Plasmodium Falciparum Cases Research Articles

Age-specific malaria seroprevalence rates: a cross-sectional analysis of malaria transmission in the Ouest and Sud-Est departments of Haiti

BackgroundMalaria transmission continues to occur in Haiti, with 25,423 confirmed cases of Plasmodium falciparum and 161,236 suspected infections reported in 2012. At low prevalence levels, passive surveillance measures, which rely primarily on reports from health systems, becomes less appropriate for capturing annual malaria incidence. To improve understanding of malaria transmission in Haiti, participants from the Ouest and Sud-Est departments were screened using a highly sensitive enzyme-linked immunosorbent assay (ELISA).MethodsBetween February and May 2013, samples were collected from four different sites including a rural community, two schools, and a clinic located in the Ouest and Sud-Est departments of Haiti. A total of 815 serum samples were screened for malaria antibodies using an indirect ELISA coated with vaccine candidates apical membrane antigen (AMA-1) and merozoite surface protein-1 (MSP-119). The classification of previous exposure was established by using a threshold value that fell three standard deviations above the mean absorbance for suspected seronegative population members (OD of 0.32 and 0.26 for AMA-1 and MSP-1, respectively). The observed seroprevalence values were used to fit a modified reverse catalytic model to yield estimates of seroconversion rates.ResultsOf the samples screened, 172 of 815 (21.1%) were AMA-1 positive, 179 of 759 (23.6%) were MSP-119 positive, and 247 of 815 (30.3%) were positive for either AMA-1 or MSP-1; indicating rates of previous infections between 21.1% and 30.3%. Not surprisingly, age was highly associated with the likelihood of previous infection (p-value <0.001). After stratification by age, the estimated seroconversion rate indicated that the annual malaria transmission in the Ouest and Sud-Est department is approximately 2.5% (95% CI SCR: 2.2%, 2.8%).ConclusionsThese findings suggest that despite the absence of sustained malaria control efforts in Haiti, transmission has remained relatively low over multiple decades. Elimination in Haiti appears to be feasible; however, surveillance must continue to be strengthened in order to respond to areas with high transmission and measure the impact of future interventions.

High proportion of knowlesi malaria in recent malaria cases in Malaysia

BackgroundPlasmodium knowlesi is a simian parasite that has been recognized as the fifth species causing human malaria. Naturally-acquired P. knowlesi infection is widespread among human populations in Southeast Asia. The aim of this epidemiological study was to determine the incidence and distribution of malaria parasites, with a particular focus on human P. knowlesi infection in Malaysia.MethodsA total of 457 microscopically confirmed, malaria-positive blood samples were collected from 22 state and main district hospitals in Malaysia between September 2012 and December 2013. Nested PCR assay targeting the 18S rRNA gene was used to determine the infecting Plasmodium species.ResultsA total of 453 samples were positive for Plasmodium species by using nested PCR assay. Plasmodium knowlesi was identified in 256 (56.5%) samples, followed by 133 (29.4%) cases of Plasmodium vivax, 49 (10.8%) cases of Plasmodium falciparum, two (0.4%) cases of Plasmodium ovale and one (0.2%) case of Plasmodium malariae. Twelve mixed infections were detected, including P. knowlesi/P. vivax (n = 10), P. knowlesi/P. falciparum (n = 1), and P. falciparum/P. vivax (n = 1). Notably, P. knowlesi (Included mixed infections involving P. knowlesi (P. knowlesi/P. vivax and P. knowlesi /P. falciparum)) showed the highest proportion in Sabah (84/115 cases, prevalence of 73.0%), Sarawak (83/120, 69.2%), Kelantan (42/56, 75.0%), Pahang (24/25, 96.0%), Johor (7/9, 77.8%), and Terengganu (4/5, 80.0%,). In contrast, the rates of P. knowlesi infection in Selangor and Negeri Sembilan were found to be 16.2% (18/111 cases) and 50.0% (5/10 cases), respectively. Sample of P. knowlesi was not obtained from Kuala Lumpur, Melaka, Perak, Pulau Pinang, and Perlis during the study period, while a microscopically-positive sample from Kedah was negative by PCR.ConclusionIn addition to Sabah and Sarawak, which have been known for high prevalence of P. knowlesi infection, the findings from this study highlight the widespread distribution of P. knowlesi in many Peninsular Malaysia states.

Epidemiological and Clinical Characteristics of Imported Malaria in the United Arab Emirates

The United Arab Emirates (UAE) was certified by the World Health Organization to be free of endemic malaria transmission in 2007. There continued to be, however, a substantial number of imported malaria cases. A retrospective laboratory and chart review was performed to describe the epidemiological, clinical, and laboratory characteristics of imported malaria in Dubai, UAE. Laboratory records were reviewed at the largest public hospital in Dubai to identify cases of peripheral blood smear-positive malaria from January 1, 2008 to December 31, 2010. Predefined demographic, clinical, and laboratory information was extracted from the electronic medical record system. A total of 629 cases of malaria were identified including 493, 122, and 14 cases of Plasmodium vivax, Plasmodium falciparum, and mixed P. vivax/P. falciparum infections, respectively. Of these, 567 (90.1%) cases were either from India or Pakistan and 7% from sub-Saharan Africa. There were no cases among the local Emirati population. There were 162 hospitalizations, including 8 requiring intensive care support and 1 death. More than 10% of P. vivax infections required hospitalization. The interval between arrival in the UAE and diagnosis was 3 months or longer for 25% of P. vivax cases. Imported malaria remains an important cause of morbidity in the UAE. Clinicians need to be aware that P. vivax is not benign and can cause severe disease and that malaria cases may present to health facilities several months after arrival from malaria-endemic regions.

Performance of a new gelled nested PCR test for the diagnosis of imported malaria: comparison with microscopy, rapid diagnostic test, and real-time PCR

Microscopy and rapid diagnostic tests (RDTs) are the techniques commonly used for malaria diagnosis but they are usually insensitive at very low levels of parasitemia. Nested PCR is commonly used as a reference technique in the diagnosis of malaria due to its high sensitivity and specificity. However, it is a cumbersome assay only available in reference centers. We evaluated a new nested PCR-based assay, BIOMALAR kit (Biotools B&M Labs, Madrid, Spain) which employs ready-to-use gelled reagents and allows the identification of the main four species of Plasmodium. Blood samples were obtained from patients with clinical suspicion of malaria. A total of 94 subjects were studied. Fifty-two (55.3%) of them were malaria-infected subjects corresponding to 48 cases of Plasmodium falciparum, 1 Plasmodium malariae, 2 Plasmodium vivax, and 1 Plasmodium ovale. The performance of the BIOMALAR test was compared with microscopy, rapid diagnostic test (RDT) (BinaxNOW® Malaria) and real-time quantitative PCR (qPCR). The BIOMALAR test showed a sensitivity of 98.1% (95% confidence interval [CI], 89.7-100), superior to microscopy (82.7% [95% CI, 69.7-91.8]) and RDT (94.2% [95% CI, 84.1-98.8]) and similar to qPCR (100% [95% CI, 93.2-100]). In terms of specificity, the BIOMALAR assay showed the same value as microscopy and qPCR (100% [95% CI, 93.2-100]). Nine subjects were submicroscopic carriers of malaria. The BIOMALAR test identified almost all of them (8/9) in comparison with RDT (6/9) and microscopy (0/9). In conclusion, the BIOMALAR is a PCR-based assay easy to use with an excellent performance and especially useful for diagnosis submicroscopic malaria.

Severe morbidity and mortality risk from malaria in the United States, 1985-2011.

Background. Recent reports of Plasmodium vivax associated with severe syndromes and mortality from malaria endemic areas questions the “benign” course of non-falciparum malarias.Methods. We retrospectively analyzed data from patients reported to the US Centers for Disease Control and Prevention with a diagnosis of malaria parasite single-species infection between 1985 and 2011. Patients classified as having severe illness were further classified according to outcome (survival versus death) and clinical syndrome.Results. Among all cases, .9% of Plasmodium falciparum cases resulted in death and 9.3% were classified as severe, whereas .09% of P. vivax cases resulted in death and 1.3% were classified as severe. The odds ratios for severe illness among 15 272 diagnoses of P. falciparum relative to patients diagnosed with P. vivax (n = 12 152), Plasmodium malariae (n = 1254), or Plasmodium ovale (n = 903) was 7.5, 5.7, and 5.0, respectively (P < .0001 for all); in contrast, the corresponding odds ratios for death among those severely ill was 1.6, 1.1, and .8 (P > .1 for all), respectively. Compared with P. vivax (n = 163), the odds of P. falciparum cases classified as severely ill (n = 1416) were 1.9 (P = .0006), .5 (P = .001), and 1.3 times (P = .1) as likely to present as cerebral, acute respiratory distress, and renal syndromes, respectively.Conclusions. Although less common, patients presenting with non-falciparum even in the United States can develop severe illness, and severe illness in patients having malaria of any species threatens life.

Asymptomatic refugee malaria screening - implications of using a rapid immunochromatographic antigen test only: retrospective analysis of 1248 patients

Background Current screening guidelines for malaria in new refugees include a combination of thick and thin film examination and immunochromatographic antigen test (ICT)1. However, as the prevalence of malaria in our population has decreased due to changing refugee demographics,2,3 an immunochromatographic antigen test (ICT) alone may be sufficient to exclude malaria in asymptomatic patients. Aim To determine if an ICT alone can reliably exclude malaria in our asymptomatic refugee population. Methods A retrospective analysis was conducted of all investigations for malaria performed from 01/08/2011 to 31/07/2013, including external morphological and PCR validation where applicable. Results 45 of 1248 (3.6%) patients investigated were diagnosed with malaria, all cases were in symptomatic patients. Overall 42/45 malaria cases were detected by the BinaxNOW ICT; sensitivity (95%CI) 93.3% (80.7-98.3%) and negative predictive value (NPV) 99.8% (99.2-99.9%). All 21 cases of Plasmodium falciparum were detected; sensitivity and NPV of 100% (80.8-100%) and 100% (99.6-100%), respectively. ICT detected 18/20 cases of P. vivax; sensitivity and negative predictive value of 90.9% (69.4%-98.4%) and 99.8% (99.3%-100%), respectively. Too few cases of P. malariae and no cases of P. ovale or P. knowlesis were diagnosed for adequate assessment. Discussion These data suggest that an ICT alone may be sufficient for malaria screening in our asymptomatic refugee population.

First published record of urban malaria in Puerto Gaitan, Meta, Colombia

Patterns of malaria cases were compared between the department of Meta and the municipality of Puerto Gaitán, Colombia, to examine temporal change in malaria from 2005-2010. During this time frame in Meta the mean ratio was 2.53; in contrast, in Puerto Gaitán it was 1.41, meaning that a surprisingly high proportion of Plasmodium falciparum cases were reported from this municipality. A detailed analysis of data from Puerto Gaitán for 2009 and 2010 detected a significant difference (χ2, p < 0.001) in the distribution of plasmodia, with Plasmodium vivax more prevalent in 2009 and P. falciparum in 2010. Males had the highest number of cases but there was no difference in the distribution of cases between sexes and years. In both years, for both sexes, people 16-40 accounted for the majority of cases (58.9% in 2009; 60.4% in 2010). There were significant differences in the distribution of both P. vivax (χ2, p < 0.01) and P. falciparum cases (χ2, p < 0.05) by geographic setting (urban vs. non-urban) between years. Urban cases of both P. vivax and P. falciparum are recorded in this study for the first time in Puerto Gaitán, possibly the result of area wide displacement and migration due to armed conflict.

The Usefulness of Rapid Diagnostic Tests in the New Context of Low Malaria Transmission in Zanzibar

BackgroundWe assessed if histidine-rich-protein-2 (HRP2) based rapid diagnostic test (RDT) remains an efficient tool for Plasmodium falciparum case detection among fever patients in Zanzibar and if primary health care workers continue to adhere to RDT results in the new epidemiological context of low malaria transmission. Further, we evaluated the performance of RDT within the newly adopted integrated management of childhood illness (IMCI) algorithm in Zanzibar.Methods and FindingsWe enrolled 3890 patients aged ≥2 months with uncomplicated febrile illness in this health facility based observational study conducted in 12 primary health care facilities in Zanzibar, between May-July 2010. One patient had an inconclusive RDT result. Overall 121/3889 (3.1%) patients were RDT positive. The highest RDT positivity rate, 32/528 (6.1%), was found in children aged 5–14 years. RDT sensitivity and specificity against PCR was 76.5% (95% CI 69.0–83.9%) and 99.9% (95% CI 99.7–100%), and against blood smear microscopy 78.6% (95% CI 70.8–85.1%) and 99.7% (95% CI 99.6–99.9%), respectively. All RDT positive, but only 3/3768 RDT negative patients received anti-malarial treatment. Adherence to RDT results was thus 3887/3889 (99.9%). RDT performed well in the IMCI algorithm with equally high adherence among children <5 years as compared with other age groups.ConclusionsThe sensitivity of HRP-2 based RDT in the hands of health care workers compared with both PCR and microscopy for P. falciparum case detection was relatively low, whereas adherence to test results with anti-malarial treatment was excellent. Moreover, the results provide evidence that RDT can be reliably integrated in IMCI as a tool for improved childhood fever management. However, the relatively low RDT sensitivity highlights the need for improved quality control of RDT use in primary health care facilities, but also for more sensitive point-of-care malaria diagnostic tools in the new epidemiological context of low malaria transmission in Zanzibar.Trial registrationClinicalTrials.gov NCT01002066

High attack rate for malaria through irregular migration routes to a country on verge of elimination

Irregular migration in the form of human smuggling and human trafficking is recognized as a global public health issue. Thirty-two cases of Plasmodium falciparum were detected in 534 irregular migrants returning to Sri Lanka via failed human smuggling routes from West Africa in 2012, contributing to the largest burden of imported cases in Sri Lanka as it entered elimination phase. Beyond the criminality and human rights abuse, irregular migration plays an important, but often forgotten, pathway for malaria re-introduction. Active surveillance of the growing numbers of irregular migrant flows becomes an important strategy as Sri Lanka advances towards goals of malaria elimination.

Chemotherapy and drug resistance status of malaria parasite in northeast India

India reports the highest number of malaria cases in Southeast Asia, of which Plasmodium falciparum contribute more than half of the cases every year. North eastern states of India contribute only 3.96% of country's population but account for >10% of total reported malaria cases, 11% of Plasmodium falciparum cases and 20% of malaria related deaths annually. In India, chloroquine resistance was reported for the first time from northeast region and since then chloroquine treatment failure is being reported from many parts of the region. Increased chloroquine treatment failure has led to change of the drug policy to artemisinin combination therapy as first line of malaria treatment in the region. However, replacing chloroquine to artemisinin combination therapy has not shown significant difference in the overall malaria incidence in the region. The present review addresses the current malaria situation of northeastern region of India in the light of antimalarials drug resistance.

Malaria Cases Detected by Active and Passive Surveillance in Adıyaman between 2000-2008

In this study, malaria cases were determined in Adıyaman with active and passive surveillance studies by Local Health Authority, Centre for Struggle against malaria between the years 2000-2011. In 312.125 blood samples, obtained with the method of active and passive surveillance from the region where malaria is common, malarial parasite was investigated by the method of thin and thick blood smears. In the observed samples, 184 malaria cases were determined; 38 (21.1%) with active, 145 (78.8%) of them with passive surveillance method. The rate of positive cases among all the observations was 0.05%. 108 (58.6%) of the cases were male, 76 (41.3%) of the cases were female. It was stated that 3 of the cases were provincial cases and 181 of them originated from extra-provincial sources. It was observed that, apart from one Plasmodium falciparum case which was from a foreign-source; all of the cases were plasmodium vivax positive. there were no cases of malaria between 2008 and 2011 years. The fact that there are many farming workers in Adıyaman and that these workers work in regions where malaria is endemic, threatens the population in the region with malarial infection . It was considered important for the Centre for the Struggle against Malaria and Adıyaman University, Medical Faculty to cooperate in the struggle against malaria by offering planned training programs in public health.

Study of thrombocytopenia in patients of malaria

Background:Malaria is a Protozoal disease caused by infection with parasites of the genus Plasmodium and transmitted to man by certain species of infected female Anopheline mosquito. In 2008 there were 1.52 million cases of malaria in India, out of which 0.76 million case of Plasmodium falciparum, comprising 50% of total malaria cases. There were 924 deaths from malaria. Hematological abnormalities have been observed in patients with malaria, with anemia, and thrombocytopenia being the most common.Materials and Methods:We conducted this study to find out the frequency and the degree of thrombocytopenia in patients with malaria. In our study, 230 patients with malaria positive were investigated with platelet count.Results:In the study group of 230 patients: 130 (56.51%) were positive for Plasmodium vivax, 90 (39.13%) were positive for P. falciparum and 10 (4.34%) had mixed infection with both P. vivax and P. falciparum. Out of 130 cases detected with vivax malaria, 100 cases had thrombocytopenia. Out of 90 cases detected with falciparum malaria, 70 cases had thrombocytopenia. Among 10 cases of mixed infection, 9 cases had thrombocytopenia.Conclusions:Presence of thrombocytopenia in a patient with acute febrile illness in the tropics increases the possibility of malaria. The above finding can have therapeutic implications in context of avoiding unnecessary platelet infusion in malaria patients.

Artemisinin resistance containment project in Thailand. (I): Implementation of electronic-based malaria information system for early case detection and individual case management in provinces along the Thai-Cambodian border

BackgroundThe Bureau of Vector-borne Diseases, Ministry of Public Health, Thailand, has implemented an electronic Malaria Information System (eMIS) as part of a strategy to contain artemisinin resistance. The attempt corresponds to the WHO initiative, funded by the Bill & Melinda Gates Foundation, to contain anti-malarial drug resistance in Southeast Asia. The main objective of this study was to demonstrate the eMIS’ functionality and outputs after implementation for use in the Thailand artemisinin-resistance containment project.MethodsThe eMIS had been functioning since 2009 in seven Thai-Cambodian border provinces. The eMIS has covered 61 malaria posts/clinics, 27 Vector-borne Disease Units covering 12,508 hamlets at risk of malaria infections. The eMIS was designed as an evidence-based and near real-time system to capture data for early case detection, intensive case investigation, monitoring drug compliance and on/off-site tracking of malarial patients, as well as collecting data indicating potential drug resistance among patients. Data captured by the eMIS in 2008–2011 were extracted and presented.ResultsThe core functionalities of the eMIS have been utilized by malaria staff at all levels, from local operational units to ministerial management. The eMIS case detection module suggested decreasing trends during 2009–2011; the number of malaria cases detected in the project areas over the years studied were 3818, 2695, and 2566, with sero-positive rates of 1.24, 0.98, and 1.16%, respectively. The eMIS case investigation module revealed different trends in weekly Plasmodium falciparum case numbers, when classified by responsible operational unit, local and migrant status, and case-detection type. It was shown that most Thai patients were infected within their own residential district, while migrants were infected either at their working village or from across the border. The data mapped in the system suggested that P. falciparum-infected cases and potential drug-resistant cases were scattered mostly along the border villages. The mobile technology application has detected different follow-up rates, with particularly low rates among seasonal and cross-border migrants.ConclusionThe eMIS demonstrated that it could capture essential data from individual malaria cases at local operational units, while effectively being used for situation and trend analysis at upper-management levels. The system provides evidence-based information that could contribute to the control and containment of resistant parasites. Currently, the eMIS is expanding beyond the Thai-Cambodian project areas to the provinces that lie along the Thai-Myanmar border.

Study of some epidemological aspects of Malaria in a tribal district (Nandurbar), Maharashtra

Background : Ten percent of the total population of the State of Maharashtra belongs to tribal population groups. These groups remain isolated, living in remote forest and hilly areas far from civilization. Nandurbar district has been a newly carved tribal district (July 1998). Objective : To find out the prevalence of various type of malaria and to see the correlation between rainfall and incidence of malaria cases. Materials and Methods : It was a retrospective, cross sectional study carried out during 1999 to 2004. The reports from the years, 1999 to 2004, were taken from district health office and district malaria office, respectively. Results : There were total 5228 cases of malaria; out of these, 3237 were Plasmodium vivax (PV) cases, and 2001 were Plasmodium falciparum (PF) malarial cases, during the years, 1999 to 2004. In the years, 1999 to 2002, percentage of PV malaria was more than PF malaria. Majority of PV malaria cases was observed in the year 1999. In the year 2004, the PV malaria started showing an upward trend in Nandurbar district, Maximum numbers of cases were reported in rainy season as compared to winter and summer seasons. It was observed that the PF cases were increased during the months of July to October, every year. It was also observed that as rain fall increases, the number of malaria cases also increases. Conclusion : There is an upward trend of malarial cases in the tribal block. Incidence of malarial cases closely correlates with the rainfall.

Plasmodium species co-infection as a cause of treatment failure

We report a case of Plasmodium falciparum and Plasmodium malariae coinfection with associated failure of clinical response to artemether+lumefantrine therapy. This case highlights the need to consider co-infection in the setting of apparent treatment failure and the impact of mixed species infection upon host dynamics and clinical presentation. Recognition of malarial co-infection is clinically important for determining appropriate therapy and preventing disease sequelae.

A case of Plasmodium falciparum malaria: the importance of an integrated diagnostics

We report a case of Plasmodium falciparum in an Italian woman of thirty years old, back from Mozambico. The diagnostic suspect came from various factors: a recent stay in a country where the disease is endemic, fever and an inadeguate prophylaxis. The presence of Plasmodium falciparum in thin blood smear and in the immunochromatography assay positivity confirmed the diagnosis.

Fight malaria at home: Therapeutic and prophylaxis clinical data

ObjectiveTo identify a new, safe and effective source to combat and prevent drug resistant malaria therapeutically and to make it as a home-made bio-medicine which is called as OMARIA (Orissa malaria research indigenous attempt) and use it on long term basis (decade) in mono clinical station and in field. MethodsThe rind of a lesser known Indian indigenous fruit dalimba/Punica granatum (P. granatum) is taken. Manual process to make a hand-made or home-made bio-medicine is done. Hand-filled into gelatin capsules and administered as an internal medicine. Therapy to 532 clinical cases is given at the Govt Red Cross Clinic, and Prophylaxis at site is administered to 401 cases by adopting 3 villages. ResultsHydrophyllic, ellagitannins viz., punicalagin (C48H28O30; mw 1100∼1125), punicalin (C34H22O22; mw 780∼785), ellagic acid (C14H6O8; mw 302) and K+ co-exists as the only drug moieties. OMARIA has no other confounding or confabulating compounds. There is non alkaloid. ConclusionsOMARIA delivers therapeutics and prophylaxis to drug resistant Plasmodium falciparum (P. falciparum) cases. There are no side effects and no contradictions. Non-toxic at bolus/loading doses. No case progressed to cerebral malaria. OMARIA is a first time work. Original report on pan global basis.

The role of El Niño southern oscillation (ENSO) on variations of monthly Plasmodium falciparum malaria cases at the cayenne general hospital, 1996-2009, French Guiana

BackgroundMalaria remains a serious problem in French Guiana, which is at potential risk for drought linked with the El Niño Event and where there could be a risk of malaria epidemic after the onset of an El Niño event.MethodsA time series analysis using ARIMA was developed to investigate temporal correlations between the monthly Plasmodium falciparum case numbers and El Niño Southern Oscillation (ENSO) as measured by the Southern Oscillation Index (SOI) at the Cayenne General Hospital between 1996 and 2009.ResultsThe data showed a positive influence of El Niño at a lag of three months on P. falciparum cases (p < 0.001). The incorporation of SOI data in the ARIMA model reduced the AIC by 4%.ConclusionsAlthough there is a statistical link, the predictive value of ENSO to modulate prevention intervention seems marginal in French Guiana. However, additional work should refine the regional dependence of malaria on the ENSO state.

Prescription pattern of anti—malarial drugs in a tertiary care hospital

Objective To evaluate the prescribing pattern of anti malarial drugs in a tertiary care hospital. Methods A prospective cross-sectional study was conducted for months of patients visiting in Basaveshwar Teaching and General Hospital, Gulbarga. Data were analyzed for various drug use indicators. Results A total of 212 prescriptions were collected, with 136 (64.15%)male and 76 (35.85%) female. There were 128 (60.37%) Plasmodium vivax cases and 84 (39.63%) Plasmodium falciparum cases. All Plasmodium vivax cases were treated with chloroquine alone and among these 16 (12.5%) recieved radical treatment with primaquine along with chloroquine. Among 84 patients with Pasmodium falciparum, 40 patients received single drug such as quinine/ mefloquinine/artesunate/arteether. Another 44 patients received multidrug regime like, quinine+artesunate (54.54%), quinine+mefloquine (27.27%) and quinine+arteether (18.18%). Chloroquine was not administered to any of the patients with Plasmodium falciparum malaria. The most common adverse effects with chloroquine were anorexia, nausea, vomiting and tinnitus in 9.37% of the cases. With quinine it was nausea and vomiting in 17.64%, tinnitus in 11.76% and hypoglycemia in 2.1% of cases. Conclusions Our study found the perennial favorites like chloroquine for Plasmodium vivax and quinine for Plasmodium falciparum were the most effective drug. In the severe Plasmodium falciparum cases the artesunate derivatives and combination of artesunate with quinine/mefloquine were most effective with fewer incidences of side effects.

Mass screening and treatment for malaria among gold miners in Suriname

Background: The activities and habits of small to medium scale gold miners -and their interaction with both the environment and the local population- are recognized as one of the main determinants of the current occurrence and dispersion of malaria in the Amazon Region. Gold miners are the group with highest risk for malaria in the region. Their exploration techniques are based on damming creeks and rivers, to provide water that is used in high pressure hoses, to dig for gold. This practice, multiplies the potential breeding sites of the main vectors in the region. We assessed the malaria prevalence in gold mining areas in Suriname. Methods: Mass screening and treatment for malaria was conducted in 4 main gold mining areas in Suriname. A standardized national malaria form was used to collect the information. Malaria blood films were stained with 4% Giemsa and read using microscopy (1000X). 100 microscopic thick film fields were inspected before a slide was being declared malaria negative. For positive-malaria smears, parasite species were identified and treatment was given following the national malaria protocol. Results: Between June and October, 2009, there were 2543 people screened for malaria in 4 main gold mining areas in Suriname. These 4 areas had 261 gold mining camps (Victoria:26; Benzdorp:88; Sellacreek:79; Maku:68). Sixty-six percent of the people seen were Brazilian. Malaria infections were reported among 85 people with an overall prevalence of 3%. There were 42, 40 and 3 cases of Plasmodium falciparum, P. vivax and P. malariae, respectively. Parasite specific prevalence ranged from 1-4%(Pf), 1-3%(Pv) and <1%(Pm). All malaria cases were uncomplicated infections and treated. No cases were detected among pregnant women. Conclusion: Despite a steep decline of malaria morbidity in Suriname (∼95% reduction), “hot spots” still exist. From the 4 gold mining areas evaluated, Sellacreek was the only malariafree region. Gold mining activities implies population movements and transmission of malaria which make diagnosis and treatment, a critical gap for the sustainability of the impact obtained in other areas. A strategy to increase access to adequate diagnosis and treatment for malaria -training locals and serving their populations- in gold mining areas is ongoing. Abstracts for SupplementInternational Journal of Infectious DiseasesVol. 14Preview Full-Text PDF Open Archive