Suspicion Of Malaria Research Articles

Frequency of Dengue and Malaria Co-Infection in Patients Admitted in Jinnah Hospital, Lahore

Prevalence of malaria and dengue infection coexistence is increasing during endemic periods although causing quite similar symptoms and signs, the treatment of these two illnesses is different. Any suspicion of malaria in disease-endemic areas must be excluded with microscopy and/or rapid antigen test. Objective: To find out the incidence of co-infection of dengue and malaria based on clinical and hematological parameters in patients presenting with acute febrile illness. Methods: This cross-sectional study was done in the Medicine Unit of Jinnah hospital, Lahore from October - December 2022. 140 diagnosed as dengue fever by Non-Structural Protein 1 (NS1) and IgM were included in the study. All the cases were subject to a thorough medical examination i.e. complete battery summary of temperature together with the serology of Dengue, X-ray of the chest, abdominal ultrasound scan, renal function test (RFT), liver function test (LFT), malarial parasite slide, complete blood count with peripheral smear etc. Accordingly, the treatment was given to them with follow-up medical evaluation including detailed investigations. Data were entered and analyzed in SPSS version. 27.0 and presented as frequency and percentages. Chi square test was used to assess statistical significance with P < .05. Results: Mean age of respondent was 35.5 + 15.6 years. Co-infection rate with malaria and severe disease along with prolong duration fever and persistent thrombocytopenia among subjects was15.0%. Conclusions: Majority of co infected individuals were having severe disease, with subsequent development of disseminated intravascular coagulation and sepsis, responding well to anti-malarial treatments

Evaluation of new haematology analyser, XN-31, for malaria detection in blood donors: A single-centre study from India.

Malaria continues to be a significant public health concern in India, with several regions experiencing endemicity and sporadic outbreaks. The prevalence of malaria in blood donors, in India, varies between 0.02% and 0.07%. Common techniques to screen for malaria, in blood donors and patients, include microscopic smear examination and rapid diagnostic tests (RDTs) based on antigen detection. The aim of this study was to evaluate a new fully automated analyser, XN-31, for malaria detection, as compared with current practice of using RDT. Cross-sectional analytical study was conducted to evaluate clinical sensitivity and specificity of new automated analyser XN-31 among blood donors' samples and clinical samples (patients with suspicion of malaria) from outpatient clinic collected over between July 2021 and October 2022. No additional sample was drawn from blood donor or patient. All blood donors and patients' samples were processed by malaria rapid diagnostic test, thick-smear microscopy (MIC) and the haematology analyser XN-31. Any donor blood unit incriminated for malaria was discarded. Laboratory diagnosis using MIC was considered the 'gold standard' in the present study. Clinical sensitivity and specificity of XN-31 were compared with the gold standard. Fife thousand and five donor samples and 82 diagnostic samples were evaluated. While the clinical sensitivity and specificity for donor samples were 100%, they were 96.3% and 100% for diagnostic samples. Automated haematology analysers represent a promising solution, as they can deliver speedy and sensitive donor malaria screening assessments. This method also has the potential to be used for pre-transfusion malaria screening along with haemoglobin estimation.

How should Travel-Related Malaria Management in Emergency Departments of Non-endemic Countries? Single-center Study

Purpose: Advancements in air travel enabled an increase in traveling to malaria-endemic countries such as those in sub-Saharan Africa. An increase in the incidence of imported malaria accompanied these advancements. This study aims to summarize how malaria patients who have imported the disease into non-endemic countries present to the emergency departments and to enlighten physicians in emergency departments by providing suggestions for practical approaches to handling such situations.
 Methods: This study was conducted retrospectively in a university hospital, from January 1, 2014 to March 1, 2022. Seven years of emergency department records of patients who were examined in the emergency department with a suspected, or definitive diagnosis of malaria were included in the study. Epidemiological and clinical characteristics were evaluated.
 Results: 892 patients were admitted to the emergency department with suspicion of malaria. Thirty of these patients were diagnosed with malaria, and 846 of the 892 patients were members of airline cabin crews. 94.3% (n=798) of the cabin crew did not use prophylactic medication for malaria. The mean age of the patients was 33.2±8.5. Twenty-five patients were diagnosed via peripheral blood smears, and the remaining three patients were diagnosed with PCR. Rapid diagnostic tests were positive in 26 out of 28 patients.
 Conclusion: The risk of acquiring malaria is still high despite short-term visits and airport-limited stays. Travel history should be routinely asked of patients by emergency physicians. Education of people traveling to malaria-endemic countries, including cabin crew, regarding malaria prophylaxis and protective measures to prevent mosquito bites plays a crucial role in preventing malaria.

EXPLORING THE SUBSTANTIAL ROLE OF MULTIPLEX PCR TO DIAGNOSE MALARIA IN EASTERN NEPAL

Background: Malaria is still a major health problem in Nepal as 43.3% of population are at risk of infection. However, the national priorities have been given to achieve malaria elimination in Nepal, the question of diag­nostic accuracy could jeopardize the elimination target. Among others, multiplex PCR could be the reliable alternative tool to detect the low num­ber of parasitemia and circulating asymptomatic infection in low endemic countries like Nepal. Hence, this paper aims to analyse the diagnostic pre­cision among microscopy, rapid diagnostic test (RDT) and multiplex real time PCR assay. 
 Methods: A total of 63 archived blood samples obtained from patient with clinical suspicion of malaria were subjected to multiplex PCR and their re­sults were compared with microscopy and rapid diagnostic test. The La­tent Class Analysis (LCA) approach was used to compare the diagnostic precision among three different assays. 
 Results: Our study documented that PCR had 97.4% sensitivity and 83.9% specificity. Among the negative microscopy results, 10 (15.9%) were false negatives whereas 4 (6.3%) RDT results were false negatives based on PCR results. 
 Conclusions: PCR could be the useful alternative tool to detect the low number of parasite in low endemic settings which could be crucial to rule out the false diagnosis determined by microscopy or RDT.

Malaria in Pregnancy

Malaria is a potentially life-threatening disease that is transmitted by the bite of an infected Anopheles mosquito. Five known species of genus Plasmodium infect humans: Plasmodium vivax, Plasmodium ovale, Plasmodium Knowlesi, Plasmodium Malariae and Plasmodium falciparum. Malaria infection during pregnancy is a significant public health problem with substantial risks for the pregnant woman, her fetus and the newborn child.. The symptoms and complications vary according to malaria transmission intensity in the given area and the individual’s level of acquired immunity. Presented below is a case of a 26-years old primigravida, who returned to the UK from Nigeria after one week presenting with a 24 hour history of abdominal pain, nausea, vomiting and signs of sepsis. During her hospitalization, despite being treated for sepsis, the patient’s overall condition did not improve, therefore suspicion for malaria became very questionable. In consideration of the patient’s history and clinical presentation; a thorough investigation was to take in effect for this possible infection. Once diagnosis of malaria was confirmed, the appropriate treatment was administered.

Exploring the Substantial Role of Multiplex Pcr to Diagnose Malaria in Eastern Nepal

Background: Malaria is still a major health problem in Nepal as 43.3% of population are at risk of infection. However, the national priorities have been given to achieve malaria elimination in Nepal, the question of diag­nostic accuracy could jeopardize the elimination target. Among others, multiplex PCR could be the reliable alternative tool to detect the low num­ber of parasitemia and circulating asymptomatic infection in low endemic countries like Nepal. Hence, this paper aims to analyse the diagnostic pre­cision among microscopy, rapid diagnostic test (RDT) and multiplex real time PCR assay.
 Methods: A total of 63 archived blood samples obtained from patient with clinical suspicion of malaria were subjected to multiplex PCR and their re­sults were compared with microscopy and rapid diagnostic test. The La­tent Class Analysis (LCA) approach was used to compare the diagnostic precision among three different assays.
 Results: Our study documented that PCR had 97.4% sensitivity and 83.9% specificity. Among the negative microscopy results, 10 (15.9%) were false negatives whereas 4 (6.3%) RDT results were false negatives based on PCR results.
 Conclusions: PCR could be the useful alternative tool to detect the low number of parasite in low endemic settings which could be crucial to rule out the false diagnosis determined by microscopy or RDT.

Malaria care-seeking behaviour among HIV-infected patients receiving antiretroviral treatment in South-Eastern Nigeria: A cross-sectional study.

This study assesses malaria prevention and treatment behaviour among people living with HIV/AIDS (PLWHA) in Owerri, South Eastern Nigeria. Although Nigeria bears one of the world’s largest burdens of both malaria and HIV, there is almost no research studying how co-infected patients manage their care. We systematically sampled 398 PLWHA receiving care at Imo State Specialist Hospital and the Federal Medical Centre in Owerri to complete a structured, pre-tested questionnaire on malaria care-seeking behaviour. Descriptive statistics were reported and chi-square tests and multivariate logistic regressions were also used. The majority of HIV-infected patients (78.9%) reported having had an episode of suspected malaria quarterly or more often. There was a large variation in care-seeking patterns: on suspicion of malaria, 29.1% of participants engaged in self-medication; 39.2% went to drug shops, and only 22.6% visited HIV/AIDS care centres. Almost 40% waited more than 24 hours before initiating treatment. Most (60.3%), reported taking recommended artemisinin-based combination treatments (ACT) but a significant minority took only paracetamol (25.6%) or herbal remedies (3.5%). Most (80%) finished their chosen course of treatment; and completion of treatment was significantly associated with the frequency of suspected malaria occurrence (p = 0.03). Most (62.8%) did not take anti-malaria medication while taking antiretroviral treatment (ART) and almost all (87.6%) reported taking an ACT regimen that could potentially interact with Nigeria’s first-line ART regimen. Our findings suggest the need to pay more attention to malaria prevention and control as a crucial element in HIV/AIDS management in this part of Nigeria and other areas where malaria and HIV/AIDS are co-endemic. Also, more research on ART-ACT interactions, better outreach to community-level drug shops and other private sector stakeholders, and clearer guidelines for clinicians and patients on preventing and managing co-infection may be needed. This will require improved collaboration between programmes for both diseases.

Interpretation on coexistence or association of thrombocytopenia with malaria

Background: Malaria is a major health problem especially in developing countries. It is a major causeof morbidity and mortality especially in the tropics. There are several hematological changes in thisparticular disease, which includes thrombocytopenia, anemia , atypical lymphocytosis and infrequentlyintravascular coagulation. The aim of the study is to detect and compare the severity of varioushematological changes, especially thrombocytopenia in the particular type of malaria.Materials and Methods: This was an observational study done on the patients attending the outpatientand inpatient departments clinically suspected for malaria in Nobel Medical College, Biratnagar, Nepal.Thick and thin slides were made and stained with Leishman’s stain for malarial parasites and also antigentests were included wherever necessary. Other tests included were, complete blood counts.Results: Amongst the included 800 patients with suspicion of malaria, 135 (17%) patients demonstratedmalarial parasites on peripheral blood film. Male predominance in male to female predominance of 3.5:1was observed. Total number of 120 out of 135 had thrombocytopenia. Thrombocytopenia was observedhigher in P. Vivax (79.3%) followed by Mixed infection (17%) and P. falciparum (3.7%) respectively.Conclusion: Anemia with mainly thrombocytopenia was mainly seen in P. Vivax type followed by P.Falciparum. Since thrombocytopenia is associated with malaria, which is demonstrated in our study,treating physicians should keep malaria as one of the differential diagnosis in patients with fever and lowplatelets.

Burden of Malaria in Rural area Jhansi- A clinico-epidemiological study.

Introduction: Malaria is a protozoan disease transmitted by the bite of infected Anopheles mosquitoes.WHO estimates that there were 216 million cases of malaria in 2016 resulting in 445,000 deaths. According to world malaria report 2012, India alone has an estimated 24 million cases per year. It is preventable and curable. Aims and objectives: To assess the burden of malaria in a rural area, and evaluate the clinico-epidemiological factors among malaria positive cases. Material and Methods: The study was conducted among 300 adult patients of malaria (Pf, Pv, Pf+ Pv) in the rural field practice area, by the Department of Community Medicine at MLB Medical College from March 2017 to October 2017. All the patients presenting fever with the suspicion of malaria were examined. Only peripheral smear / quantitative buffy coat positive patient was included. Results: Out of total 300 patients of malaria 147 (49%) patients were of P. falciparum , 110 (36.67%) were of P. vivax and 43(14.33%) were of mixed infection. There was no predilection observed in this study towards any sex. Fever was the most common manifestation followed by Chills and rigors. While altered sensorium was seen in 71 (23.67%). Conclusion: Use of multipronged strategies to combat the disease transmission and control with an integration of multi-sectoral collaboration is needed in a rural area.

A Comparative evaluation of diagnostic performance of Immunochromatographic Rapid Card Test for malarial antigen against Peripheral smear Microscopy

Background: Malaria poses a major public health problem in India and has emerged as a biggest health burden in terms of morbidity and mortality. Rapid detection of malarial parasite can ensure the prompt timely and efficient management of clinical cases and control of the disease. Objectives: To evaluate the diagnostic performance of Immunochromatographic Rapid Card Test (ICT) for malarial antigen against Peripheral smear microscopy for diagnosing Malaria. Materials and Methods : This Cross sectional study was conducted in Dept. of Microbiology of a Rural tertiary care teaching hospital of Western Uttar Pradesh from January 2016 to August 2016. Eight Hundred thirty seven patients with clinical suspicion of malaria whose samples were sent on advice by clinicians to the Microbiology laboratory for the peripheral smear microscopy and Rapid card test for malarial antigen were included in this study after obtaining clearance from Institutional Ethics committee. Results : Out of the 837 blood samples tested, 106(12.66%) samples tested positive for malaria by Peripheral smear microscopy and 109(13%) by ICT Rapid card tests. The sensitivity of ICT for non-falciparum malaria (82.65%) came out to be lower than that for falciparum malaria (87.5%). The specificity of ICT for non falciparum malaria (98.9%) was almost same as for falciparum malaria (99.3%).The accuracy of ICT for falciparum malaria (99.16%) was slightly higher than for non-falciparum malaria (97%). Conclusion: This study suggests that ICT Rapid card test couldnt replace PS microscopy completely, but can be used as an alternative or complimentary to microscopy, particularly in resource constrained remote rural areas of India.

Clinical characteristics of imported malaria: An 11-year experience in a Serbian referral center.

Due to intercontinental traffic, population migration trends, natural disasters, and climate change, imported malaria remains important to consider in a febrile returning traveler. This study aims to raise awareness about malaria and help European clinicians maintain a working knowledge of this disease by reviewing the most important clinical characteristics in a non-endemic setting. Using medical records, a retrospective study was performed on clinical and laboratory data in order to analyze 103 malaria cases managed at the Clinic for Infectious and Tropical Diseases in Belgrade, from 2000 to 2010. Descriptive statistics, Chi-squared test, Spearman's rank correlation, and analysis of variance were used. Patients were predominantly male (89.3%) with a mean age of 46.66 ± 12.45 years, and most (98.06%) returned from Africa without having taken chemoprophylaxis (72.88%). Fever, arthralgia, myalgia, headache, vomiting, dark urine, and cough were common at presentation. Hepatosplenomegaly, jaundice, neurological and pulmonary findings, and thrombocytopenia were dominant findings on physical and laboratory examinations. Most (73.48%) were infected with P. falciparum. Few patients (17.55%) who were hyperparasitemic had significantly higher values of bilirubin and more frequent neurological complications. All patients were treated with artemisinin-based drug combinations regardless of Plasmodium species. Three (2.9%) patients succumbed to P. falciparum malaria. We suggest a high index of suspicion of malaria be maintained when evaluating febrile patients returning from endemic regions, especially if thrombocytopenia and hemolysis are present. Hyperparasitemia, high bilirubin levels, and neurological symptoms are associated with severe malaria. The importance of adequate malaria chemoprophylaxis cannot be overstated.

Comparison of two real-time PCR assays for the detection of malaria parasites from hemolytic blood samples - Short communication.

We compared the performance of an in-house and a commercial malaria polymerase chain reaction (PCR) assay using freeze–thawed hemolytic blood samples.A total of 116 freeze–thawed ethylenediamine tetraacetic acid (EDTA) blood samples of patients with suspicion of malaria were analyzed by an in-house as well as by a commercially available real-time PCR.Concordant malaria negative PCR results were reported for 39 samples and malaria-positive PCR results for 67 samples. The in-house assay further detected one case of Plasmodium falciparum infection, which was negative in the commercial assay as well as five cases of P. falciparum malaria and three cases of Plasmodium vivax malaria, which showed sample inhibition in the commercial assay. The commercial malaria assay was positive in spite of a negative in-house PCR result in one case. In all concordant results, cycle threshold values of P. falciparum-positive samples were lower in the commercial PCR than in the in-house assay.Although Ct values of the commercial PCR kit suggest higher sensitivity in case of concordant results, it is prone to inhibition if it is applied to hemolytic freeze–thawed blood samples. The number of misidentifications was, however, identical for both real-time PCR assays.

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.

Malaria

Malaria is the most important infectious disease imported by travelers and migrants from tropical and subtropical areas. It is imported quite frequently. It is a life-threatening disease. Symptoms are nonspecific and cannot easily be distinguished from a wide range of other febrile conditions. Therefore, travel history must be taken in all patients with fever of unknown origin and malaria diagnostics must be performed immediately on suspicion of malaria. Uncomplicated falciparum malaria should be treated in the hospital with either atovaquone-proguanil or with an artemisinin-based combination preparation. If there is evidence of severe malaria, the patient must be moved to an intensive care unit. The antiparasitic agent of choice is then artesunate.

Diagnosis of Malaria – Status of Malaria Rapid Diagnostic Test

Malaria is the most important parasitic disease of humans. Cochrane Review support the World Health Organization (WHO) guidelines for malaria treatment which recommend that in all settings clinical suspicion of malaria should be confirmed by parasitological diagnosis using microscopy or Malarial Rapid Diagnostic Test (MRDT). Microscopic diagnosis sensitivity requires expertise and may not be feasible in developing countries in endemic areas and hence MRDT may complement this test. As declared in the World Malaria report 2013 there has been increased use of MRDT which reflect that this test is being taken seriously for diagnostic and management. With every diagnosis test there are lacunae which must be reviewed before interpretation of result. A rapid diagnosis test may be used in endemic areas because it is cost effective, so that rational treatment would be given and hence prevent drug resistance as well as reduce the economic burden.

Hematologic Abnormalities Improve The Clinical Suspicion Of Malaria In Non-Endemic Countries

Malaria is one of the most frequent hemoparasitic infections in developing countries, responsible for a high health burden; with increasing world travel, growing numbers of patients present with malaria in non-endemic areas. While the clinical presentation of malaria is well characterized in the literature, it is non-specific, and suspicion is often raised simply by a fever and a report of a recent stay in an endemic area. Due to the connection of Europe with its former colonies, with bilateral migratory patterns, this anamnestic suspicion is frequent. To determine whether the addition of classic malaria hematology findings (thrombocytopenia, anemia and increased serum lactate dehydrogenase – LDH - levels) can improve clinical suspicion in patients presenting in non-endemic countries, We reviewed all malaria testing resulting from emergency room (ER) visits between 01-01-2000 and 06-30-2013. Repeated tests related to the same ER visit were analysed together; patients with more than one unrelated ER visit with suspected malaria were treated as separate subjects. Results 1357 subjects (69.0% male) fulfilled our criteria (median of 96 per year); the percentage of yearly Positive results varied between 2.6 and 17.0%, with no discernible temporal pattern, for an overall average of 9.5% of Positives. The monthly distribution of testing was balanced, with each month accounting for 6.4 to 10.2% of yearly tests; however, the percentage of Positives had a bimodal distribution, with two significant peaks in April (14.3% positivity) and December (16.5%); males were twice as likely to be Positive (11.0 vs 6.2%, p=0.005). There was a significant decrease in the mean haemoglobin of malaria-Positive patients (12.8±2.6 vs 13.5±2.2 g/dL, p<0.001), leading to a higher incidence of anemia (39.8 vs 18.6%, p<0.001). The positivity for malaria in anemic patients was 18.6% (vs the overall 9.5%). Mean platelet counts decreased in Positives (102.2±82.8 vs 227.1±91.8 G/L, p<0.001), leading to an increase in thrombocytopenia from 16.1 to 80.6%, p<0.001. Malaria-positivity in thrombocytopenic patients was 34.9%, rising to 36.6% when anemia was also present. Mean leukocyte counts decreased in Positives (5.5±2.4 vs 8.3±4.2 G/L, p<0.001), affecting all lineages, with overt leukopenia present in 20.9 vs 6.8%, p<0.001. Positivity for malaria in leukopenic patients was 20.9%. Leukocytosis was more frequent in suspicious patients without malaria (38.0 vs 17.8%, p<0.001), as was an elevated erythrocyte sedimentation rate (30.8±38.1 vs 16.5±16.8 mm, p=0.005). Serum LDH increased in Positives from 263±287 to 414±201 U/L, p=0.003, with values over the upper limit of normal being more likely in Positives (78.7 vs 35.8%, p<0.001); however, among Positives, high LDH was as likely to be found in patients with anemia as without (87.5 vs 74.2%, p=NS). Malaria-positivity was 19.5% in the presence of high LDH, rising to 35.9% with concomitant anemia or 53.1% with thrombocytopenia. The simultaneous presence of thrombocytopenia, anemia and high LDH (irrespective of leukopenia) resulted in 62% of Positive results, although only 10% of malaria patients fulfilled these criteria. Only 1.8% of patients who were normal on all three counts had malaria, and only 3% of malaria patients were negative for all three. We found that malaria was suspected more often in males, who were in fact more likely to have a positive result. Although suspicion was spread out across the year, there were two seasonal peaks of positive diagnoses, around Easter and Christmas, temporally coinciding with the migratory movements of expatriates and their families. Compared to patients with a clinical suspicion of malaria but without infection, patients who tested positive were more likely to be anemic, thrombocytopenic or leukopenic and to present with elevated LDH levels (irrespective of anemia). Patients with normal haemoglobin, platelets and LDH had a very low likelihood of malaria. The incorporation of these laboratory findings into the clinical scenario improved on clinical suspicion nearly 6-fold (with the percentage of positivity rising from just under 10% to over 60%), although at a high cost of false-negatives. In patients presenting at the ER in non-endemic countries with a fever and recent travel, the presence of combinations of anemia, thrombocytopenia and high LDH greatly increased the likelihood of malaria, although their absence should not impede testing. Disclosures: No relevant conflicts of interest to declare.

Bone Marrow Transplantation for Thalassemia: A Global Perspective

Even though severe thalassemia is a preventable disease, over 100,000 new cases are born yearly, particularly in the Middle East and South-East Asia. Most of these children may not reach adulthood because long-term appropriate supportive care is either inaccessible or unaffordable. Bone marrow transplantation (BMT) remains the only available definitive cure and success rates can be very high in appropriately selected patients, i.e. low-risk younger children with a matched family donor. In these circumstances BMT may be justified medically, ethically as well as financially, in fact, the cost of low-risk BMT is equivalent to that of a few years of non-curative supportive. This manuscript will briefly review the current status of bone marrow transplantation for thalassemia major with particular emphasis on a global prospective and present the experience of the Cure2Children Foundation supporting sustainable and scalable start up BMT programs in low-resource settings. The initial twelve consecutive patients managed in two start up BMT units in Pakistan (Children’s Hospital of the Pakistan Institute of Medical Sciences, Islamabad) and India (South East Asia Institute for Thalassemia, Jaipur) were included in this analysis. These initial six patients per each institution where purposely chosen as the focus of this report because they represent the steepest phase of the learning curve. The median age at transplant was 3.9 years, range 0.9 to 6.0, liver was no greater than 2 cm from costal margin, and all received matched related BMT. A structured on-site focused training program as well as ongoing intensive on-line cooperation was provided by the Cure2Children team of professionals. At a median follow-up of 7.5 months (range 3.5 to 33.5 months) both thalassemia-free and overall survival are 92%, one patient died of encephalitis-meningitis of unknown cause. No rejections where observed. Neutrophil recovery occurred at a median of 15.5 days (range 13-25) and platelet recovery at 18 days (range 12-27). Toxicities included, fever and neutropenia (10 patients), CMV reactivation (9 patients), acute GVHD grade 3 or less (4 patients), hypertension (4 patients), mild mucositis (3 patients), bacterial sepsis (1 patient). Median number of transfusions was 2 for red cells (range 0 to 7) and 5 for platelet transfusions (range 1 to 18). Median post-BMT hospital stay was 49 days (range 33 to 109). No patients developed significant chronic GVHD, one had a suspicion of malaria 8 months post-BMT and one of tuberculosis 11 months post-BMT, both where treated empirically and are doing well. The mean cost of a BMT and follow-up was around 10.164€ (8.952€ in Pakistan and 11.377€ in India), range 5.618€ to 14.604€. In low resource settings matched-related low-risk BMT for thalassemia can be performed with outcomes comparable to richer countries and with a fraction of the costs even from the very beginning of newly developed BMT units and by relatively untrained personnel provided a structured and intensive cooperation program with BMT experts is provided. This observation may have important implications to increase access to cure thalassemia major worldwide and for the startup of new BMT services in low- to middle income countries.

Report of a case of neonatal malaria (Plasmodium falciparum) in Nigeria

Neonatal malaria has been considered to be rare even in malaria-endemic areas and this assumption has led to a significant proportion of neonates with malaria being missed or wrongly diagnosed. A case is reported of a 15-day-old female with Plasmodium falciparum malaria in Lagos, Nigeria. An initial diagnosis of septicaemia was made and peripheral blood film for malaria parasite was not included among the laboratory investigations due to a low index of suspicion for malaria in this age group. The diagnosis of neonatal malaria was eventually made after poor improvement in the clinical state of the baby prompting microscopic examination for malaria parasite in the patient's blood. The patient was successfully treated and recovered without any complications. Knowledge of the prevalence of malaria in neonates will ensure screening for malaria parasite is included as part of the routine investigations or sepsis work-up for all neonates with fever. As non-endemic countries such as Australia continue to receive a high number of immigrants from neighbouring and distant malaria endemic regions, it is imperative to consider this condition in babies of mothers who have recently travelled to or emigrated from a malaria-endemic region. This has implications for infection control professionals and travel medicine clinics as they need to have a good understanding of malaria to provide expert advice and manage patients appropriately.

Management of imported malaria in Europe.

In this position paper, the European Society for Clinical Microbiology and Infectious Diseases, Study Group on Clinical Parasitology, summarizes main issues regarding the management of imported malaria cases. Malaria is a rare diagnosis in Europe, but it is a medical emergency. A travel history is the key to suspecting malaria and is mandatory in patients with fever. There are no specific clinical signs or symptoms of malaria although fever is seen in almost all non-immune patients. Migrants from malaria endemic areas may have few symptoms.Malaria diagnostics should be performed immediately on suspicion of malaria and the gold- standard is microscopy of Giemsa-stained thick and thin blood films. A Rapid Diagnostic Test (RDT) may be used as an initial screening tool, but does not replace urgent microscopy which should be done in parallel. Delays in microscopy, however, should not lead to delayed initiation of appropriate treatment. Patients diagnosed with malaria should usually be hospitalized. If outpatient management is preferred, as is the practice in some European centres, patients must usually be followed closely (at least daily) until clinical and parasitological cure. Treatment of uncomplicated Plasmodium falciparum malaria is either with oral artemisinin combination therapy (ACT) or with the combination atovaquone/proguanil. Two forms of ACT are available in Europe: artemether/lumefantrine and dihydroartemisinin/piperaquine. ACT is also effective against Plasmodium vivax, Plasmodium ovale, Plasmodium malariae and Plasmodium knowlesi, but these species can be treated with chloroquine. Treatment of persistent liver forms in P. vivax and P. ovale with primaquine is indicated after excluding glucose 6 phosphate dehydrogenase deficiency. There are modified schedules and drug options for the treatment of malaria in special patient groups, such as children and pregnant women. The potential for drug interactions and the role of food in the absorption of anti-malarials are important considerations in the choice of treatment.Complicated malaria is treated with intravenous artesunate resulting in a much more rapid decrease in parasite density compared to quinine. Patients treated with intravenous artesunate should be closely monitored for haemolysis for four weeks after treatment. There is a concern in some countries about the lack of artesunate produced according to Good Manufacturing Practice (GMP).

Rapid diagnosis of malaria using plasmodium lactate dehydrogenase (OptiMAL) test

Abstract We compared the sensitivity and specificity of OptiMAL test and Quantitative Buffy Coat(QBC) method with both thick & thin peripheral blood smear microscopic examination (gold standard) for diagnosing malaria in 103 children aged 1–15 years admitted with clinical suspicion of malaria. Of 103 cases, PBS study was positive in 59 (57.3%) children, QBC was positive in 60 (58.2%) and OptiMAL test was positive in 59 (57.3%) cases. Sensitivity and specificity of OptiMAL test was 100% and 97.8% while sensitivity and specificity of QBC method was 100% and 91.3%, respectively. OptiMAL test is a simple, sensitive and specific test for timely diagnosis of malaria in children.