Seroprevalence of Toxoplasma gondii among School Children in Pyin Oo Lwin and Naung Cho, Upper Myanmar

Toxoplasma gondii is an apicomplexan parasite that can cause toxoplasmosis in a wide range of warm-blooded animals including humans. In this study, we analyzed seroprevalence of T. gondii among 467 school children living in the rural areas of Pyin Oo Lwin and Naung Cho, Myanmar. The overall seroprevalence of T. gondii among school children was 23.5%; 22.5% of children were positive for T. gondii IgG, 0.4% of children were positive for T. gondii IgM, and 0.6% of children were positive for both T. gondii IgG and IgM. Geographical factors did not significantly affect the seroprevalence frequency between Pyin Oo Lwin and Naung Cho, Myanmar. No significant difference was found between males (22.2%) and females (25.0%). The overall seroprevalence among school children differed by ages (10 years old [13.6%], 11–12 years old [19.8%], 13–14 years old [24.6%], and 15–16 years old [28.0%]), however, the result was not significant. Polymerase chain reaction analysis for T. gondii B1 gene for IgG-positive and IgM-positive blood samples were negative, indicating no direct evidence of active infection. These results collectively suggest that T. gondii infection among school children in Myanmar was relatively high. Integrated and improved strategies including reinforced education on toxoplasmosis should be implemented to prevent and control T. gondii infection among school children in Myanmar.

Clinics in diagnostic imaging (198). Small bowel obstruction secondary to a bezoar

A 60-year-old man presented with abdominal pain. He was later diagnosed on imaging to have high-grade small bowel obstruction. The patient underwent surgery, and a hard, rounded bezoar resembling the endosperm of Nypa fruticans, colloquially known as attap chee, was found at the point of obstruction. Small bowel obstruction is a common acute surgical condition with multiple causes, including bezoars. We discuss the typical imaging features of bezoars causing small bowel obstruction as well as potential pitfalls that can mimic the appearance of a bezoar.

Effectiveness of an algorithm in reducing the number of unnecessary ultrasound scans for deep vein thrombosis: an evaluation report

<p><b>INTRODUCTION</b>Patients with suspected deep vein thrombosis (DVT) pose a diagnostic dilemma to the Emergency Department (ED) clinician. This study aimed to implement a known algorithm incorporating the modified Wells criteria and D-dimer testing to guide the ED clinician, thus reducing unnecessary ultrasound scans (USS).</p><p><b>METHODS</b>Patients who presented to the ED between August 2008 and April 2009 with suspected DVT underwent Wells scoring. Those with scores < 2 were deemed unlikely to have DVT and underwent D-dimer testing first. Patients with scores ≥ 2 were regarded as likely to have DVT and underwent urgent USS. USS findings were tabulated as positive or negative/indeterminate for DVT. The latter group was followed up for one year to check whether DVT was missed during the initial USS.</p><p><b>RESULTS</b>75 patients presented with suspected DVT and underwent USS. Of these, 14 results were positive and 61 were negative. 37 patients had Wells scores < 2, with three (8.1%) having DVT. Another 38 patients had Wells scores ≥ 2, with 11 (28.9%) having DVT. D-dimer testing was performed on 27 of the 75 patients. Those with DVT had higher average values compared to those without DVT (1.305 vs. 0.595 µg/ml). The majority of patients with raised D-dimer values had cellulitis, although three also had DVT (with values ≥ 0.99 µg/ml).</p><p><b>CONCLUSION</b>We managed to reduce the number of unnecessary USS and increase the pick-up rate of DVT. A cut-off score ≥ 2 in our algorithm is suitable for use in the ED setting.</p>

High Levels of Antibodies to Plasmodium falciparum Liver Stage Antigen-1 in Naturally Infected Individuals in Myanmar

Plasmodium falciparum liver stage antigen-1 (PfLSA-1) is one of the few antigens expressed exclusively in liver stage parasites. In this study, we evaluated the antibody responses against recombinant PfLSA-1 in naturally infected individuals in Myanmar. High levels of antibody responses (70.7%) were detected in 82 serum samples from 116 infected individuals, and IgG responses to PfLSA-1 principally composed of responses of IgG1 and IgG3 subclasses. These results show that PfLSA-1 elicits effective antibody responses in individuals infected with P. falciparum, and thus it could be not only an attractive candidate protein for vaccine development, but also a useful antigen for serodiagnosis of the infection.

Usefulness of the recombinant liver stage antigen-3 for an early serodiagnosis of Plasmodium falciparum infection

In order to develop tools for an early serodiagnosis of Plasmodium falciparum infection, we evaluated the usefulness of P. falciparum liver stage antigen-3 (LSA-3) as a serodiagnostic antigen. A portion of LSA-3 gene was cloned, and its recombinant protein (rLSA-3) was expressed in Escherichia coli and purified by column chromatography. The purified rLSA-3 and 120 test blood/serum samples collected from inhabitants in malaria-endemic areas of Mandalay, Myanmar were used for this study. In microscopic examinations of blood samples, P. falciparum positive rate was 39.1% (47/120) in thin smear trials, and 33.3% (40/120) in thick smear trials. Although the positive rate associated with the rLSA-3 (30.8%) was lower than that of the blood stage antigens (70.8%), rLSA-3 based enzyme-linked immunosorbent assay could detect 12 seropositive cases (10.0%), in which blood stage antigens were not detected. These results indicate that the LSA-3 is a useful antigen for an early serodiagnosis of P. falciparum infection.

Efficacy of polymerase chain reaction (PCR) Technique in detection of malaria parasite species

Since 1985, Polymerase Chain Reaction (PCR) technique has been developed and applided as a diagnostic tool for edtection of many parasitic infections. Because of its ability to amplify DNA fragments and using specific nucleotide primers, the test is highly sensitive as well as specific. Efficacy of PCR test in detection of malaria species was compared with that of conventional microscopic examination of Giemsa stained blood film in the study. A study done on (111) patients attending the Central Malaria Clinic revealed that,(20) patients were found to be positive by PCR test, while only (12) patients were positive by microscopic examination could detect only Plasmodium falciparum and Plasmodium vivax, while PCR test was able to detect all human malaria parasite species includinPlasmodium ovale in (10) samples. Thus PCR test was founcd to be highly effective for detection of malaria parasites, especially in cases of mixed infections.

Efficacy of polymerase chain reaction (PCR) technique in detection of malaria parasite species

Since 1985, Polymerase Chain Reaction (PCR) technique has been developed and applied as a diagnostic tool for detection of many parasitic infections. Because of its ability to amplify DN fragments and using specific nucleotide primer, the test is highly sensitive as ell a specific. Efficacy of PCR test in detection of malaria pecies wwas compared with that of conventional microscopic examination of Giemsa stained blood film in the study. a study done on (111) patients attending the Central Malaria Clinic reveald that, (20) patients were found to be positive by PCR test, while only (12) patients were positive by microscopic examination could detect only Plasmodium falciparum and Plasmodium vivax, hile PCR test was able to detect all human malaria parasite species including Plasmodium ovale in (10) samples. Thus PCR test was found to be highly effective for detection of malaria parasites, especially in cases of mixed infections.

Situation analysis of drug resistant malaria in Myanmar

Since early 70's drug resistant falciparum malaria has been discovered and gradually emerged as a major hindrance to effective management of malaria. Drug sensitivity tests conducted all over the country revealed that, chloroquine resistant was highest near the Thailand border, with RII/III more than 60 percent and lower near India border with RII/III 25 percent. Sulphadoxine-Pyrimethamine (S-P) resistance was also highest near the Thailand border with RII/III 45 percent and lowest in the delta area with RII/III 15 percent. Although Mefloquine resistance has been discovered near the Thailand border with RII/III 5-20 percent Plasmodium falciparum is almost sensitive to the drug in other parts of Myanmar. The studies conclude that, chloroquine and S-P drugs are still effective for treatment of uncomplicated malaria among the semiimmune persons residing in the endemic areas, while mefloquine is a drug of choice for non-immune persons and high risk groups.