Establishment Of Foci Research Articles

Imported malaria: a possible threat to the elimination of malaria from Sri Lanka?

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.

Epidemiology of Leprosy

ACCORDING to a paper on this subject by Dr. G. W. McCoy, medical director (retired) of the United States Public Health Service (Public Health Rep., Dec. 18), leprosy tends to disappear from many parts of the world, while in other parts it tends to spread freely. At the present time in Europe the disease spreads apparently only in the countries bordering on the Mediterranean and the Baltic. As regards the United States, in Louisiana, Florida and Texas the presence of imported cases from the British West Indies, Dutch Guiana, South America, China and Chile, has resulted in the establishment of foci in which the disease shows a strong tendency to perpetuate itself, while in the central north-western States, such as Minnesota, leprosy has shown little tendency to become established. In other parts of the United States the disease is so rare as to be practically negligible from the public health aspect. Dr. McCoy concludes that in an age in which great social and economic changes are occurring, it is impossible to predict what effect they may have on leprosy or other diseases.

Arthritis in Rats Caused by Pleuropneumonia-Like Micro-Organisms and the Relationship of Similar Organisms to Human Rheumatism

The etiology of rheumatoid arthritis has remained obscure in spite of considerable investigation. The difficulty of its elucidation is increased by the fact that no experimental animal has yet been found in which it is possible to reproduce the disease or in which a strictly comparable disease has occurred spontaneously. Until comparatively recent, all attempts to produce arthritis in animals by the injection of microorganisms, either directly into joints, into the blood stream or by the establishment of foci elsewhere, have led to the development of joint disease which bears only slight resemblance to the typical changes of rheumatoid arthritis. The animal arthritis produced by bacteria is an acute process, usually markedly purulent, which may go on to a chronic state in which the late stages of the inflammatory process suggest, to a certain extent, the pathological changes found in rheumatoid arthritis, but the animal disease lacks many of the outstanding features of the human, particularly the phenomenon of recurrences, and also destruction of cartilage under a granulation tissue pannus. Recently there have appeared reports of spontaneous arthritis occurring in rats and mice, which have given new impetus to attempts to find an animal disease which resembles more closely rheumatoid arthritis and also to investi-