Pneumocystis carinii infection among human immunodeficiency virus (HIV) infected Myanmar patients.

A total of 60 HIV infected patients complaining of dry cough for at least two weeks and attending the Out-patient Department of the Specialist Hospital, Waibargi, were screened for Pneumocystis carinii. Induced sputum samples were examined with Giemsa and Gomori silver methenamine stains. P. carinii were detected in 18 patients (30%) with silver stain and 13 patients (21.7%) with Giemsa stain. The sensitivity and specificity of the Giemsa stain were 72.2% and 95.2%, respectively. The range of CD4 counts in P. carinii-positive patients was found to be 0-562/microl, and the mean CD4 count was 132.3/microl. Out of 18 P. carinii-positive cases, CD4 counts of 15 cases (83.3%) were <200/microl and those of 3 cases were >200/microl. Clinically, P. carinii-positive cases were associated with fever in 55.5%, with tightness of the chest in 38.9%, and with cyanosis and tightness of the chest in 11.1%. Co-infection with tuberculosis was found in 16.7%. Anti-pneumocystic prophylaxis is recommended for those patients with a CD4 count <200/microl. Giemsa staining could be used as an alternative diagnostic method for detecting P. carinii. This study documented the existing prevalence of P. carinii among HIV-infected Myanmar patients.

Humoral immune response to falciparum malaria during pregnany

Humoral immune respone against Plasmodium Falciparum was studied ontwo hundred and thirty seven pregnant and non pregnant women in Tha-hton township during premonsoon season of 1998. Slide positivity rate among pregnant women was 7.3

(10/137), fifty percent of which were primigravide. Eighty percent of infection occured druing second trimester. Antimalarial antibiodies were determined by both Indirect Fluorescent Antibody Test (IFAT) and Enzyme Linked Immunosorbent Assay (ELISA). IFAT seropositivity rate was 63.33

(n=33) in primigravidae and 83.63

(n=11) in non pregnant healthy women. In the convalescent sera, the rates were 77.14

(n=7) and 87.33

(n=15) respectively. These IFAT results were also comparable with those of ELISA. Lower seropositivity rate and mean antibodytitre were observed in pregnant women compared with non-pregnants. These findings inply that there is suppression of antimalarial immunity druing pregnancy

A rapid diagnosis of malaria parasites by acridine orange staining method

The study was designed to find out the diagnostic value of Acridine orange staining method in detection of malaria parasite (Plasmodium falciparum) in comparison with the conventional thick and thin blood films. Thirty two P. falciparum and two P. vivax malaria cases were included in thestudy and the thick blood film and acridine orange staining methods were found to be more sensitive in detecting asexual and sexual parasites (gametocytes) than the thin film. It needs 2-4 weeks time to train a technician to beable to detect the parasites in thick and thin film methods, but acridine orange staining method can be transferred within an hour. Another advantage of acridine orange staining method is the shortest examination time, lasting only 45 seconds whereas the thick and thin blood films need 5 to 10 minutes. Hence, it is concluded that the acridine orange staining method is useful for quick diagnosis of malaria although accessary eauipment is required.

The changing incidence of plasmodium vivax infection in subjects with malaria (Short report)

Malaria is still the most important parasitic disease in the tropics. Malaria is caused by a protozoan parasite of the genus Plasmodium, of which three species are commonly known to infect people living in Union of Myanmar. They are P. falciparum, P. vivax and P. malariae. Although vivax and malariae infections are not generally life threatening , they can cause a sometime severe acute illness. Vivax forms of malaria are characterized by relapses i.e. reappearance of symptoms of parasitaemia following a "latent" or symptomless period of up to five years. Chronic or repeated vivax malaria infection often causes impaired growth in activity in adults. Therefore our findings will suggest closer supervision and effective measures against increasing incidence of vivax malaria in some areas of Myanmar Naing-Ngan.

The effect of antimalarials on the development of Plasmodium Falciparum trophozoites

The effect of different antimalarials (Artemether, Quinine, Chloriquine, Amodiaquine and Sulphadoxine/ Pyrimethamine) on the in vivo development of a sexual parasites during the treatment of falciparum malaria was studied on 29 patients. Maturation of trophozoites from tiny to large ring forms were noted on blood films taken every 6 hourly. The shortest clearance time of tiny forms and fastest parasite clearence rate was detected in the artemether treated group than other antimalials. The parasite clearance time also does not depend on the disappearance time of tiny ring forms, though it does on small and large forms. The drug resistant cases showed longer durationof clearence time of small and large forms in both the sulphadoxine/pyrimethamine and artemether treated groups. The possible early interpretation of resistant cases and application of the methods for the documentation of the action of the antimalarial was discussed.

Inhibition of Plasmodium falciparum merozoites invasion by immune sera from malaria infected subjects

The study was conducted on sera samples of 92 subjects from malaria endemic areas. All 92 subjects have experienced either previous or present infection with different parasitaemia levels of Plasmodium falciparum. The relationship between frequency of malaria infection, parasite densities and immunofluorescence malaria antibody titres of P. falciparum were studied. There was no significant correlation between IFA titres and parasitaemia levels or frequency of malarial infection. The serum inhibition to invasion of P. falciparum merozoites in vitro was found to vary according to the sera obtained from subjects with various malarial immune status. Parasite inhibitory antibody was not evident in sera from acutely infected subjects but was significantly observed in sera from convalescent subjects with an inhibition of P.falciparum merozoite invasion up to 85 per cent.

Hospital based in vivo monitoring of the degree of resistance of P.Falciparum to standard anti-malarials

This preliminary study was done to monitor the changing trend in sensitivity of anti-malarials at a fixed hospital in central Burma near Pegu Mountain Range. During 1986 malarial season out of 15 patients treated with chloroquine (6.6per cent) was resistant at R2 level and (73.3 per cent) were resistant at R1 level. Remaining 20 per cent of patients were either S (sensitive)of R1 (resistant). Out of 29 patients treated with amodiaquine (6.9 per cent) were resistant at R2 level and (51.7 per cent) were resistant at R1 level. (13.8 per cent) patients were proved as sensitive and the remaining (27.6 per cent) patients were either S (sensitive) or R1 (resistant). Out of 24 patients treated with sulphadoxine pyrimethamine (16.7 per cent) were resistant at R2 level. 50 per cent were resistant at R1 level. (20.8 per cent) cases were sensitive to the drug. The remaining 12.5 per cent of patients were either S (sensitive) or R1 (resistant). Out of 31 patients treated with quinine (6.5 per cent) were resistant at R2 llevel. (9.7 per cent) were resistant at R1 level. (48.3 per cent) were sensitive to the drug. Remaining (35 per cent) were either S (sensitive) or resistant at R1 level. Out of 35 patients treated with mefloquine sulphadoxine pyrimethamine (3.0 per cent) was resistant at R2 level. (12.1 per cent) were resistant at R1 level. (69.6 per cent) were sensitive to the drug and the remaining (15.2 per cent) of patients were either S or R1 resistant. The problems faced with the present method of drug monitoring will be discussed. Although re-infection during the follow up period could not be totally excluded it may be concluded that significant resistance to quinine exists and mefloquine resistance may also become a problem in the not too distant future.

Seasonal variation in acute diarrhoea in children in two village communities in Burma

639 under-five children at Htaukkyant villages in 1979-80, and over 700 under five children at Intakaw villages in 1982-83, were followed up by daily diarrhoea surveillance and monthly anthropometry for a duration of one year. There was a definite seasonality for acute diarrhoea, the incidence rates during the monsoon months being significantly higher than those during the winter months. Bacterial agents, especially enterotoxigenic Escherichia coli, were the most common pathogens for acute diarrhoea during monsoon, and rotavirus was the most common pathogen detected during winter. Presumably, because of the cytopathic effect of rotavirus, children who developed diarrhoea during winter had smaller gain in body weights per month than those who developed diarrhoea during monsoon (being most commonly associated with enterotoxigenic Escherichia coli).