopy in cross-sectional surveys of samples from persons during the dry (0/1,178) and wet (0/1,128) seasons. Antibody responses against P. falciparum or P. vivax were detected in 17.9% (179/1,001) and 19.3% (202/1,044) of persons tested. Reactivity against P. falciparum was significantly different between 3 villages (p<0.001); clusters of seroreactivity were present. Distance to the nearest seasonal river was negatively associated with P. falciparum (p = 0.028) and P. vivax seroreactivity (p = 0.016). Serologic markers are a promising tool for detecting spatial variation in malaria exposure and evaluating malaria control efforts in areas where transmission has decreased to levels below the detection limit of microscopy.     

Differences in automated depolarization patterns of Plasmodium faiciparum and P. vivax malaria infections defined by the Cell-Dyn® CD4000 haematology analyser

Of 1014 samples submitted for full blood count analysis and malaria screening, 854 were designated malaria-negative by blood film microscopy, 79 were unequivocally identified as Plasmodium vivax and 81 as P. falciparum. All samples were additionally analysed with the Abbott Cell-Dyn® CD4000 haematology instrument, and leucocyte differential plots of 90° polarized vs. 90° depolarized (NEU-EOS plot) and 90° depolarized vs. 0° light (EOS I plot) scatter were specifically examined for abnormal depolarization patterns. Depolarization pattern types were correlated with microscopy (species) results, and these correlations were consolidated by polymerase chain reaction analysis. All 854 microscopically-designated malaria-negative samples showed a type 1 (normal) CD4000 depolarization pattern. Abnormal pattern types 2, 3a and 3b were entirely restricted to one of the two malaria categories. Plasmodium falciparum malaria showed two CD4000 pattern types only; a ‘normal’ type 1 pattern was seen in 36/75 (48%) cases and the remaining 39 cases were all abnormal pattern type 3a. In contrast, most (79/85) P. vivax malaria cases showed a distinctive clustered EOS I population (types 2 and 3b patterns) that was not seen with P. falciparum. Automated depolarization analysis provides an effective means of detecting malaria-associated haemozoin, and the patterns of intracellular haemozoin further appear to provide species differentiation between P. falciparum and P. vivax.     

A focus of hyperendemic Plasmodium malariae��P. vivax with no P. falciparum in a primitive population in the Peruvian Amazon jungle: Studies by means of immunofluorescence and blood smear

Findings in a sample population in southeastern Peru with a very high rate of malaria infection, due to Plasmodium malariae and P. vivax with apparently no P. falciparum, are described. The proportion of persons with P. malariae in this sample population, as determined by slide examination, appears to be the greatest ever reported for any area before the introduction of control measures. Although very few P. vivax were found on stained slides, results of the indirect immunofluorescence test indicated that this species was probably as prevalent as P. malariae; the absence of P. falciparum was supported by results of serologic tests. Possible reasons for this focus of malaria with no P. falciparum are discussed.     

A case of congenital malaria in Malaysia with IgM malaria antibodies

Congenital malaria from Malaysia is reported here for the first time. It occurred in a baby boy born to a 16-year-old primigravida who contracted Plasmodium falciparum infection during pregnancy. She suffered malaria during the later stages of pregnancy and at parturition. The placenta was heavily infested with various asexual stages of P. falciparum. Gametocytes were not seen. Extensive search did not show other species. Cord blood showed very light infection with young trophozoites of P. falciparum.Serological studies using IFA technique showed specific IgG and IgM antibodies to P. falciparum in maternal cord and two early neonatal sera. These serum samples showed lower levels of IgG antibodies against P. vivax and P. malariae, but there were no specific IgM antibodies against these species. The value of specific IgM antibody in the diagnosis of congenital malaria is discussed.     

Plasmodium vivax est-il encore le paradigme d'un paludisme simple ?

P. vivax is supposed to be involved in benign tertian fever, responsible for a non-complicated disease that could be easily treated by standard antimalarial drug regimen. This could be considered as a long-standing paradigm of a non-virulent malaria parasite. When a patient exhibits severe malaria with the vivax parasite, the issue is often to find falciparum. However, with the implementation of molecular diagnosis, it has becoming more evident that vivax parasites could be involved in severe disease with probably a different pathogenesis. Mixed infections are frequent in various parts of Southeast Asian endemic areas and it was speculated that drugs used to treat falciparum could be involved in the development of vivax drug resistance. How should primaquine be used today for the treatment and prophylaxis of vivax malaria? Considering the re-emergence of vivax malaria in several areas, improving the treatment for this disease is certainly an important issue to avoid late episodes and transmission potential.     

Co-infections with Plasmodium knowlesi and Other Malaria Parasites, Myanmar

To determine the frequency of co-infections with Plasmodium species in southern Myanmar, we investigated the prevalence of P. knowlesi. More than 20% of patients with malaria had P. knowlesi infection, which occurred predominantly as a co-infection with either P. falciparum or P. vivax.     

Guidance on the evaluation of Plasmodium vivax vaccines in populations exposed to natural infection

In this paper we give guidance for the design and conduct of vaccine trials against Plasmodium vivax malaria. The paper supplements earlier guidelines on the planning of vaccine trials against Plasmodium falciparum malaria [WHO. Guidelines for the evaluation of Plasmodium falciparum vaccines in populations exposed to natural infections. Geneva: World Health Organization; 1997, http://www.who.int/vaccine_research/feuill_1_4-2.pdf], with further considerations in two later documents [Moorthy VS, Reed Z, Smith PG. Measurement of malaria vaccine efficacy in phase III trials: report of a WHO consultation. Vaccine 2007 July 9;25(28):5115–23; Moorthy V, Reed Z, Smith P. MALVAC 2008: measures of efficacy of malaria vaccines in phase 2b and phase 3 trials – scientific, regulatory and public health perspectives. Vaccine 2009 January 29;27(5):624–8]. We deal specifically with study design and methodological issues for the assessment of pre-erythrocytic and blood-stage vaccines against P. vivax. The role of vaccines in blocking transmission of P. vivax is not considered as the methodological issues are similar to those for P. falciparum, though longer follow-up would be required because of the potential for relapse discussed below. In this paper we discuss the rationale and background to trials of P. vivax vaccines, requirements for Phase IIb and Phase III field trials, implementation of clinical trials, methods of measurement and analysis, and ethical aspects.