Challenges and strategies in malaria control: A case series from East Azerbaijan Province, 2023-2024.

Background: In spite of enormous preventive and control measures, malaria has resurged in many tropical countries including India. The limited access to effective diagnosis and treatment of cases in endemic areas is one of the most important factors hampering the reduction of morbidity and mortality associated with malaria. Aims and objective: The present study was conducted with an aim to evaluate immunochromatography test (ICT) and quantitative buffy coat (QBC) against peripheral blood smear (PBS) examination for diagnosis of malaria. Material and methods: Blood samples collected from 186 clinically suspected cases of malaria was used for preparation of PBS for examination of malarial parasite, QBC and ICT. Results: Out of 186 patients included in study, 122 (65.5%) of were positive for malaria by any of the three tests used. 116 (95.1%) were positive for malarial parasite on the PBS. ICT was positive in 103 (84.4%) cases and QBC was positive in 70 (57.3%) cases. Conclusions: ICT for malaria can be used as rapid, simple and mass screening test in remote and rural areas as skilled professional are not required. ICT may prove as useful tool for malaria control programmes. In established setup where skilled and expert personnel are available PBS remains the test of choice and ICT can be used as an adjuvant to PBS.

The microscopic examination of stained smears of peripheral blood is of vital significance in the speedy diagnostics of infectious and parasitic diseases, in particular during the stage of infection when the cause is present in the blood, or blood cells. It is sometimes possible to make a definitive diagnosis of an infectious or parasitic disease following an examination of a stained smear of the peripheral blood. Since microscopic examinations of a peripheral blood smear are applied increasingly rarely in clinical practice, due to the development of other methods for the diagnostics of infectious and parasitic diseases in dogs, as well as the lack of knowledge of the morphology of the numerous causes that can be present in the blood, we carried out an investigation into the presence and spread of infections whose causes can be present in dog blood. The investigations covered 100 dogs from which peripheral blood smears were taken and then stained with a Giemsa solution according to the standard protocol and examined under a microscope with an immersion lens. The examination of peripheral blood smears stained according to Giemsa resulted in the identification of the presence of an Ehrlichia spp. morula in a neutrophil granulocyte in one dog. The presence of hemotropic mycoplasmas was established in erythrocytes of eleven dogs, while the presence of the protozoa Babesia canis in erythrocytes was identified in five dogs included in the investigations. A microscopic examination of dog peripheral blood smears stained according to Giemsa was shown as a speedy, practical, simple, and inexpensive method for making a definitive etiological diagnosis of these infections, and it should be included regularly in standard protocols for the diagnostics of infectious and parasitic diseases.

As automated blood cell analysers and sophisticated diagnostic technologies become widespread, requests for peripheral blood smear (PBS) examination—for the diagnosis of infectious diseases—diminish. Yet, PBS examination can provide rapid and...

BackgroundFalse negative rapid diagnostic tests (RDTs) accruing to the non-detection of Plasmodium falciparum histidine-rich protein 2/3 (Pfhrp2/3) is threatening the diagnosis and management of malaria. Although regular monitoring is necessary to gauge the level of efficacy of the tool, studies in Cameroon remain limited. This study assessed Plasmodium spp. prevalence and Pfhrp2/3 gene deletions across ecological and transmission zones in Cameroon.MethodsThis is a cross-sectional, multi-site, community- and hospital- based study, in 21 health facilities and 14 communities covering all five ecological settings in low seasonal (LS) and intense perennial (IPT) malaria transmission zones between 2019 and 2021. Participants were screened for malaria parasite using Pfhrp2 RDT and light microscopic examination of thick peripheral blood smears. DNA was extracted from dried blood spot using chelex®-100 and P. falciparum confirmed using varATS real-time quantitative Polymerase Chain Reaction (qPCR), P. malariae and P. ovale by real-time qPCR of Plasmepsin gene, and P. vivax using a commercial kit. Isolates with amplified Pfcsp and Pfama-1 genes were assayed for Pfhrp 2/3 gene deletions by conventional PCR.ResultsA total of 3,373 participants enrolled, 1,786 Plasmodium spp. infected, with 77.4% P. falciparum. Discordant RDT and qPCR results (False negatives) were reported in 191 (15.7%) P. falciparum mono-infected samples from LS (29%, 42) and IPT (13.9%, 149). The Pfhrp2+/Pfhrp3 + genotype was most frequent, similar between LS (5.5%, 8/145) and IPT (6.0%, 65/1,076). Single Pfhrp2 and Pfhrp3 gene deletions occurred in LS (0.7%, 1/145 each) and IPT (3.6%, 39/1,076 vs. 2.9%, 31/1,076), respectively. Whilst a single sample harboured Pfhrp2-/Pfhrp3- genotype in LS, 2.4% (26/1,076) were double deleted at IPT. Pfhrp2+/Pfhrp3- (0.3%, 3/1,076) and Pfhrp2-/Pfhrp3+ (1.2%, 13/1,076) genotypes were only observed in IPT. Pfhrp2, Pfhrp3 deletions and Pfhrp2-/Pfhrp3- genotype accounted for 78.8% (26), 69.7% (23) and 63.6% (21) RDT false negatives, respectively.ConclusionPlasmodium falciparum remains the most dominant and widely distributed Plasmodium species across transmission and ecological zones in Cameroon. Although the low prevalence of Pfhrp2/3 gene deletions supports the continued use of HRP2-based RDTs for routine malaria diagnosis, the high proportion of false-negatives due to gene deleted parasites necessitates continued surveillance to inform control and elimination efforts.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12879-024-09935-4.

To assess the impact of intensified malaria control interventions in an ethnic minority community in Betul using existing tools. Two rounds of indoor residual spraying with synthetic pyrethroid insecticide were applied and larvivorous fish introduced, followed by intensive surveillance for early detection of Plasmodium falciparum with rapid diagnostic tests and prompt treatment with sulphadoxine pyrimethamine. Pre-intervention surveys revealed a very high fever rate in the community in all age groups with a slide positivity rate of >50% with >90%P. falciparum. The post-intervention phase showed a sharp steady decline in number of malaria cases (beta 0.972; P < 0.0001, 95% CI 0.35-0.47). Monitoring of entomological results revealed a significant decline in both Anopheles species and An. culicifacies (P < 0.0001). A combination of indoor residual spraying and early detection and prompt treatment complemented by rapid diagnostic tests and larvivorous fishes successfully brought malaria under control. These approaches could be applied in other regions of different endemicity to control malaria in India.

Background: Malaria is a protozoan disease transmitted by the bite of infected female anopheles mosquitoes is one of the most important parasitic diseases of human with transmission in 109 countries, affecting more than one billion people worldwide. This study was planned to compare the gold standard i.e. peripheral blood smear examination and the newer rapid diagnostic test (malaria plasmodium falciparum/ plasmodium vivax antigen card) to know the diagnostic accuracy of Rapid Diagnostic Test (RDT) kits. Methods: All the suspected cases of WHO defined malaria between 1month to 18 years of age were enrolled in the study.Results: Out of 96 clinically suspected cases of malaria 63 were confirmed by peripheral smear. The age range of participants ranged from 4 months to 17 years. On peripheral smear examination, out of 96 clinically suspected cases, 37 (38.5%) cases were positive for P. vivax, 23 (23.9%) were positive for P. falciparum and 3 (3.1%) were positive for both parasites by microscopy. Sensitivity and specificity of RDT for Plasmodium Vivax is 92.5% and 96.4% respectively. Sensitivity and specificity of RDT for Plasmodium Falciparum is 96.2% and 90%.Conclusions: The rational use of RDTs as a complement to microscopy might give substantial health benefits through earlier treatment, reduction in morbidity and mortality and more rationalized approach for choosing anti-malarial drugs, which in terms may prevent drug resistance.

To discuss epidemiological aspects of imported malaria and the potential impact of imported malaria cases reported in Sri Lanka 2008-2011 in terms of a possible resurgence of the disease. The national malaria database was used to assess details regarding country where the infection was possibly acquired, species of Plasmodium, number of days lapsed between disembarkation in Sri Lanka and diagnosis, compliance with national treatment guidelines including percentage of patients followed up as per the national guidelines. After the strengthening of malaria surveillance, during the 4-year period, 152 imported malaria cases were recorded: an increase of 176% in the number of cases. Most of the imported malaria infections were acquired by Sri Lankan Nationals mainly from South Asia, especially India. Plasmodium vivax accounted for 64% of the infections. Approximately 50% of the cases were diagnosed in the Western Province. The average period from disembarkation in Sri Lanka to malaria diagnosis was 3.6days. Patients were managed and treated according to the national guidelines. 82% of the patients were followed up for 28days to ensure parasite clearance. There is a possible increasing risk of re-introduction of malaria to the country from imported cases. Enhanced surveillance activities and the increase in international travel have contributed to an increase in recorded case numbers. There is a need to further strengthen surveillance, especially for monitoring and timely addressing of imported malaria, if the country is to prevent the re-establishment of transmission within. The importance of having an efficient response mechanism to deal with imported malaria is also highlighted.

Malaria control. generating evidence from local to global level

This paper reported one acute lymphoblastic leukemia patient who infected with Plasmodium falciparum after blood transfusion. Through the epidemiological investigation on this patient and the related blood donors as well as laboratory detections, the source of infection was ascertained. This blood donor was an overseas student from Africa, whose blood sample was positive in the rapid diagnostic test, and the results of microscopic examination of peripheral blood smear and PCR both suggested P. falciparum positive.

Malaria is a vector-borne disease that primarily affects rural dwellers in the tropics and subtropics. In areas of high transmission, the highest mortality and morbidity rates are found in rural settings with seasonal variations that might be governed by irrigated rice farming. The use of long-lasting insecticidal nets (LLINs), adequate case management facilitated by rapid diagnostic tests (RDTs) and prompt treatment with artemisinin-based combination therapy are key tools for malaria control. The effectiveness of these control measures might be further enhanced by the implementation of communication strategies aiming at increasing population LLINs ownership. We evaluated the effect of routine LLINs monitoring and active surveillance of Plasmodium falciparum infection using RDTs and treatment administration at the community level on malaria transmission, infection and morbidity. Additionally, the acceptability of RDTs for malaria was investigated.&#13;\nGoal and specific objectives&#13;\nThis PhD pursued four specific objectives: (i) to evaluate the effect of LLINs on species composition and abundance of wild Culicidae; (ii) to evaluate the impact of LLINs routine monitoring on transmission indicators; (iii) to evaluate the impact of LLINs routine monitoring associated with the detection of malaria cases using RDTs on malaria prevalence and morbidity; and (iv) to determine socio-economic factors impacting the use of LLINs and identify attitudes and beliefs affecting RDTs acceptability.&#13;\nMethods&#13;\nThe study was carried out between July 2009 and May 2012 in three villages (N’dakonankro, Yoho and Bozi) in central Côte d’Ivoire. In Bozi, 150 households were given LLINs free of charge. Five entomological surveys (collection of larvae and adult mosquitoes) were conducted: two before and three after free distribution of LLINs at 3-month intervals. Three parasitological surveys (examination of Giemsa-stained thick and thin blood films and RDTs) were carried out: one prior to and two after free LLIN distribution at 6-month intervals. Additionally, two socio-cultural and economic surveys using a questionnaire were carried out.&#13;\nResults&#13;\nThe results of our study showed that longitudinal monitoring and implementing a locally adapted communication strategy at the household level were associated with reduced malaria transmission and lower P. falciparum prevalence rates. The adherence of the population to properly use LLINs increased net utilization to very high levels (95-100%). While a rapid decrease in malaria transmission in Bozi was observed, declines in malaria incidence and prevalence required longer time. Our results highlight the scope and limitations of implementing local malaria control measures. A significant relationship between people’s educational attainment, socio-economic position and nets ownership have been observed. In addition social representations about malaria, blood and blood-related diseases preventing an efficient introduction and routine use of RDTs have been found.&#13;\nConclusions&#13;\nIn central Côte d’Ivoire, scaling up and sustained use of LLINs should be carefully monitored at the household level. Moreover, the integration of larval control holds promise to significantly reducing malaria transmission. Specific health messages tailored to the local context should be used to raise awareness about the use of RDTs for malaria. Remaining challenges (e.g. strategies adapted to the local conditions of information, education and communication, and diagnosis and prevention) must be overcome for integrated control and eventual local elimination of malaria.&#13;\n

Background: Major aetiologies of acute undifferentiated fever (AUF) show wide variations, especially in developing countries including India. A better understanding of ‘AUF causes’ helps in better management of such cases with attendant reduction in morbidity and mortality. The present analytical study, retrospective in nature, estimates burden of the AUF in the years 2013 and 2014 with some useful information and conclusions.Methods: Important pathogens ‘investigated for’ either as a ‘direct or indirect evidence’ included - Malaria parasite, Dengue virus, Salmonella typhi and paratyphi A and Chikungunya virus. Malaria testing included examination of peripheral blood smear with Giemsa stain and also immuno-chromatographic test to detect lactate dehydrogenase (LDH) for Plasmodium falciparum and Plasmodium vivax and also HRP2 for detection of Plasmodium falciparum infections. For dengue and chikungunya virus infections - specific IgM antibodies - were detected by ELISA test. Enteric fever was diagnosed by detecting IgM and IgG antibodies using enzyme immunoassay. For Widal test, agglutinating antibodies against the O and H antigens of S. typhi and “H” antigens of ‘S. paratyphi A’ were undertaken. All the test procedures, including sample collections, were performed as per manufacturer’s recommendations, and, as per ‘standard operating procedures (SOPs)’.Results: Of the 10,670 samples received for dengue investigations, 3646 i.e. 34.17% tested seropositive for dengue cases. Percentage seropositivity for chikungunya was 18.6 (8/48). For dengue, 1193 (43.92%) and 488/577 (84.57%) samples were positive in the year 2013 and 2014 respectively in Delhi alone. Annual peak in months of September to November was observed for dengue while a bi-annual pattern was observed for malaria with two peaks occurring in months of May-June and August-September respectively for the year (s) i.e. 2013 and 2014. Enteric fever was present throughout the year with no specific distribution pattern. Majority of patients were from Delhi and adjoining Haryana followed by Western Uttar Pradesh. Co-infection of dengue with enteric fever was observed in only four cases.Conclusions: Dengue, chikungunya, malaria and enteric fever were the most important major causes of AUF in the year 2013 and 2014. Improved interactions with clinician counterparts generating awareness about major aetiologies of AUF would help in timely detection of such illnesses and hence better management reducing morbidity and mortality in the long run.

A 76-year-old woman, who had never been seriously ill, was admitted to our hospital with fever and shaking chills. She progressively developed septic shock. We detected Streptococcus pneumoniae in a routine examination of a Giemsa-stained peripheral blood smear. Despite intensive care with antibiotic therapy, she died within several hours after admission. A peripheral blood smear occasionally shows bacteria in cases of overwhelming septicemia, thus indicating a severe impairment of splenic function. We suggest that, in cases of severe septicemia, an examination of a peripheral blood smear is therefore useful for the rapid detection of organisms in comparison to a traditional blood culture.

Comparative evaluation of malaria antigen test and peripheral blood smears in diagnosis of malaria - IJMMTD- Print ISSN No: - 2581-4753 Online ISSN No:- 2581-4761 Article DOI No:- 10.18231/2581-4761.2019.0008, IP International Journal of Medical Microbiology and Tropical Diseases-IP Int J Med Microbiol Trop Dis

Background Malaria which is an occasionally fatal, preventable, parasitic disease is a major health problem in endemic countries like India and is caused by Plasmodium species. Malaria infection has been associated with variations in the hematological parameters, and complete blood count (CBC) is the first line of investigation carried out for looking any alterations in hematological parameters. The aim of this study was to analyze the correlation between hematological parameters and malarial parasite indices and its effect on treatment outcome. Patients and methods This study was conducted on patients who were admitted to and attended JN Medical College and Hospital, Aligarh, for a period of 2 years. CBC of all of the clinically suspected cases of malaria was done, and diagnosis of malaria was confirmed using quantitative buff coat, rapid diagnostic test, and peripheral blood smear examination. Results Of 408 cases that presented with fever and were clinically suspected to have malaria, 144 (35.29%) cases were positive for malaria by one or more than one test performed for diagnosis. When hematological parameters were compared, it was seen that thrombocytopenia and anemia were most significantly encountered derangements in malarial infection followed by eosinophilia. These parameters were more affected in Plasmodium falciparum infection, which was seen quantitively increasing with the malarial parasite density index. Conclusion As CBC is the earliest investigation carried out, fever with chills and rigors along with hematological parameters/indices can be used as a provisional diagnostic tool for malarial infection, and treatment can be started early. It will prevent the complication and hence morbidity and mortality, especially in those cases in which diagnosis of malaria could not be possible by quantitative buff coat, rapid diagnostic test, or peripheral detection of the malarial parasite.

School children are increasingly recognised as an important target for malaria control. However, limited evidence exists on the relative benefits of alternative school-based malaria control interventions or how impact may vary according to transmission intensity. Nested within the first evaluation of school-based intermittent screening and treatment (IST), in a region of low-to-moderate transmission, this thesis aimed to investigate the influence of heterogeneity in underlying transmission risk and variation in the fidelity of the intervention on the impact and possible operational applications of IST. The thesis utilized data from a cluster-randomised trial, over two years, evaluating the impact of school-based IST on health and education of children in 101 schools in south coast, Kenya. In the intervention children were screened for Plasmodium falciparum infection using rapid diagnostic tests (RDTs) once a term, with those found RDT-positive treated with artemether-lumefantrine. Cross-sectional analysis of baseline data, indicated marked heterogeneity in P. falciparum infection and anaemia at school-level. P. falciparum infection was strongly associated with anaemia, but health status was not associated with educational performance. Subsequent analysis of the impact of IST showed no benefit on the primary health or education outcomes even when stratified by baseline Plasmodium prevalence, or number of treatments received. Latent class analysis suggested reasonable diagnostic performance of RDTs, with seasonal variability observed. Bayesian geostatistical analysis of the spatial and temporal heterogeneity of school-level P. falciparum infection highlighted the relative stability in observed heterogeneity, despite periodic treatment of infection. Analysis at the individual-level suggested overdispersion of P. falciparum infection with prevalence-based models showing a greater proportion of individuals repeatedly infected than expected even after accounting for exposure. Collectively, these findings indicate that, in such a locally heterogeneous transmission setting, school-based IST provided no health or education benefits, with a number of factors identified for lack of impact. The persistence of high infection levels in certain schools despite periodic treatment highlights the importance of fine-scale targeting with a need for community-wide coverage in high-risk clusters. Moreover, the findings suggest a potential role for school-level screenings in both the identification of communities for targeted control, and periodic monitoring of impact.