Malaria en pacientes con infección por VIH: serie de casos en un hospital peruano / Malaria in HIV-Infected patients: a series of cases in a peruvian hospital

RESUMEN Las manifestaciones clínicas de la malaria en pacientes con VIH pueden ser variables dependiendo del estado inmunológico del paciente. La evidencia en relación a la coinfección es escasa a nivel nacional. Se describen cuatro casos procedentes de un hospital de Iquitos-Perú con diagnóstico de infección por VIH y examen de sangre positivo para malaria. De estos pacientes, dos tenían infección por Plasmodium falciparum y dos por Plasmodium vivax. Un paciente se encontraba en estadio sida con mala adherencia a la terapia antirretroviral combinada (TARVc) y el resto se encontraba en estadios tempranos sin recibir TARVc.

ABSTRACT The clinical signs of malaria in HIV patients may vary depending on the immunological status of the patient. Nationally, evidence regarding co-infection is scarce. This research describes four cases from a hospital in Iquitos, Peru, of patients diagnosed with HIV infection and a positive blood test for malaria. Two of these patients had Plasmodium falciparum infection, and two had Plasmodium vivax infection. One of the patients was in the AIDS stage with poor adherence to combination antiretroviral therapy (cART), and the other three were in the early stages and not receiving cART.

Malaria grave en mujeres gestantes hospitalizadas entre el 2010 y el 2014 en el departamento de Antioquia, Colombia / Severe malaria in pregnant women hospitalized between 2010 and 2014 in the Department of Antioquia (Colombia)

Resumen Introducción. La malaria (o paludismo) durante la gestación impacta negativamente la salud de la madre y del neonato, con alto riesgo de complicaciones clínicas y mortalidad. En las regiones de alta endemia se han caracterizado, especialmente, la anemia materna y el bajo peso al nacer, pero es poco conocido el espectro clínico en las zonas de baja endemia. Objetivo. Caracterizar clínica y epidemiológicamente los episodios de malaria en mujeres gestantes hospitalizadas en el departamento de Antioquia entre el 2010 y el 2014. Materiales y métodos. Se hizo un estudio descriptivo, transversal y retrospectivo, con historias clínicas de mujeres gestantes con malaria por Plasmodium falciparum y P. vivax. Se utilizaron los criterios diagnósticos de malaria complicada de la Organización Mundial de la Salud (OMS) y de la Guía para la atención clínica integral del paciente con malaria vigente en Colombia. Resultados. Se analizaron 111 casos; el 13,5 % se clasificó como complicación grave según los criterios de la OMS, porcentaje que ascendió a 23,4 % según los criterios de la guía colombiana. Las complicaciones detectadas fueron disfunción hepática, anemia, acidosis y trombocitopenia grave. No se observó diferencia en la frecuencia de las complicaciones según la especie de plasmodio. El 39,4 % de los casos presentó signos generales de peligro; la palidez y la ictericia fueron los más frecuentes. El 40,5 % presentó signos de peligro para la gestación como la cefalea persistente, el dolor abdominal y el sangrado vaginal. Conclusiones. La malaria grave se presenta con gran frecuencia en las mujeres gestantes, sin diferencia según la especie de plasmodio, y se manifiesta con signos de peligro precozmente reconocibles. Se encontró un subregistro hospitalario del 88 % de los casos graves y falta de exámenes de laboratorio para un diagnóstico más completo. Se requiere un protocolo para el diagnóstico clínico de las mujeres gestantes con malaria.

Abstract Introduction: Malaria during pregnancy has a negative impact on maternal-neonatal health, with a high risk of clinic complications and mortality. High endemic areas are specially characterized by maternal anaemia and low birth weight. The clinical spectrum is little known in low endemic areas. Objective: To clinically and epidemiologically characterize malaria episodes in hospitalized pregnant women in the Department of Antioquia (Colombia) in the period 2010-2014. Materials and methods: Retrospective, cross-sectional, descriptive study with medical records of pregnant women with P. falciparum and P. vivax malaria. The WHO severe malaria diagnostic criteria and the Colombian Guía para la atención clínica integral del paciente con malaria (guidelines for comprehensive malaria treatment) were used. Results: We analyzed 111 cases, out of which 13.5% were classified as severe malaria according to the WHO criteria. Following the Colombian Guidelines, the proportion increased to 23.4%. Identified complications included hepatic dysfunction, anaemia, acidosis, and severe thrombocytopenia. No difference in the frequency of complications by Plasmodium species was observed; 39.4% of the cases presented general danger signs, pallor and jaundice being the most frequent; 40.5% showed danger signs for pregnancy, such as persistent headache, abdominal pain, and vaginal bleeding. Conclusions: Severe malaria is a highly frequent event in pregnant women, without differences by Plasmodium species. It shows early recognizable dangers signs. Hospital under-reporting was identified in 88% of severe cases as well as a lack of laboratory tests for a more comprehensive diagnosis. A protocol for the clinical diagnosis of pregnant women with malaria is required.

Ruptura esplénica espontánea como complicación en la malaria aguda grave por plasmodium falciparum / Spontaneous splenic rupture as a complication in plasmodium falciparum acute severe malaria

Se presenta el caso clínico de un paciente con rotura espontánea del bazo, como complicación grave y poco frecuente de la malaria aguda. Esta complicación puede acontecer desde la primera semana de enfermedad y su diagnóstico tardío es potencialmente fatal. Debe sospecharse en todo paciente con malaria grave, que evolutivamente presente un abdomen agudo y signos de shock hipovolémico. El manejo médico o quirúrgico dependerá de la magnitud de la ruptura y del estado hemodinámico del paciente. Se presenta el caso por la gravedad y escasa frecuencia de esta complicación(AU)

We present a clinical case of a patient with spontaneous rupture of the spleen, as a serious and uncommon complication of acute malaria. This complication can occur from the first week of illness and its late diagnosis is potentially fatal. It should be suspected in all patients with severe malaria, who evolutionarily present an acute abdomen and signs of hypovolemic shock. Medical or surgical management will depend on the extent of the rupture and hemodynamic status of the patient. The case is presented due to the severity and low frequency of this complication(AU)

Comprometimento pulmonar grave em paciente com associação entre diagnóstico de malária e HIV: relato de caso / Severe pulmonary involvement in a patient with associated malaria and HIV: a case report

A associação entre Vírus da Imunodeficiência Humana (HIV) e Malária é um evento de grande repercussão clínica. A grande importância de tal concomitância de diagnósticos dá-se por sua associação negativa, na qual se observa risco aumentado de infecção por malária em pacientes com HIV e o aumento de replicação viral nesses pacientes em decorrência da coinfecção pela malária. Os achados radiológicos incluem infiltrado intersticial ou alveolar, localizado preferencialmente nas regiões peri-hilares e em bases pulmonares, que pode ser associado a derrame pleural. O caso relatado é de um homem de 40 anos, branco, previamente hígido, que interna por quadro de febre, mialgia difusa e fadiga, após viagem de turismo ao continente africano. Em investigação laboratorial inicial, apresenta hemoconcentração e plaquetopenia importante. No decorrer da internação, tem diagnóstico de malária (demonstração do parasita no esfregaço sanguíneo) e inicia tratamento específico. Solicitou-se sorologia para HIV, a qual se apresentou positiva. O paciente evolui com febre ictero-hemorrágica, confusão mental, vômitos, insuficiência ventilatória e insuficiência renal aguda, sendo transferido para Unidade de Terapia Intensiva. Comprovou-se comprometimento pulmonar grave através da realização de Tomografia Computadorizada de Tórax de Alta Resolução, que evidenciou espessamento de septos interlobulares e de bainhas peribroncovasculares, com áreas esparsas de atenuação em vidro fosco e de consolidações, além de evidência de derrame pleural. Conclui-se que padrão de comprometimento radiológico do paciente foi compatível com os relatos já descritos pela literatura, o que corrobora para unificação de apresentação do quadro nos exames de imagem (AU)

The association between human immunodeficiency virus (HIV) and malaria is an event of great clinical repercussion. The great importance of such concomitance of diagnoses is due to its negative association, where there is an increased risk of malaria infection in patients with HIV and increased viral replication in these patients due to malaria co-infection. Radiological findings include interstitial or alveolar infiltrate, preferably located in the peri-hilar regions and at the lung bases, which may be associated with pleural effusion. The case reported here is of a white 40-year-old man, previously healthy, who was hospitalized for fever, diffuse myalgia and fatigue after a trip to the African continent. In initial laboratory investigation, he presented hemoconcentration and important thrombocytopenia. During the hospitalization, malaria was diagnosed (demonstration of the parasite in the blood smear) and specific treatment was initiated. HIV serology was requested and positive. As the patient progressed with icterohemorrhagic fever, mental confusion, vomiting, ventilatory failure and acute renal failure, he was transferred to the Intensive Care Unit. Severe pulmonary involvement was confirmed by high-resolution computed tomography, which showed thickening of interlobular septa and peribroncovascular sheaths, with sparse areas of ground-glass attenuation and consolidations, as well as evidence of pleural effusion. It was concluded that the patient's radiological involvement pattern was consistent with the reports already described in the literature, which corroborates the unification of the presentation of the picture in the imaging tests (AU)

Influence of age on the haemoglobin concentration of malaria-infected patients in a reference centre in the Brazilian Amazon

Anaemia is amongst the major complications of malaria, a major public health problem in the Amazon Region in Latin America. We examined the haemoglobin (Hb) concentrations of malaria-infected patients and compared it to that of malaria-negative febrile patients and afebrile controls. The haematological parameters of febrile patients who had a thick-blood-smear performed at an infectious diseases reference centre of the Brazilian Amazon between December 2009-January 2012 were retrieved together with clinical data. An afebrile community control group was composed from a survey performed in a malaria-endemic area. Hb concentrations and anaemia prevalence were analysed according to clinical-epidemiological status and demographic characteristics. In total, 7,831 observations were included. Patients with Plasmodium falciparum infection had lower mean Hb concentrations (10.5 g/dL) followed by P. vivax-infected individuals (12.4 g/dL), community controls (12.8 g/dL) and malaria-negative febrile patients (13.1 g/dL) (p < 0.001). Age, gender and clinical-epidemiological status were strong independent predictors for both outcomes. Amongst malaria-infected individuals, women in the reproductive age had considerably lower Hb concentrations. In this moderate transmission intensity setting, both vivax and falciparum malaria are associated with reduced Hb concentrations and risk of anaemia throughout a wide age range.

Platelet profile is associated with clinical complications in patients with vivax and falciparum malaria in Colombia

Introduction Thrombocytopenia is a common complication in malaria patients. The relationship between abnormal platelet profile and clinical status in malaria patients is unclear. In low and unstable endemic regions where vivax malaria predominates, the hematologic profiles of malaria patients and their clinical utility are poorly understood. The aim of this study was to characterize the thrombograms of malaria patients from Colombia, where Plasmodium vivax infection is common, and to explore the relationship between thrombograms and clinical status. Methods Eight hundred sixty-two malaria patients were enrolled, including 533 (61.8%) patients infected with Plasmodium falciparum, 311 (36.1%) patients infected with Plasmodium vivax and 18 (2.1%) patients with mixed infections. Results The most frequently observed changes were low platelet count (PC) and high platelet distribution width (PDW), which were observed in 65% of patients; thrombocytopenia with <50,000 platelets/µL was identified in 11% of patients. Patients with complications had lower PC and plateletcrit (PT) and higher PDW values. A higher risk of thrombocytopenia was identified in patients with severe anemia, neurologic complications, pulmonary complications, liver dysfunction, renal impairment and severe hypoglycemia. The presence of thrombocytopenia (<150,000 platelets/µL) was associated with a higher probability of liver dysfunction. Conclusions Young age, longer duration of illness and higher parasitemia are associated with severe thrombocytopenia. Our study showed that thrombocytopenia is related to malaria complications, especially liver dysfunction. High PDW in patients with severe malaria may explain the mechanisms of thrombocytopenia that is common in this group of patients. .

Rhabdomyolysis in Falciparum Malaria with Acute Renal Failure.

Acute renal failure is an important complication of falciparum malaria. Though rhabdomyolysis has been reported in falciparum malaria occasionally, its role in the causation of acute renal failure in malaria has not been investigated. Therefore, we have undertaken this research to study skeletal involvement in malaria and to correlate it to acute renal failure. Material and Methods: Sixty patients of malaria were included in this study. Of them there were 23 (38.3%) patients of cerebral malaria with renal failure (Group A), 15 (25.0%) patients with cerebral malaria without renal failure (Group B), and 22 (36.6%) patients of uncomplicated malaria (Group C). The diagnosis of malaria was done by Giemsa stained peripheral blood smear or QBC. All patients were subjected to detailed investigations. In addition serum creatine kinase (CK) and myoglobin (Mb) levels were estimated. Muscle biopsy was performed in 10 cases and tissue specimens were stained with hematoxylin-eosin stain. Results: The mean serum CK level (IU/L) in Group A, Group B and Group C were 406.8 ± 290.8 IU/L, 127.4 ± 112.1 IU/L, 110.4 ± 99.0 IU/L respectively. The mean serum Mb level (ng/ml) in Group A, Group B and Group C were 344.6 ± 260.1 ng/ml, 103.9 ± 97.0 ng/ml and 45.9 ± 45.4 ng/ml respectively. Serum Mb concentration was significantly high in cerebral malaria with renal failure. Significant correlation had been observed between serum CK and Mb level (r = 0.71 for 60 patents; p = <0.001; 95% Cl = 0.55 to 0.82). Serum CK correlated well with parasitemia (r = 0.56, p<0.001).There was a significant correlation between serum Mb concentration with the simultaneous serum creatinine level (r = 0.46; p value = 0.001). There was significant association observed between muscle injury and renal failure (Chi square =6.72, p = 0.01). There was no evidence of muscle necrosis in any of the biopsy specimens examined. Conclusion: The present study showed that biochemical evidence of muscle injury was found in patients of falciparum malaria with renal failure. Therefore myoglobin may have a pathogenetic role in malarial acute renal failure.

Prevalence and Clinical Manifestations of Malaria in Aligarh, India

Malaria is one of the most widespread infectious diseases of tropical countries with an estimated 207 million cases globally. In India, there are endemic pockets of this disease, including Aligarh. Hundreds of Plasmodium falciparum and P. vivax cases with severe pathological conditions are recorded every year in this district. The aim of this study is to find out changes in liver enzymes and kidney markers. Specific diagnosis for P. falciparum and P. vivax was made by microscopic examination of Giemsa stained slides. Clinical symptoms were observed in both of these infections. Liver enzymes, such as AST, ALT, and ALP, and kidney function markers, such as creatinine and urea, were estimated by standard biochemical techniques. In Aligarh district, P. vivax, P. falciparum, and mixed infections were 64%, 34%, and 2%, respectively. In case of P. falciparum infection, the incidences of anemia, splenomegaly, renal failure, jaundice, and neurological sequelae were higher compared to those in P. vivax infection. Recrudescence and relapse rates were 18% and 20% in P. falciparum and P. vivax infections, respectively. Liver dysfunctions and renal failures were more common in P. falciparum patients, particularly in elderly patients. Artesunate derivatives must, therefore, be introduced for the treatment of P. falciparum as they resist to chloroquine as well as sulfadoxine-pyrimethamine combinations.

An Imported Case of Severe Falciparum Malaria with Prolonged Hemolytic Anemia Clinically Mimicking a Coinfection with Babesiosis

While imported falciparum malaria has been increasingly reported in recent years in Korea, clinicians have difficulties in making a clinical diagnosis as well as in having accessibility to effective anti-malarial agents. Here we describe an unusual case of imported falciparum malaria with severe hemolytic anemia lasting over 2 weeks, clinically mimicking a coinfection with babesiosis. A 48-year old Korean man was diagnosed with severe falciparum malaria in France after traveling to the Republic of Benin, West Africa. He received a 1-day course of intravenous artesunate and a 7-day course of Malarone (atovaquone/proguanil) with supportive hemodialysis. Coming back to Korea 5 days after discharge, he was readmitted due to recurrent fever, and further treated with Malarone for 3 days. Both the peripheral blood smears and PCR test were positive for Plasmodium falciparum. However, he had prolonged severe hemolytic anemia (Hb 5.6 g/dl). Therefore, 10 days after the hospitalization, Babesia was considered to be potentially coinfected. A 7-day course of Malarone and azithromycin was empirically started. He became afebrile within 3 days of this babesiosis treatment, and hemolytic anemia profiles began to improve at the completion of the treatment. He has remained stable since his discharge. Unexpectedly, the PCR assays failed to detect DNA of Babesia spp. from blood. In addition, during the retrospective review of the case, the artesunate-induced delayed hemolytic anemia was considered as an alternative cause of the unexplained hemolytic anemia.

Enhanced T cell activation in Plasmodium falciparum malaria-infected human immunodeficiency virus-1 patients from Mozambique

Human immunodeficiency virus (HIV)-1 infection has an important impact on malaria. Plasmodium falciparum and HIV-1 co-infected patients (Pf/HIV) present with a high degree of anaemia, enhanced parasitaemia and decreased CD4+ T cell counts, which increase the risk of developing severe malaria. In addition, infection with either Pf or HIV-1 alone causes extensive immune activation. Our hypothesis was that lymphocyte activation is potentiated in Pf/HIV co-infected patients, consequently worsening their immunosuppressed state. To test this hypothesis, 22 Pf/HIV patients, 34 malaria patients, 29 HIV/AIDS patients and 10 healthy controls without malaria or HIV/acquired immune deficiency syndrome (AIDS) from Maputo/Mozambique were recruited for this study. As expected, anaemia was most prevalent in the Pf/HIV group. A significant variation in parasite density was observed in the Pf/HIV co-infected group (110-75,000 parasites/µL), although the median values were similar to those of the malaria only patients. The CD4+ T cell counts were significantly lower in the Pf/HIV group than in the HIV/AIDS only or malaria only patients. Lymphocyte activation was evaluated by the percentage of activation-associated molecules [CD38 expression on CD8+ and human leukocyte antigen-DR expression on CD3+ T cells]. The highest CD38 expression was detected in the Pf/HIV co-infected patients (median = 78.2%). The malaria only (median = 50%) and HIV/AIDS only (median = 52%) patients also exhibited elevated levels of these molecules, although the values were lower than those of the Pf/HIV co-infected cases. Our findings suggest that enhanced T-cell activation in co-infected patients can worsen the immune response to both diseases.

Acute disseminated encephalomyelitis following falciparum malaria.

Acute disseminated encephalomyelitis (ADEM) is a demyelinating disease of the brain and spinal cord which is preceded by many viral and bacterial infections. We present a rare case of ADEM following falciparum malaria infection. Early identification of ADEM is highly required as it responds to treatment very well and delay in diagnosis may lead to permanent neurological sequelae.

Point-of-admission hypoglycaemia among under-five Nigerian children with Plasmodium falciparum Malaria: prevalence and risk factors

Hypoglycaemia is a well recognized complication of falciparum malaria in children but its diagnosis may be overlooked because all the clinical features may be mimicked by severe malaria. To determine the prevalence of hypoglycaemia at the point of hospital admission of under-fives with falciparum malaria and identify its risk factors in patients seen in a Nigerian secondary-health-care institution. During a 12-month period and at the point of hospital admission, venous blood sample was collected into an appropriate sample bottle [fluoride-oxalate bottle] from 502 children who were below 5 years of age with positive falciparum malaria parasitaemia. The blood sample was analysed using the glucose-oxidase method. The duration of illness, degree of parasitaemia and time of last meal were noted for each child. Ninety two [18.3%] out of 502 children below five years old with falciparum malaria had hypoglycaemia [blood glucose below 2.6 mmol/L or 50 mg/dl] at the point of hospital admission. Twenty three percent [78 out of 339] of children below 36 months old were hypoglycaemic compared to 8.6% [14 out of 163] children aged 36 months and above; [p=0.01]. Prevalence of hypoglycaemia was higher in girls [20.7%] than boys [16.3%] [Odd ratio, OR = 0.75 [95% Confidence Interval, CI = 0.48-1.18]]. Forty [13.1%] out of 305 children whose time of last meal was 12 hours and below had hypoglycaemia compared to 52[26.4%] out of 197 whose time of last meal was greater than 12 hours; [p=0.02]. Hypoglycaemia at admission point was associated with a significant increase in mortality rate; [p=0.00]. The duration of illness and the degree of parasitaemia did not have significant difference with the prevalence of hypoglycaemia. In falciparum malaria, a greater interval [between 2 meals] than 12 hours in children below 36 months old predisposed them to hypoglycaemia. Routine monitoring of blood glucose at the admission point is suggested in malaria endemic region

Postmalaria neurological syndrome: a case report / Síndrome neurológica pós-malária: relato de um caso

Described here is a case of postmalaria neurological syndrome in a patient who presented infection by Plasmodium falciparum two months earlier. The patient received empiric use of acyclovir for herpetic meningoencephalitis, but neuropsychiatric symptoms improved only after administration of methylprednisolone.

Descrição de um caso de síndrome neurológica pós-malária em paciente que apresentou infecção por Plasmodium falciparum dois meses antes. O paciente fez uso empírico de aciclovir para meningoencefalite herpética, mas a melhora dos sintomas neuropsiquiátricos só ocorreu após administração de metilprednisolona.

Myocardial Infarction Associated with Plasmodium Falciparum Malarial Infection.

Cardiac functions are almost well preserved in malarial infection. We report a rare case with fatal complication of myocardial infarction in patient with delayed diagnosis of Plasmodium falciparum infection. The authors therefore, suggest that every case of fever especially if associated with risk factor for cardiovascular disease should be immediately investigated for malaria so as to prevent this grave complication. This is even more important for people living in malarial endemic areas.

Hemophagocytic syndrome associated with Plasmodium falciparum infection.

Hemophagocytic syndrome (HPS) has been associated with infections, hematological malignancies and autoimmune conditions. Malaria is rarely reported to cause HPS. We report a case of an 11-month-old infant with fever, hepatosplenomegaly, pancytopenia, high serum ferritin, hypertriglyceridemia, and bone marrow hemophagocytosis, consistent with hemophagocytic syndrome. Gametocytes of plasmodium falciparum were identified on bone marrow aspiration. Rapid recovery was observed after treatment with antimalarials.

Retardo no crescimento intrauterino, baixo peso ao nascer e prematuridade em recém-nascidos de grávidas com malária, na Colômbia / Intrauterine growth retardation, low birth weight and prematurity in neonates of pregnant women with malaria in Colombia

INTRODUÇÃO: É frequente a associação da malária com complicações como prematuridade, retardo no crescimento intrauterino, baixo peso ao nascer e mortalidade infantil, efeitos pouco estudados em áreas hipoendêmicas para malaria. O objetivo deste estudo foi analisar a relação da malária gestacional com estes efeitos em recém-nascidosnuma região endêmica para malária na Colômbia, entre 1993 e 2007. MÉTODOS: Foram estudadas as características em 1.716 recém-nascidos num estudo de coorte. Fez-se seguimento em 394 gestantes com malária (27 por cento por Plasmodium falciparum e 73 por cento por P. vivax) e 1.322 sem malária. RESULTADOS: Foi encontrada uma relação entre a exposição à malária na gestação e o risco maior de baixo peso ao nascer (RR = 1,37; 1,03-1,83), assim como estatura baixa (RR = 1,52; 1,25-1,85), retardo no crescimento intrauterino (RR = 1,29; 1,0-1,66) e prematuridade (RR = 1,68; 1,3-2,17). A frequência de nascimentos prematuros foi maior nas mães com malária por P. falciparum (77 por cento) que aquelas com P. vivax (RR = 1,77; IC 95 por cento: 1,2-2,6). CONCLUSÕES: O baixo peso ao nascer e o retardo no crescimento foi associado com malária na gestação na Colômbia. A infecção por P. vivax foi relacionada com efeitos adversos sobre o recém-nascido, de modo semelhante em relação ao P. falciparum.

INTRODUCTION: Association between malaria and pregnancy complications, such as prematurity, intrauterine growth restriction, low birthweight and infant mortality has been reported. These effects have been studied widely in areas hyperendemic for malaria, but studies in low-endemic areas are scarce. The study investigated the relation between gestational malaria and low birthweight and intrauterine growth retardation in neonates of a malarial endemic region in Colombia, between 1993 and 2007. METHODS: The pattern of development in 1,716 neonates of women with and without malaria infection during pregnancy was evaluated in a cohort study. A total of 394 infected (27 percent by P. falciparum and 73 percent by P. vivax) and 1,322 noninfected pregnant women were followed. RESULTS: Exposure to gestational malaria was associated with increased risk of low birth weight (RR = 1.37; 1.03-1.83), short height (RR = 1.52; 1.25-1.85), intrauterine growth retardation (RR = 1.29; 1.0-1.66) and prematurity (RR = 1.68; 1.3-2.17). Prematurity was 77 percent higher in infants of mothers with malaria by P. falciparum than infants of mothers with malaria by P. vivax (RR = 1.77; 1.2-2.6). CONCLUSIONS: Low birth weight and intrauterine growth retardation were associated with malaria during pregnancy. Infection with P. vivax was related with adverse effects on the newborn, similar to that reported for P. falciparum.

Aspects du paludisme a Plasmodium falciparum pendant la grossesse selon les cas observes au CHU de Toamasina Madagascar

Objectif: Decrire les facteurs de risque; les signes cliniques et les complications du paludisme a Plasmodium falciparum pendant la grossesse. Methodes: Il s'agit d'une etude prospective de 12 mois portant sur les patientes enceintes presentant une parasitemie positive au Plasmodium falciparum vues au Service Maternite du Centre Hospitalier de Toamasina. Resultats: Quarante cas de paludisme etaient diagnostiques sur 642 femmes enceintes soit une frequence de 6;23. La transmission etait maximale pendant les saisons humides. L'age inferieur a 19 ans (47;5); la primiparite (62;5)predominaient chez les femmes avec parasitemie positive a Plasmodium falciparum. Les taux de frequentation des consultations prenatales et de la prise d'au moins une dose de etaient faible respectivement de 27;5et de 22;5. La valeur predictive positive des signes cliniques classiques du paludisme etait faible.Les complications etaient dominees par l'anemie maternelle et l'hypotrophie foetale respectivement 40(p0;0001) et 5(p0;05). Conclusion: L'approche diagnostique du paludisme basee sur les symptomes avait une valeur predictive positive faible pendant la grossesse. Une goutte epaisse ou au moins un test de diagnostic rapide doit etre systematiquement realisee devant tout acces febrile

Concurrent dengue and malaria in the Amazon region / Co-infecção por dengue e malária na região Amazônica

INTRODUCTION: The Amazon region has extensive forested areas and natural ecosystems, providing favorable conditions for the existence of innumerous arboviruses. Over 200 arboviruses have been isolated in Brazil and about 40 are associated with human disease. Four out of 40 are considered to be of public health importance in Brazil: Dengue viruses (1-4), Oropouche, Mayaro and Yellow Fever. Along with these viruses, about 98 percent of the malaria cases are restricted to the Legal Amazon region. METHODS: This study aimed to investigate the presence of arboviruses in 111 clinical serum samples from patients living in Novo Repartimento (Pará), Plácido de Castro (Acre), Porto Velho (Rondônia) and Oiapoque (Amapá). The viral RNA was extracted and RT-PCR was performed followed by a Multiplex-Nested-PCR, using Flavivirus, Alphavirus and Orthobunyavirus generic and species-specific primers. RESULTS: Dengue virus serotype 2 was detected in two patients living in Novo Repartimento (Pará) that also presented active Plasmodium vivax infection. CONCLUSIONS: Despite scant data, this situation is likely to occur more frequently than detected in the Amazon region. Finally, it is important to remember that both diseases have similar clinical findings, thus the diagnosis could be made concomitantly for dengue and malaria in patients living or returning from areas where both diseases are endemic or during dengue outbreaks.

INTRODUÇÃO: A região Amazônica possui extensas áreas florestadas e ecossistemas naturais, provendo condições favoráveis para a existência de diversos arbovírus. Aproximadamente, 200 arbovírus foram isolados no Brasil, e 40 estão associados com doenças em humanos. Quatro destes 40 são considerados ser de importância para a saúde pública no Brasil: vírus da dengue (1-4), Oropouche, Mayaro e febre amarela. Juntamente com estes vírus, aproximadamente 98 por cento dos casos de malária estão restritos à região da Amazônia Legal. MÉTODOS: O objetivo deste estudo foi investigar a presença de arbovírus em 111 amostras clínicas de sangue de pacientes que residiam em Novo Repartimento (Pará), Plácido de Castro (Acre), Porto Velho (Rondônia) and Amapá (Macapá). O RNA viral foi extraído, RT-PCR foi realizada seguida de uma Multiplex-Nested-PCR, usando primers genéricos e espécie-específicos para Flavivirus, Alphavirus and Orthobunyavirus. RESULTADOS: Detectamos o vírus da dengue, sorotipo 2, em dois pacientes que residiam em Novo Repartimento (Pará), que também tinham infecção por Plasmodium vivax. CONCLUSÕES: Apesar de dados escassos, esta situação, provavelmente, ocorre mais frequência que a detectada na região Amazônica. Definitivamente, é importante lembrar que ambas as doenças possuem achados clínicos similares, assim o diagnóstico deveria ser feito concomitantemente para dengue e malária em pacientes que residem ou estão voltando de áreas onde ambas as doenças são endêmicas.

Haematological parameters in Malaria.

Malaria accounts for majority of the cases of acute febrile illness with predominance of P.falciparum during the malaria transmission period. Alterations in hematological parameters in the form of anemia and thrombocytopenia are frequently encountered in malaria, especially P.falciparum malaria. Low hemoglobin value and thrombocytopenia increase the probability of malaria in cases of acute febrile illness. Platelet count below 150,000 cells/cu.mm in cases acute fever is single most important parameter indicative of malaria.