Malarial Endemic Areas Research Articles

Lung Damage Induced by Plasmodium berghei ANKA in Murine Model of Malarial Infection is Mitigated by Dietary Supplementation with DHA-Rich Omega-3.

Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) are severe complications that can occur in infections caused by any Plasmodium species. Due to the high lethality rate and the lack of specific treatment for ALI/ARDS, studies aimed at understanding and searching for treatment strategies for such complications have been fundamental. Here, we investigated the protective role of dietary supplementation with DHA-rich fish oil against lung damage induced by Plasmodium berghei ANKA in a murine model. Our results demonstrated that alveolar vascular damage, lung edema, and histopathological alterations were significantly reduced in mice that received dietary supplementation compared to those that did not receive the supplementation. Furthermore, a significant reduction in the number of CD8+ T lymphocytes, in addition to reduced infiltration of inflammatory cells in the bronchoalveolar lavage fluid was also observed. High levels of IL-10, but not of TNF-α and IFN-γ, were also observed in infected mice that received the supplementation, along with a reduction in local oxidative stress. Together, the data suggest that dietary supplementation with DHA-rich fish oil in malarial endemic areas may help reduce lung damage resulting from the infection, thus preventing worsening of the condition.

A dot-blot ELISA preliminary evaluation using PvMSP1-42 recombinant protein as antigen for serological diagnosis of Plasmodium vivax infection in Thailand.

Plasmodium vivax is the most prevalent cause of malaria in Thailand and is predominant in malarial endemic areas worldwide. P. vivax infection is characterized by low parasitemia, latent liver-stage parasites, or asymptomatic infections leading to underreported P. vivax cases. These are significant challenges for controlling and eliminating P. vivax from endemic countries. This study developed and evaluated a dot-blot enzyme-linked immunosorbent assay (ELISA) using PvMSP1-42 recombinant antigen for serological diagnosis based on the detection of antibodies against P. vivax. The optimal PvMSP1-42 concentration and dilutions of anti-human IgG horseradish peroxidase (HRP)-conjugated antiserum were tested on 88 serum samples from P. vivax, Plasmodium falciparum and bacterial infection, including healthy individuals. A cut-off titer of 1:800 produced optimal values for sensitivity and specificity of 90.9 and 98.2%, respectively, with an accuracy of 95.5%. The positive and negative predictive values were 96.8 and 94.7% respectively. The results from microscopic examination and dot-blot ELISA showed strong agreement with the 0.902 kappa index. Thus, the dot-blot ELISA using PvMSP1-42 antigen provided high sensitivity and specificity suitable for serodiagnosis of P. vivax infection. The test is a simple and quick diagnostic assay suitable for field testing as it does not require specific equipment or particular skills.

Clinico-aetiological profile and outcome in children with acute febrile encephalopathy

Background: Acute febrile encephalopathy (AFE) is a medical emergency as well as diagnostic and therapeutic challenge in children. Objective of this study was to assess clinico-aetiological profile and outcome in children with AFE.Methods: This prospective observational study was carried out at tertiary care hospital Udaipur, from January 2020 to July 2021. Total 61 children aged 1 month to 18 years who were admitted in PICU with fever ≤2 weeks duration and altered sensorium either at onset or following fever were enrolled. Patient’s detailed history and physical examination including detailed neurological examinations were recorded on pre-structured performa. The investigations included CBC with PBF, ESR, malarial parasite, dengue, scrub typhus, typhi-dot, blood sugar, KFT, electrolytes, LFT, calcium, CSF examination, urine examination, X-ray chest. ABG, serum ammonia, blood culture for bacteriological studies and CT/MRI brain were performed whenever required.Results: 61 patients were admitted with fever and loss of sensorium. The most common clinical sign was the pallor (63.9%) and vomiting (55.7%) was the most common clinical symptom. Cerebral malaria was the commonest cause (31.1%) of AFE followed by suspected viral encephalitis (14.7%) and pyogenic meningitis 9 (14.7%). Out of total 61 patients, 45 (73.8%) patients were discharged and 16 (26.2%) patients were expired. Maximum mortalities were seen in Reye’s syndrome (5 out of 6 cases) and was most in age group <5 years of age (26 cases).Conclusions: Cerebral malaria was the leading cause of AFE followed by suspected viral encephalitis and pyogenic meningitis. While determining the aetiology of AFE in a malarial endemic area, cerebral malaria should be considered in all patients. Reye’s syndrome should also be considered in patients of AFE should be evaluated to diagnose or rule out this entity.

Breeding Preference and Bionomics of Anopheles spp. at the Malarial Endemic Area, Runut Village, East Nusa Tenggara Province, Indonesia

Introduction: Anopheles mosquito is transmitting malaria, one of the health problems in Indonesia. Understanding Anopheles mosquito behaviour and its breeding preference is one of the crucial keys to prevent malaria transmission. This study aimed to identify the breeding place distribution and bionomics of Anopheles spp. in Runut village, Sikka district, East Nusa Tenggara. Methods: A descriptive observational study was conducted in Runut village, Waigete sub- district, in April 2018. Anopheles spp. larvae were collected in 7 suspected breeding places consisting of 2 rice fields, 3 fish ponds, and 2 puddles. Mosquitos behaviour was observed using bed-net traps located inside and outside the house from 7.15 PM to 1.15 AM after obtaining informed consent. Mosquito collection using bed-net trap were performed for 40 minutes then followed by resting mosquito collection for 10 minutes. Results: Anopheles spp. larvae were found in most of the suspected aquatic habitats, presenting different densities and together with larvae of the other mosquito species. Relatively high number of Anopheles spp. larvae was obtained from a puddle. Only one female mosquito of Anopheles spp. resting on the wall inside house was found around 00.55 – 01.05 AM and resulted in low mosquito density determination. Conclusion: Anopheles spp. larvae were harbouring in most of the aquatic habitats and one puddle contained moderately abundant larvae of Anopheles in Runut village, Sikka district, East Nusa Tenggara, Indonesia. Even only one Anopheles spp. mosquito was detected inside the house, residents in Runut village should regular use insecticide-treated bed nets and continuous observation of mosquito breeding places especially puddles to prevent malaria and other mosquito-borne diseases.

Malaria and COVID-19 in Malarial Endemic Area: Incidence and Coincidence

Anahtar Kelimeler: Sıtma, COVID-19, insidans, tesadüf.

Paediatric formulations of artemisinin-based combination therapies for treating uncomplicated malaria in children.

BackgroundIn endemic malarial areas, young children have high levels of malaria morbidity and mortality. The World Health Organization recommends oral artemisinin‐based combination therapy (ACT) for treating uncomplicated malaria. Paediatric formulations of ACT have been developed to make it easier to treat children.ObjectivesTo evaluate evidence from trials on the efficacy, safety, tolerability, and acceptability of paediatric ACT formulations compared to tablet ACT formulations for uncomplicated P falciparum malaria in children up to 14 years old.Search methodsWe searched the Cochrane Infectious Diseases Group Specialized Register; Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE; Embase; the Latin American and Caribbean Health Science Information database (LILACS); ISI Web of Science; Google Scholar; Scopus; and the metaRegister of Controlled Trials (mRCT) to 11 December 2019.Selection criteriaWe included randomised controlled clinical trials (RCTs) of paediatric versus non‐paediatric formulated ACT in children aged 14 years or younger with acute uncomplicated malaria.Data collection and analysisTwo authors independently assessed eligibility and risk of bias, and carried out data extraction. We analyzed the primary outcomes of efficacy, safety and tolerability of paediatric versus non‐paediatric ACT using risk ratios (RR) and 95% confidence intervals (CI). Secondary outcomes were: treatment failure on the last day of observation (day 42), fever clearance time, parasite clearance time, pharmacokinetics, and acceptability.Main resultsThree trials met the inclusion criteria. Two compared a paediatric dispersible tablet formulation against crushed tablets of artemether‐lumefantrine (AL) and dihydroartemisinin‐piperaquine (DHA‐PQ), and one trial assessed artemether‐lumefantrine formulated as powder for suspension compared with crushed tablets. The trials were carried out between 2006 and 2015 in sub‐Saharan Africa (Benin, Mali, Mozambique, Tanzania, Kenya, Democratic Republic of the Congo, Burkina Faso, and The Gambia).In all three trials, the paediatric and control ACT achieved polymerase chain reaction (PCR)‐adjusted treatment failure rates of < 10% on day 28 in the per‐protocol (PP) population.For the comparison of dispersible versus crushed tablets, the two trials did not detect a difference for treatment failure by day 28 (PCR‐adjusted PP population: RR 1.35, 95% CI 0.49 to 3.72; 1061 participants, 2 studies, low‐certainty evidence). Similarly, for the comparison of suspension versus crushed tablet ACT, we did not detect any difference in treatment failure at day 28 (PCR‐adjusted PP population: RR 1.64, 95% CI 0.55 to 4.87; 245 participants, 1 study).We did not detect any difference in serious adverse events for the comparison of dispersible versus crushed tablets (RR 1.05, 95% CI 0.38 to 2.88; 1197 participants, 2 studies, low‐certainty evidence), or for the comparison of suspension versus crushed tablet ACT (RR 0.74, 95% CI 0.17 to 3.26; 267 participants, 1 study).In the dispersible ACT arms, drug‐related adverse events occurred in 9% of children in the AL study and 34% of children in the DHA‐PQ study. In the control arms, drug‐related adverse events occurred in 12% of children in the AL study and in 42% of children in the DHA‐PQ study. Drug‐related adverse events were lower in the dispersible ACT arms (RR 0.78, 95% CI 0.62 to 0.99; 1197 participants, 2 studies, moderate‐certainty evidence).There was no detected difference in the rate of drug‐related adverse events for suspension ACT versus crushed tablet ACT (RR 0.66, 95% CI 0.33 to 1.32; 267 participants, 1 study).Drug‐related vomiting appeared to be less common in the dispersible ACT arms (RR 0.75, 95% CI 0.56 to 1.01; 1197 participants, 2 studies, low‐certainty evidence) and in the suspension ACT arm (RR 0.66, 95% CI 0.33 to 1.32; 267 participants, 1 study), but both analyses were underpowered.No study assessed acceptability.Authors' conclusionsTrials did not demonstrate a difference in efficacy between paediatric dispersible or suspension ACT when compared with the respective crushed tablet ACT for treating uncomplicated P falciparum malaria in children. However, the evidence is of low to moderate certainty due to limited power. There appeared to be fewer drug‐related adverse events with dispersible ACT compared to crushed tablet ACT. None of the included studies assessed acceptability of paediatric ACT formulation.

Application of Epidemiological Geographic Information System: An Open-Source Spatial Analysis Tool Based on the OMOP Common Data Model.

Background: Spatial epidemiology is used to evaluate geographical variations and disparities in health outcomes; however, constructing geographic statistical models requires a labor-intensive process that limits the overall utility. We developed an open-source software for spatial epidemiological analysis and demonstrated its applicability and quality. Methods: Based on standardized geocode and observational health data, the Application of Epidemiological Geographic Information System (AEGIS) provides two spatial analysis methods: disease mapping and detecting clustered medical conditions and outcomes. The AEGIS assesses the geographical distribution of incidences and health outcomes in Korea and the United States, specifically incidence of cancers and their mortality rates, endemic malarial areas, and heart diseases (only the United States). Results: The AEGIS-generated spatial distribution of incident cancer in Korea was consistent with previous reports. The incidence of liver cancer in women with the highest Moran’s I (0.44; p < 0.001) was 17.4 (10.3–26.9). The malarial endemic cluster was identified in Paju-si, Korea (p < 0.001). When the AEGIS was applied to the database of the United States, a heart disease cluster was appropriately identified (p < 0.001). Conclusions: As an open-source, cross-country, spatial analytics solution, AEGIS may globally assess the differences in geographical distribution of health outcomes through the use of standardized geocode and observational health databases.

The global burden of sickle cell disease in children under five years of age: a systematic review and meta-analysis.

BackgroundSickle cell disease (SCD) is a common haematological disorder, affecting millions of people worldwide. It is most prevalent in malarial endemic areas in the tropics where outcomes are often poor due to resource constraints, resulting in most children dying before reaching adulthood. As increasing progress is made towards reducing under 5 mortality from infectious causes, non-communicable diseases (NCDs) including SCD have risen to the forefront of the global health agenda. Despite this, the global mortality burden of SCD remains poorly understood. This study aimed to estimate the incidence and mortality of SCD in children under 5 years of age in order to inform policy and develop sustainable strategies to improve outcomes.MethodologyWe performed a systematic literature search of Medline, EMBASE, Journals@Ovid, and Web of Science for studies on the incidence and mortality of SCD in children under 5, with search dates set from January 1980 and July 2017. We conducted random effects meta-analysis to obtain pooled meta-estimates of birth prevalence and mortality rates globally, and for each World Health Organization (WHO) region.Results67 papers were found with relevant data. 52 contained data on incidence and prevalence and 15 contained data on mortality. The overall pooled estimate of mortality from the limited data available was 0.64 per 100 years of child observation (95% CI = 0.28-1.00) with the highest rate seen in Africa 7.3 (95% CI = 4.03-10.57). The global meta-estimate for the birth prevalence of homozygous sickle cell disease was 112 per 100 000 live births (95% CI = 101-123) with a birth prevalence in Africa of 1125 per 100 000 (95% CI = 680.43-1570.54) compared with 43.12 per 100 000 (95% CI = 30.31-55.92) in Europe.ConclusionThere were a number of limitations in the depth and breadth of available data however it is clear that both the highest prevalence and highest mortality of SCD is in Africa. In order to address this burden, there is a need for national comprehensive newborn screening to identify patients, and the development of holistic SCD care programmes to provide therapeutics and education for families and children with SCD. This targeted funding should form part of a broader increased global focus on NCDs in childhood.

Evaluasi Penggunaan Obat Antimalaria di Rumah Sakit Umum Daerah (RSUD) Abepura, Jayapura

Evaluation of drug use is a quality assurance process that is carried out continuously, organizational structured and recognized to ensure that the drug is used appropriately and effectively. Until recently, Jayapura city is still as a malarial endemic area. In 2012, the number of malaria cases are malarial tertiana 8.535 (39%) cases, malarial tropical 12.256 (57%), malarial mix (tertiana+tropical) 612 (2,84%) and malarial quartana 73 (0,33%). The highest percentage of malarial cases in the Jayapura city is caused by Plasmodium falciparum. The aims of this study are to evaluate the drug use and the dose accuracy of antimalarial drugs in the General Hospital of Abepura from July to December 2014. This is a descriptive study conducted by a retrospective review of medical records of patients. The results of the study concluded that the highest incidence rates occurred in the male (59.04%) and lowest in women (40.96%), 15-25 years of age (57.8%), 26-35 years of age (27.7%) and  36-45 years of age (14.5%). The dose accuracy for antimalarial drugs (100%) indicated that antimalarial drugs used are Primaquine, Artesunate injection and Dihydroartemisin + piperaquine (DHP) or Darplex. Key words: Abepura hospital, antimalarial drug, Jayapura, malaria

Longitudinal Study of the Species Composition and Spatio-Temporal Abundance ofAnophelesLarvae in a Malaria Risk Area in Argentina

Species composition and spatio-temporal abundance of Anopheles (Diptera: Culicidae) larvae and their relationship with environmental variables were studied in an endemic malarious area of northwestern Argentina, where Anopheles pseudopunctipennis is the main vector involved in malaria transmission. From Dec 2001 to Dec 2005, we performed monthly samplings of different aquatic larval habitats, such as puddles, irrigation canals, ponds and pools of Mountain Rivers. To determine the relationship among environmental variables and larval abundance, we used Poisson's regression analysis. We collected 5,079 larvae of which An. pseudopunctipennis was the most abundant species followed by Anopheles argyritarsis and Anopheles evansae. The density of Anopheles pseudopunctipennis larvae fluctuated between the end of spring until autumn, when malaria cases occur in the area. Concurrently, the larval densities of the other anophelinae species fluctuated throughout these climatic seasons. Poisson regression revealed that an increase of mean minimum temperature produced an increase in the abundance of An. pseudopunctipennis and An. argyritarsis. The mean maximum temperature and the water temperature greatly influenced the abundance of An. pseudopunctipennis, An. evansae and An. strodei. Increases of these temperature variables produced increases in abundance of these species. These factors should be taken into consideration when control measures for immature mosquitoes are implemented to reduce the number of larval habitats and the production of larvae, which may ultimately result in the elimination of malaria in this area.

Polymorphism of Plasmodium Falciparum Dihydrofolate Reductase and Dihydropteroate Synthase Genes among Pregnant Women with Falciparum Malaria in Banjar District, South Kalimantan Province, Indonesia

Pregnant women are highly vulnerable to malaria infection in its endemic areas, particularly infection by Plasmodium falciparum that can cause premature, low birth weight, severe anemia in pregnant women, and death. Sulfadoxine-pyrimethamine (SP) for Intermittent Preventive Treatment for pregnant (IPTp) is used for malaria control in pregnancy recommended by the World Health Organization that has already been implemented in Africa. The P. falciparum resistance to SP has been reported in several malarial endemic areas, and mutations in the genes of Plasmodium falciparum Dihydrofolate Reductase (Pfdhfr) and Dihydropteroate Synthase (Pfdhps) are shown to be associated with parasite resistance to SP treatment. Genetic analysis of Pfdhfr and Pfdhps genes in pregnant women infected with P. falciparum has not yet been examined in Indonesia. The cross-sectional study was conducted at two subdistricts, Sungai Pinang and Peramasan, in Banjar district of South Kalimantan Province, where 127 pregnant women were recruited from 2008 to April 2010. Two important mutations in Pfdhfr gene (amino acid positions at N51 and S108) and three in Pfdhps gene (A437, K540 and A581) were analyzed by nested PCR-RFLP method. All of the seven pregnant women samples infected with P. falciparum presented PfDHFR 108N and PfDHPS 437G mutations. One of the samples had the additional mutation at PfDHPS 540, in which Lys is substituted by Glu. These results suggested that P. falciparum might present only some resistance to SP at Sungai Pinang and Peramasan subdistricts, Banjar District, South Kalimantan province, Indonesia. Although there were limited number of samples, this study showed only few mutations of Pfdhfr and Pfdhps genes in P. falciparum at Banjar district, South Kalimantan Province, that suggests SP might be effective for IPTp in this area. Thus, further analysis of the other mutation sites in Pfdhfr and Pfdhps genes and in vivo efficacy study of SP with more sufficient sample numbers will be necessary to confirm this preliminarily result.Keywords: PfDHFR and PfDHPS genes, Pregnant women, Falciparum malaria

OS025. Placental malaria infection as a risk factor for hypertensivedisorders of pregnancy in malaria endemic regions: A systematic review and meta-analysis

Hypertensive disorders of pregnancy (HDP) are a leading cause of maternal mortality in low and middle income countries (LMICs). HDP complicates pregnancy in many malarial endemic areas with the greatest burden in sub-saharan Africa. It has been suggested that there is a link between placental malaria infection (PMI) caused by Plasmodium falciparum and HDP. To our knowledge, a systematic review has never been conducted on the relationship between PMI and HDP and the modification of that relationship with parity. 1. To critically assess the association between PMI and HDP among a general obstetrical population in malarial endemic regions 2. To evaluate if the relationship between PMI and HDP is modified by parity. We conducted a systematic review for any study reporting on placental malaria and hypertension. A literature search based on a prospectively prepared protocol was conducted in PubMed Central and EMBASE until 06/09/2011. Additional data on parity of study participants in each study group was requested from corresponding authors of included studies by personal contact through email. Studies were assessed using the Newcastle-Ottawa Scale. The Cochrane Revman 5.1 software was used for statistical analysis according to standardised methodology. Risk Ratios with 95% confidence interval were calculated. Seven studies met our inclusion criteria [1-7]. These included cross-sectional, case control and observational studies. Six were in English and one was translated internally from French. One study [2] was further excluded because it did not represent a general obstetrical population. Our meta-analysis found no association between PMI and HDP in a general obstetric population in malaria endemic areas [RR of 1.00, 95% CI of 0.82,1.23]. Furthermore, we did not find that this relationship was modified by parity in two studies [RR (nulliparous) 0.92, 95% CI of 0.26,3.25)]. Events=women with HDP (). Although trends and associations have been reported in individual studies, we did not find a significant association between PMI and the risk of HDP. There is an apparent need for a large prospective cohort study to be conducted on PMI and the possible association with HDP.

Paediatric Formulations of Artemisinin-Combination Therapies for Treating Uncomplicated Malaria in Children

BACKGROUND In endemic malarial areas, young children have high levels of malaria morbidity and mortality. The World Health Organization recommends oral artemisinin-based combination therapy (ACT) for treating uncomplicated malaria. Paediatric formulations of ACT have been developed to make it easier to treat children. OBJECTIVES To evaluate evidence from trials on the efficacy, safety, tolerability, and acceptability of paediatric ACT formulations compared to tablet ACT formulations for uncomplicated P falciparum malaria in children up to 14 years old. SEARCH METHODS We searched the Cochrane Infectious Diseases Group Specialized Register; Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE; Embase; the Latin American and Caribbean Health Science Information database (LILACS); ISI Web of Science; Google Scholar; Scopus; and the metaRegister of Controlled Trials (mRCT) to 11 December 2019. SELECTION CRITERIA We included randomised controlled clinical trials (RCTs) of paediatric versus non-paediatric formulated ACT in children aged 14 years or younger with acute uncomplicated malaria. DATA COLLECTION AND ANALYSIS Two authors independently assessed eligibility and risk of bias, and carried out data extraction. We analyzed the primary outcomes of efficacy, safety and tolerability of paediatric versus non-paediatric ACT using risk ratios (RR) and 95% confidence intervals (CI). Secondary outcomes were: treatment failure on the last day of observation (day 42), fever clearance time, parasite clearance time, pharmacokinetics, and acceptability. MAIN RESULTS Three trials met the inclusion criteria. Two compared a paediatric dispersible tablet formulation against crushed tablets of artemether-lumefantrine (AL) and dihydroartemisinin-piperaquine (DHA-PQ), and one trial assessed artemether-lumefantrine formulated as powder for suspension compared with crushed tablets. The trials were carried out between 2006 and 2015 in sub-Saharan Africa (Benin, Mali, Mozambique, Tanzania, Kenya, Democratic Republic of the Congo, Burkina Faso, and The Gambia). In all three trials, the paediatric and control ACT achieved polymerase chain reaction (PCR)-adjusted treatment failure rates of < 10% on day 28 in the per-protocol (PP) population. For the comparison of dispersible versus crushed tablets, the two trials did not detect a difference for treatment failure by day 28 (PCR-adjusted PP population: RR 1.35, 95% CI 0.49 to 3.72; 1061 participants, 2 studies, low-certainty evidence). Similarly, for the comparison of suspension versus crushed tablet ACT, we did not detect any difference in treatment failure at day 28 (PCR-adjusted PP population: RR 1.64, 95% CI 0.55 to 4.87; 245 participants, 1 study). We did not detect any difference in serious adverse events for the comparison of dispersible versus crushed tablets (RR 1.05, 95% CI 0.38 to 2.88; 1197 participants, 2 studies, low-certainty evidence), or for the comparison of suspension versus crushed tablet ACT (RR 0.74, 95% CI 0.17 to 3.26; 267 participants, 1 study). In the dispersible ACT arms, drug-related adverse events occurred in 9% of children in the AL study and 34% of children in the DHA-PQ study. In the control arms, drug-related adverse events occurred in 12% of children in the AL study and in 42% of children in the DHA-PQ study. Drug-related adverse events were lower in the dispersible ACT arms (RR 0.78, 95% CI 0.62 to 0.99; 1197 participants, 2 studies, moderate-certainty evidence). There was no detected difference in the rate of drug-related adverse events for suspension ACT versus crushed tablet ACT (RR 0.66, 95% CI 0.33 to 1.32; 267 participants, 1 study). Drug-related vomiting appeared to be less common in the dispersible ACT arms (RR 0.75, 95% CI 0.56 to 1.01; 1197 participants, 2 studies, low-certainty evidence) and in the suspension ACT arm (RR 0.66, 95% CI 0.33 to 1.32; 267 participants, 1 study), but both analyses were underpowered. No study assessed acceptability. AUTHORS' CONCLUSIONS Trials did not demonstrate a difference in efficacy between paediatric dispersible or suspension ACT when compared with the respective crushed tablet ACT for treating uncomplicated P falciparum malaria in children. However, the evidence is of low to moderate certainty due to limited power. There appeared to be fewer drug-related adverse events with dispersible ACT compared to crushed tablet ACT. None of the included studies assessed acceptability of paediatric ACT formulation.

Spatio—temporal distribution of malaria vectors (Diptera: Culicidae) across different climatic zones of Iran

Abstract Malaria is a main vector-borne public health problem in Iran. The last studies on Iranian mosquitoes show 31 Anopheles species including different sibling species and genotypes, eight of them are reported to play role in malaria transmission. The objective of this study is to provide a reference for malaria vectors of Iran and to map their spatial and temporal distribution in different climatic zones. Shape files of administrative boundaries and climates of Iran were provided by National Cartographic Center. Data on distribution and seasonal activity of malaria vectors were obtained from different sources and a databank in district level was created in Excel 2003, inserted to the shape files and analyzed by ArcGIS 9.2 to provide the maps. Anopheles culicifacies Giles s.l., Anopheles dthali Patton, Anopheles fluviatilis James s.l., Anopheles maculipennis Meigen s.l., Anopheles sacharovi Favre, Anopheles stephensi Liston, and Anopheles superpictus Grassi have been introduced as primary and secondary malaria vectors and Anopheles pulcherrimus Theobald as a suspected vector in Iran. Temporal distribution of anopheline mosquitoes is restricted to April–December in northern Iran, however mosquitoes can be found during the year in southern region. Spatial distribution of malaria vectors is different based on species, thus six of them (except for Anopheles maculipennis s.l. and Anopheles sacharovi) are reported from endemic malarious area in southern and southeastern areas of Iran. The climate of this part is usually warm and humid, which makes it favorable for mosquito rearing and malaria transmission. Correlation between climate conditions and vector distribution can help to predict the potential range of activity for each species and preparedness for malaria epidemics.

Plasmodium falciparum immunodetection in bone remains of members of the Renaissance Medici family (Florence, Italy, sixteenth century)

Medical accounts and ancient autopsy reports imply that tertian malarial fevers caused the death of four members of the Medici family of Florence: Eleonora of Toledo (1522–1562), Cardinal Giovanni (1543–1562), don Garzia (1547–1562) and Grand Duke Francesco I (1531–1587). All members of the Medici family hunted in the endemic malarial areas of Tuscany, such as the marshy areas surrounding their villas and along the swampy Maremma and were, therefore, highly exposed to the risk of being infected by Falciparum malaria. To determine if the original death certificates issued by the court physicians were correct, we carried out immunological investigations and then compared the biological results to the historical sources. Bone samples were examined for the presence of Plasmodium falciparum histidine-rich- protein-2 (PfHRP2) and P. falciparum lactate dehydrogenase (PfLDH) using two different qualitative double–antibody immunoassays. Our findings provide the first modern laboratory evidence of the presence of P. falciparum ancient proteins in the skeletal remains of four members of the Medici family. We confirm the clinical diagnosis of the court physicians, using modern methods. Finally, this study demonstrates that immunodetection can be successfully applied not only to mummified tissues but also to skeletal remains, thus opening new paths of investigation for large archaeological series.

Passive Air Sampling of Organochlorine Pesticides in Mexico

The spatial and temporal variation of organochlorine pesticides (OCs) in air across Mexico was investigated by deploying passive samplers at eleven stations across the country during 2005-2006. Integrated samples were taken over three-month periods and quantified for DDT compounds, endosulfans, toxaphenes, components of technical chlordane, hexachlorocyclohexanes (HCHs), and dieldrin. Enantiomers of chiral chlordanes and o,p'-DDT were determined on chiral stationary phase columns as an indicator of source and age. Results are discussed in combination with pumped air samples taken at four other stations in southern Mexico during 2002-2004. DDT and its metabolites, endosulfan and toxaphene were the most abundant OCs detected in all sampling sites. Atmospheric concentrations of SigmaDDT (p,p'-DDT + o,p'-DDT + p,p'-DDE + o,p'-DDE + p,p'-DDD + o,p'-DDD) ranged from 15 to 2360 pg m(-3) with the highest concentrations found in southern Mexico and the lowest found in northern and central Mexico. A fresher DDT residue was observed at sites with greater DDT use and in the southern part of the country, as shown from the higher FDDTe = p,p'-DDT/(p,p'-DDT + p,p'-DDE) and nearly racemic o,p'-DDT. This agrees with the former heavy use of DDT in the endemic malarious area of the country. A local hotspot of endosulfan was identified at an agricultural area in Mazatlan, Sinaloa, with a annual mean concentration of SigmaENDO (endosulfans I + II + endosulfan sulfate) = 26,800 pg m(-3). At this site, higher concentrations of SigmaENDO were recorded during the winter (November to February) and spring (February to May) periods. From back trajectory analysis, this coincides with a shift in the air mass coming from the Pacific Ocean (May to November) to the inland agricultural area (November to May). The elevated SigmaENDO observed is likely due to the local agricultural usage. HCHs, chlordanes, transnonachlors, and dieldrin were more evenly distributed across the country likely due to them being aged residues and more diffuse in the environment. In contrast, hotspots of endosulfans, DDTs, and toxaphenes were observed as they were heavily used in localized agricultural or malarious regions of Mexico.

Ethnopharmacology and malaria: New hypothetical leads or old efficient antimalarials?

New treatments are urgently needed to curb and eradicate malaria in developing countries. As most people living in malarial endemic areas use traditional medicine to fight this disease, why have new treatments not emerged recently from ethnopharmacology-oriented research? The rationale and limitations of the ethnopharmacological approach are discussed in this paper, focusing on ethnopharmacology methodologies and techniques used for assessing botanical samples for their antimalarial properties. Discrepancies often observed between strong ethnopharmacological reputation and laboratory results are discussed, as well as new research perspectives.

Le paludisme grave d’importation à propos de neuf cas : expérience de l’hôpital militaire Avicenne de Marrakech

Incidence of severe imported malaria increases with the multiplication of humanitarian and military missions in malarial endemic areas. The purpose of this study was to describe the demographic, clinical, therapeutic and outcome aspects of 9 cases which have been hospitalized in the intensive care unit and medecine service of the military hospital of Marrakech, between january 2001 and december 2004. Out of 68 patients admitted with symptomatic malaria during this period, 9 cases were considered as severe. All of them were male soldiers (mean age: 33,3 years), 7 of them have stayed in Democratic Republic of Congo, and 2 in Ivory Coast. Chemoprophylaxis consisted in chloroquine plus proguanil in 5 cases and mefloquine in 4 cases. The mean duration of stay in endemic area was 9,3 months. The clinical presentation was dominated by troubles of consciousness, which justified initial admission in the intensive care unit. The mean duration of hospitalization was 3,3 days in intensive care unit and 5,6 days in the medical department. Thick smear always revealed high parasitemia (5-15%) with Plasmodium falciparum, associated with Plasmodium ovale in two cases. Antimalarial treatment consisted in quinine salts administration. Evolution was favourable without recurrence in 7 cases, but 2 deaths were recorded. Severe imported malaria remains associated with bad outcome and requires early diagnosis and close monitoring of such cases.

Verreisende und Rückkehrer in der Praxis

In order to competently advise people who are planning to travel abroad the doctor needs information both about the planned journey (the mode of travel, the itinerary, the time of the trip) and about possible preexisting health problems. The area where the traveller intends to stay determines the specific risk of endemic diseases such as malaria, dengue-fever, yellow-fever etc. The recommendations for prophylaxis of malaria and for the different vaccinations are constantly modified and can be attained from the internet. Pre-existing health hazards such as cardiovascular diseases, diabetes mellitus, HIV-infection need to be assessed. Special consideration should be taken for pregnant women. The traveller returning from an endemic malarious area who feels ill or is febrile is a medical emergency and must be assessed for the possibility of having malaria since nontreated malaria in non-immune people has a very high mortality rate. Diarrhea is a common problem but is rarely dangerous. Long standing or bloody diarrhea, however, calls for a thorough search for the responsible pathogen. Healthy return travellers do not need a check-up examination because there are virtually no consequences for treatment.

Current clinical presentation of malaria in Enugu, Nigeria

This study examined the malaria situation in a malarial endemic area of Nigeria. Structured questionnaire was applied to 300 doctors practising in Enugu urban, Nigeria and confirmation of the clinical diagnosis by laboratory technique was done using 468 patients. The result shows a high prevalence of Plasmodium falciparum infection (96.4% in children, 87.0% in adults). Malaria positivity rate was 51.9% in children and 42.8% in adults. Fever, vomiting and anorexia were the commonest malaria symptoms in children, while headache, fever, chills and rigors were the commonest malaria symptoms in adults. The diagnostic practice of the doctors was clinical. Fever, vomiting and cough were found to be more associated with malaria parasitaemia in children, while in adults fever was found to be more associated with malaria parasitaemia. Chloroquine and sulphadoxine-pyrimethamine were the commonest drugs used for treating uncomplicated malaria, while quinine was the commonest drug used for treating severe malaria.