Caracterización clínica del paludismo importado / Clinical characterization of imported malaria

Introducción: El paludismo es una enfermedad febril aguda potencialmente mortal causada por parásitos que se transmiten al ser humano por la picadura de mosquitos del género Anopheles. Cuba logró eliminar la transmisión de esta enfermedad gracias a grandes esfuerzos encaminados a conseguirlo, por lo que es necesario adoptar una serie de medidas para evitar su reaparición, mediante la vigilancia y el Programa de Control Sanitario Internacional. Objetivo: Caracterizar clínicamente un grupo de pacientes con paludismo importado. Métodos: Se realizó un estudio descriptivo de corte transversal de 46 pacientes adultos con paludismo importado, ingresados en el Instituto de Medicina Tropical Pedro Kourí desde enero 2015 a diciembre 2016. Los datos fueron tomados de las historias clínicas. El análisis de las variables cualitativas fue expresado en tablas de frecuencias absolutas y relativas. Resultados: Predominaron los pacientes del sexo masculino, con una edad media de 37,4 años. Entre los pacientes, 38 (82,6 por ciento) arribaron del continente africano, la mayoría de ellos de Angola (26,1 por ciento del total de casos). Fue significativa la relación existente entre el supuesto estado no inmune de los pacientes con la severidad del cuadro clínico y presencia de comorbilidades; así como la severidad del cuadro clínico con mayor parasitemia y la especie Plasmodium falciparum. La respuesta al tratamiento resultó excelente con los esquemas combinados utilizados a base de quinina y cloroquina según la especie. Conclusiones: La demora desde el arribo al ingreso hospitalario de los pacientes constituye un riesgo extraordinario para la reintroducción del paludismo en Cuba y para la vida de estos(AU)

Introduction: Malaria is an acute potentially fatal febrile disease caused by parasites transmitted to humans through the bite of mosquitoes from the genus Anopheles. Cuba succeeded in eliminating transmission of this disease thanks to great efforts geared to such an end. It is therefore necessary to take a number of measures aimed at preventing its re-emergence via surveillance and the International Health Control Program. Objective: Clinically characterize a group of patients with imported malaria. Methods: A descriptive cross-sectional study was conducted of 46 adult patients with imported malaria admitted to Pedro Kourí Tropical Medicine Institute from January 2015 to December 2016. The data were collected from the patients' medical records. Results of the analysis of qualitative variables were transferred onto absolute and relative frequency tables. Results: Male patients prevailed, with a mean age of 37.4 years. Of the patients studied, 38 (82.6 percent) were from the African continent, most of them from Angola (26.1 percent of the total cases). A significant relationship was found between the supposed non-immune status of patients and the severity of the clinical status and the presence of comorbidities, as well as between the severity of the clinical status and greater parasitemia and the presence of the species Plasmodium falciparum. An excellent response was obtained to treatment with combined schemes based on quinine and chloroquine, depending on the species. Conclusions: Delay between arrival and hospital admittance of patients is an extraordinary risk for the reintroduction of malaria in Cuba and to the patients' lives(AU)

Evaluación de la calidad del diagnóstico de malaria en la red local de laboratorios y en los laboratorios intermedios en el contexto de la eliminación de la enfermedad en Ecuador / Quality evaluation of malaria diagnosis in the local laboratories network and in intermediate laboratories in a setting towards the disease elimination in Ecuador

Resumen Introducción. El cumplimiento de la meta de eliminación de la malaria en Ecuador en el 2020 exige contar con la capacidad requerida para el diagnóstico microscópico ajustado a los estándares de calidad de la Organización Mundial de la Salud (OMS) y de la Organización Panamericana de la Salud (OPS) y proveer el tratamiento adecuado a los pacientes. Objetivo. Conocer la idoneidad o competencia de los microscopistas de la red pública local para el diagnóstico parasitológico de la malaria y el desempeño de los laboratorios intermedios de referencia. Materiales y métodos. Se hizo un estudio descriptivo de corte transversal a partir de la información obtenida en los talleres de evaluación de idoneidad en el diagnóstico microscópico de la red de laboratorios en las coordinaciones zonales de salud utilizando un panel de láminas para evaluar la concordancia del diagnóstico. Además, se calificó el desempeño de los laboratorios intermedios en el diagnóstico en el marco del programa de evaluación externa del desempeño. Los resultados se compararon con los obtenidos por el laboratorio supranacional de Perú. Resultados. En los 11 talleres realizados, se evaluó la idoneidad de 191 microscopistas, de los cuales 153 (80,1 %) aprobaron las pruebas. Las medianas de los indicadores fueron las siguientes: concordancia entre la detección y el resultado, 100 % (Q1- Q3: 96-100); concordancia en la especie, 100 % (Q1- Q3: 93-100); concordancia en el estadio, 93,0 % (Q1- Q3: 86-95) y concordancia en el recuento, 77 % (Q1- Q3: 71-82). En el programa de evaluación externa de desempeño, los tres laboratorios intermedios obtuvieron una concordancia del 100 % en el resultado y una del 96 % en la especie. Conclusiones. Los indicadores de competencia de la red local y de desempeño de los laboratorios intermedios alcanzaron altos estándares de calidad acordes con el proceso de entrenamiento implementado en el país.

Abstract Introduction: To reach the goal of malaria elimination in Ecuador for the year 2020, it is necessary to have a laboratory network with the capacity to perform microscopic diagnosis according to the WHO/PAHO quality standards and to provide the adequate treatment of cases. Objective: To determine the level of competence for parasitological diagnosis of the microscopists from the local public network and the performance of intermediate reference laboratories. Materials and methods: We conducted a cross-sectional study based on the information collected in workshops carried out to appraise the competence for microscopic diagnosis of the local laboratory network (zonal health coordinating offices 1 to 8) using a slide panel to evaluate diagnosis agreement, as well as the diagnostic performance of the intermediate laboratories using an external quality assessment program. The results were compared against the reference standards of the supranational laboratory in Perú. Results: We evaluated the competencies of 191 microscopists in 11 workshops and 153 (80.1%) of them were approved. The medians of the indicators were the following: concordance for parasite detection, 100% (Q1- Q3: 96-100), concordance for species identification, 100% (Q1- Q3: 93-100), and concordances for stage identification, 93.0% (Q1- Q3: 86-95) and parasite counting, 77.0% (Q1- Q3: 71-82). In the external quality assessment, the three intermediate laboratories obtained 100% in parasite detection concordance and 96% for species detection concordance. Conclusions: The results for the primary network and the performance indicators for the intermediate laboratories showed the high-quality standards of the training program implemented in the country.

Immunoregulation in human malaria: the challenge of understanding asymptomatic infection

Asymptomatic Plasmodium infection carriers represent a major threat to malaria control worldwide as they are silent natural reservoirs and do not seek medical care. There are no standard criteria for asymptomaticPlasmodium infection; therefore, its diagnosis relies on the presence of the parasite during a specific period of symptomless infection. The antiparasitic immune response can result in reducedPlasmodium sp. load with control of disease manifestations, which leads to asymptomatic infection. Both the innate and adaptive immune responses seem to play major roles in asymptomatic Plasmodiuminfection; T regulatory cell activity (through the production of interleukin-10 and transforming growth factor-β) and B-cells (with a broad antibody response) both play prominent roles. Furthermore, molecules involved in the haem detoxification pathway (such as haptoglobin and haeme oxygenase-1) and iron metabolism (ferritin and activated c-Jun N-terminal kinase) have emerged in recent years as potential biomarkers and thus are helping to unravel the immune response underlying asymptomatic Plasmodium infection. The acquisition of large data sets and the use of robust statistical tools, including network analysis, associated with well-designed malaria studies will likely help elucidate the immune mechanisms responsible for asymptomatic infection.

Análise do conteúdo de uma tecnologia para raciocínio diagnóstico de enfermagem / Análisis de contenido de una tecnología para el razonamiento diagnóstico en enfermería / Content analysis of a technology to the nursing diagnostic reasoning

RESUMO Objetivo: submeter à análise do conteúdo uma estratégia metacognitiva de avaliação indireta no pré-encontro com o cliente. Método: estudo metodológico. Utilizou-se o índice de concordância e confiabilidade entre juízes para os critérios de pertinência, adequação, clareza, concisão e precisão de uma tecnologia para raciocínio diagnóstico de enfermagem por iniciantes por meio de formulário eletrônico. Fizeram parte da amostra 13 juízes. Os dados foram analisados por estatística descritiva. Resultados: houve alta concordância e confiabilidade interavaliadores para 85 itens relacionados à etapa de coleta de dados e descrição da estratégia. Apenas cinco itens não alcançaram os critérios de validação e devem ser reformulados. Conclusão: a avaliação indireta no préencontro é pertinente ao processo de raciocínio diagnóstico, sendo possível desenvolver habilidades e competências diagnósticas no iniciante por meio de estratégias, propostas em uma tecnologia inovadora sob a forma de diagrama. .

RESUMEN Objetivo: analizar el contenido de una estrategia metacognitiva de la evaluación indirecta en la reunión previa con el cliente. Método: investigación metodológica; se utilizó el índice de concordancia y confiabilidad interevaluadores a los criterios de pertinencia, claridad adecuación, concisión y precisión de una tecnología para el razonamiento diagnóstico de enfermería para los principiantes a través de medios electrónicos. La muestra estuvo conformada por 13 jueces. Los datos fueron analizados utilizando estadística descriptiva. Resultados: alta confiabilidad interevaluadores de 85 artículos relacionados con la etapa de recolección de datos y la descripción de la estrategia. Sólo 05 artículos no alcanzaron los criterios de validación y deben ser modificados. Conclusión: se concluye que la evaluación indirecta en la reunión previa es relevante para el proceso de razonamiento de diagnóstico, es posible desarrollar habilidades y destrezas de diagnóstico a los principiantes a través de estrategias, propuestas sobre la tecnología innovadora en la forma de un diagrama. .

ABSTRACT Objective: to undergo a content analysis of a metacognitive strategy of indirect assessment in the pre-encounter with the client. Method: methodological study. Agreement and inter-rater reliability index for the criteria: relevance, adequacy, clarity, conciseness and accuracy of a technology to the nursing diagnosis reasoning for novices through an electronic form. The sample consisted of 13 raters. Data were analyzed using descriptive statistics. Results: high agreement and inter-rater reliability for 85 items related to data collection stage and the strategy description. Only fi ve items did not reach the validation criteria and must be rewritten. Conclusion: indirect assessment of the pre-encounter is relevant to the diagnostic reasoning process, being possible to develop competencies and diagnostic skills in the novice through strategies, proposals on innovative technology in the form of a diagram. .

Actividad antiplasmódica y hemolítica de extractos etanólicos y fracciones obtenidas de Cecropia membranacea Trécul. y Cecropia metensis Cuatrec. (sin. Cecropia peltata var. candida Velásquez) / Antiplasmodial and haemolytic activity of ethanolic extracts and fractions obtained from Cecropia membranacea Trécul. and Cecropia metensis Cuatrec. (syn. Cecropia peltata var. candida Velásquez)

Introducción: el estudio de las plantas medicinales ha permitido el desarrollo de productos fitoterapéuticos y fármacos para el tratamiento de diferentes enfermedades, entre estas la malaria. En Brasil las plantas usadas en la medicina tradicional por sus antecedentes como febrífugos o antimaláricos incluyen Cecropia hololeuca, Cecropia sp., Cecropia pachystachya y Cecropia glaziovii. Aún no ha sido comprobada la actividad antimalárica de Cecropia membranacea y Cecropia metensis, especies distribuidas en América Central y América del Sur, incluida Colombia. Objetivo: evaluar la actividad antiplasmódica frente a Plasmodium falciparum de extractos y fracciones de Cecropia membranacea y Cecropia metensis. Métodos: a partir de las hojas con peciolo de las dos especies se prepararon extractos etanólicos utilizando el método de percolación, se llevó a cabo el fraccionamiento del extracto etanólico, de cada especie, utilizando un sistema de partición con solventes de diferente polaridad (éter de petróleo, acetato de etilo, n-butanol y agua). Con los extractos y fracciones obtenidas se realizó un estudio fitoquímico preliminar. La actividad de extractos y fracciones se evaluó in vitro frente a Plasmodium falciparum FCB-2 y se estudió la actividad hemolítica. Resultados: las fracciones acetato de etilo de Cecropia membranacea (CI50 10,12 µg/mL) y Cecropia metensis (CI50 12,52 µg/mL) presentaron actividad antiplasmódica sin generar daño a la membrana de la célula hospedera (CH50> 1 000 µg/mL). La evaluación fitoquímica evidenció en estas fracciones una mezcla de compuestos tipo esteroide, terpénico y flavonoide. Conclusiones: las fracciones acetato de etilo de Cecropia membranacea y Cecropia metensis presentan actividad antiplasmódica promisoria, no asociada con propiedades líticas sobre las células eritrocitarias hospederas. Las dos especies son de interés para profundizar su estudio, en cuanto a la actividad antimalárica y composición fitoquímica(AU)

Introduction: the study of medicinal plants has led to the development of phytotherapeutic products and drugs for the treatment of various diseases, including malaria. Among the plants used in Brazilian traditional medicine for their febrifuge and antimalarial effects are Cecropia hololeuca, Cecropia sp., Cecropia pachystachya and Cecropia glaziovii. The antimalarial activity of Cecropia membranacea and Cecropia metensis has not been demonstrated. These two species may be found in Central and South America, including Colombia. Objective: evaluate the antiplasmodial activity of extracts and fractions of Cecropia membranacea and Cecropia metensis against Plasmodium falciparum. Methods: ethanolic extracts were obtained from petiolate leaves of the two species using the percolation method. The ethanolic extract of each species was then fractionated, using a partition system based on solvents of varying polarity (petroleum ether, ethyl acetate, n-butanol and water). The extracts and fractions obtained underwent preliminary phytochemical examination. Extracts and fractions were evaluated for their in vitro antiplasmodial activity against Plasmodium falciparum FCB-2, as well as for their haemolytic activity. Results: ethyl acetate fractions of Cecropia membranacea (IC50 10.12 µg/mL) and Cecropia metensis (IC50 12.52 µg/mL) showed antiplasmodial activity without damaging the host cell membrane (HC50 >1000 µg/mL). Phytochemical evaluation of these fractions revealed a mixture of steroid, terpene and flavonoid compounds. Conclusions: ethyl acetate fractions of Cecropia membranacea and Cecropia metensis showed promising antiplasmodial activity, not associated to lytic properties, over erythrocyte host cells. The two species are good ground for further study of their antimalarial activity and phytochemical composition(AU)

Seasonal prevalence & resting behaviour of Anopheles minimus Theobald & An. fluviatilis James (Diptera: Culicidae) in east-central India.

Background & objectives: Anopheles minimus has recently been reported to have re-appeared in Keonjhar district of Orissa after a period of about 45 years of launching the malaria eradication programme. An. minimus and An. fluviatilis were the incriminated major malaria vectors in the district, endemic for falciparum malaria. The information on seasonal prevalence and resting behaviour of the vectors is crucial for implementing appropriate malaria control measures. Therefore, a study was undertaken on seasonal prevalence and resting behaviour of An. minimus and An. fluviatilis in this district. Methods: Seven randomly selected villages of Keonjhar district, Orissa, were studied during August 2005 to November 2007. Daytime resting collections indoors and outdoors were made covering three seasons of the year. The Anopheles mosquitoes obtained from different habitats were identified. Collections were maintained separately according to different sites as well as heights of the walls in human dwellings. Results: Among the indoor collections, the densities of An. minimus and An. fluviatilis were higher in human dwellings than cattle sheds. An. fluviatilis was the predominant (41.5%) species followed by An. minimus (26.3%) in human dwellings. The density of both the vector species in human dwellings peaked during rainy and winter seasons followed by summer. Walls were the most preferred site by these vectors for resting and the maximum number was collected at a height of 3 to 4 ft. Interpretation & conclusions: The resting behaviour of the vector species increases their contact with the sprayed walls and therefore, a quality residual spraying of human dwellings focusing indoor walls could interrupt the malaria transmission in this area.

Análise espacial e determinação de áreas prioritárias para o controle da malária, no Estado no Tocantins, 2003-2008 / Spatial analysis and determination of priority areas for malaria control in the State of Tocantins, from 2003 to 2008

INTRODUÇÃO: No Tocantins, a malária apresenta comportamento diferenciado entre as microrregiões, com predominância dos casos importados. Este estudo descreve a análise espacial da malária no estado, no período de 2003 a 2008, buscando identificar nas microrregiões a incidência de casos autóctones e importados, bem como a procedência destes últimos. MÉTODOS: Trata-se de um estudo retrospectivo, pautado em dados secundários, que teve como fonte de dados o Sistema de Informações de Vigilância Epidemiológica - Malária (SIVEP-Malária), analisados através dos softwares estatísticos Epi Info versão 3.5.1. e Bioestat versão 5.0. RESULTADOS: Constatou-se que a malária não teve distribuição homogênea em todos os municípios. A área de maior prioridade agregou municípios localizados nas microrregiões oeste do estado, fronteira com o Pará, onde também se concentram o maior número de casos autóctones. A associação entre os casos autóctones e importados e as espécies de Plasmodium mostrou uma diferença estatisticamente significativa (G = 54,25; p < 0,0001). Das oito microrregiões, Miracema do Tocantins, Araguaína e Bico do Papagaio agruparam 75,8 por cento dos casos, e nessas, onze municípios se sobressaíram. Quanto à procedência, o Estado do Pará apresentou ampla distribuição com 85,5 por cento do total, seguido por Guiana Francesa com 7,4 por cento. CONCLUSÕES: Os resultados demonstraram a predominância dos casos importados e a diferença entre os municípios e microrregiões, apontando pela influencia de estados vizinhos na determinação das áreas de maior risco. Esses dados são importantes, pois contribuem para orientação e direcionamento das políticas públicas para o agravo no Tocantins.

INTRODUCTION: In Tocantins, the behavior of malaria differs between microregions, with predominance of imported cases. This study describes a spatial analysis on malaria in the state covering 2003 to 2008, which sought to identify the incidence of autochthonous and imported cases, and the origin of the latter, in the microregions. METHODS: This was a retrospective study using secondary data. The data source was the epidemiological surveillance information system for malaria (SIVEP-Malária), and the data were analyzed using the Epi Info version 3.5.1 and Bioestat version 5.0 statistical software. RESULTS: It was found that malaria was not homogeneously distributed in all municipalities. The area of highest priority comprised municipalities located in microregions in the west of the state, at the border of Pará, which also had the highest number of autochthonous cases. The association between the autochthonous and imported cases and the Plasmodium species showed a statistically significant difference (G = 54.25; p < 0.0001). Among the eight microregions, Miracema do Tocantins, Araguaína and Bico do Papagaio accounted for 75.8 percent of the cases and, among these, eleven municipalities stood out. Regarding provenance, the State of Pará showed widespread distribution with 85.5 percent of the total, followed by French Guiana with 7.4 percent. CONCLUSIONS: These results demonstrated the predominance of imported cases and the difference between municipalities and microregions, and showed the influence of neighboring states in determining the areas of greatest risk. These data are important, since they contribute towards guiding and directing public policies regarding this disease in Tocantins.

Situación epidemiologica de la malaria en Venezuela: Año 2009 / Epidemiological situation of malaria in Venezuela, in 2009

La malaria es la enfermedad parasitaria tropical más importante en el mundo, y la enfermedad contagiosa que más muertes causa a excepción de la tuberculosis. En el año 2009 en Venezuela fueron diagnosticados 36.448 casos, 35.725 originados en el país y 723 importados del exterior, lo cual representó un aumento en la transmisión de 11,5 % (3.688) casos, respecto al registro de 2008, terminando en situación de "alarma" dentro del área de la curva de casos de la enfermedad. Bolívar, Amazonas, Anzoátegui, Sucre, Delta Amacuro y Monagas, fueron los estados de mayor incidencia. En Bolívar, 25 localidades aportan 10.502 casos (34,5% de la incidencia del estado y 29,4% del país). En Amazonas se produce en los menores de 10 años: 32,3% de la incidencia de Plasmodium vivax, 41,6% de Plasmodium falciparum, 78,9% de Plasmodium malariae y 57,1% de infecciones mixtas. Se hace necesario definir el norte del Programa antimalárico, y plantear los objetivos, tomando como base los lineamientos de la OMS/OPS, sea de "control" o de "eliminación". El problema malárico en Venezuela es superable con voluntad política, coordinación entre las autoridades de los niveles Central, Estadal y Local, y la participación de la comunidad. Para ello es imprescindible contar con los recursos: humanos, materiales y económicos necesarios, a fin de realizar una labor eficaz y sostenible en el tiempo, que garantice el éxito de los objetivos planteados.

Malaria is the most important tropical parasitic disease in the world and a contagious disease that causes more deaths than tuberculosis. In the year 2009 in Venezuela 36,448 cases were diagnosed, 35,725 of which originated in the country and 723 imported from abroad. This represents an increase of transmission of 11.5% (3688) cases in relation to that reported of 2008, ending in situation of "alarm" in the area of the curve of cases of the disease. In Bolívar state, 25 sites provided 10,502 cases (34.5% in the incidence of state and 29.4% of the country). In Amazonas state the disease occurred in children under 10 years: 32.3% of the incidence due to Plasmodium vivax, 41.6% to P. falciparum, 78.9% to P. malariae and 57.1% to mixed infections. It is necessary to define the northern malaria program, and raise the objectives, based on the guidelines of the WHO/PAHO, ie., is the program "control" or "elimination." The malaria problem in Venezuela is overcome with political will and lack of coordination between authorities at central, state and local, and community involvement. This requires having the resources: human, material and financial resources, to undertake an effective and sustainable control and elimination program over time, to ensure the success of the objectives.

Insecticide treated nets, antimalarials and child survival in India.

Malaria has been a complex public health problem affecting mainly the poor and the rural communities in India. Insecticide treated nets (ITN) and antimalarials are the two proven interventions for prevention and control of malaria. ITN has been amply demonstrated to be an effective intervention to protect children from malaria, and in preventing deaths due to falciparum malaria. Antimalarials are a therapeutic intervention for management of malaria, and prevention of complications due to Plasmodium falciparum infection. However, implementation of these interventions is fraught with problems of complex and multidimensional nature at the periphery. These can be addressed by optimizing the use of the 2 interventions, the insecticide treated nets and antimalarials, for area specific application and country specific needs, determined by the eco-epidemiological diversity of malaria in India. This article reviews the significant role of ITN in reducing child mortality, and the judicious use of antimalarials in the management of malaria patient, and the problems associated with the use of these interventions in protecting children against malaria in India.

Malaria control in the municipality of San Esteban, Honduras / Control de la malaria en el municipio de San Esteban, Honduras

OBJECTIVES: To assess the burden of malaria in San Esteban, Department of Olancho, Honduras, and provide recommendations for control. METHODS: Malaria causes appreciable morbidity in San Esteban. In 2006, health workers reported an increase in malaria cases and requested recommendations for control. In 2005, 385 cases (Plasmodium vivax, 316; P. falciparum, 69) were detected from 4 007 blood smears in the San Esteban laboratory (slide positivity rate = 9.6 percent). During May-July 2006, we assessed the burden of malaria and made recommendations. We reviewed epidemiologic data from slide-confirmed malaria cases in 2005 and 2006 and conducted a knowledge, attitudes, and practices survey in households to assess malaria diagnostic, treatment, and prevention practices. RESULTS: During May-July 2006, 143 laboratory-confirmed malaria cases were detected (P. vivax, 134; P. falciparum, 9) in San Esteban, compared with 104 (P. vivax, 79; P. falciparum, 25) in May-July 2005. From January 2005 to July 2006, 538 cases were detected in San Esteban, with increased frequency in May-October and the highest incidence in children 0-14 years old. We administered 112 surveys in 19 communities. Seventy percent of respondents reported a history of malaria in a household member, with the highest frequency reported in mothers (45 percent) and children under 14 years old (37 percent). Most households did not have mosquito protection such as bed nets, screens, or indoor residual insecticide. CONCLUSIONS: Malaria is ongoing in San Esteban, with increased incidence in children. We recommend increased availability and promotion of insecticide-treated bed nets, improved timing and coverage of indoor residual spraying, and improved community malaria practices through education sessions.

OBJETIVOS: Evaluar la carga de malaria en San Esteban, departamento de Olancho, Honduras, y ofrecer recomendaciones para su control. MÉTODOS: La malaria es causa de una considerable morbilidad en San Esteban. En 2006, los trabajadores sanitarios informaron un aumento de casos de malaria y solicitaron recomendaciones para su control. En 2005, en el laboratorio de San Esteban se detectaron 385 casos (316 por Plasmodium vivax y 69 por P. falciparum) en 4 007 frotis sanguíneos (tasa de positividad: 9,6 por ciento). Entre mayo y julio de 2006 se evaluó la carga de malaria y se hicieron las recomendaciones. Se revisaron los datos epidemiológicos de los casos confirmados de 2005 y 2006 y se aplicó una encuesta sobre conocimientos, actitudes y hábitos en los hogares para evaluar las prácticas relacionadas con el diagnóstico, el tratamiento y la prevención de la malaria. RESULTADOS: Entre mayo y julio de 2006 en San Esteban se detectaron 143 casos de malaria confirmados por el laboratorio (134 por P. vivax y 9 por P. falciparum), en comparación con 104 (79 por P. vivax y 25 por P. falciparum) entre mayo y julio de 2005. Entre enero de 2005 y julio de 2006 se detectaron 538 casos en San Esteban, con un aumento en la frecuencia entre mayo y octubre y la mayor incidencia en niños de 0 a 14 años. Se aplicaron 112 encuestas en 19 comunidades. De los que respondieron, 70 por ciento había tenido algún miembro del hogar con malaria, con una mayor frecuencia en las madres (45 por ciento) y los menores de 14 años (37 por ciento). La mayoría de los hogares carecían de protección contra los mosquitos, como mosquiteros para las camas y ventanas o fumigación de interiores. CONCLUSIONES: La malaria se mantiene en aumento en San Esteban, con una mayor incidencia en los niños. Se recomienda incrementar la disponibilidad y la promoción de mosquiteros tratados con insecticidas, mejorar la periodicidad y la cobertura de la fumigación de interiores y mejorar los hábitos...

Paludismo por Plasmodium falciparum adquirido en África subsahariana / Plasmodium falciparum malaria acquired in Subsaharian Africa

El objetivo de este trabajo es presentar los casos de paludismo por Plasmodium falciparum ocurridos en viajeros provenientes del África tropical, atendidos en el Hospital Alemán. Se definió paludismo de origen africano como la infección adquirida en un país del África subsahariana, diagnosticado y tratado en la Argentina. El diagnóstico se realizó por la clínica y la microscopía óptica en frotis de sangre periférica coloreados con Giemsa. Se revieron las historias clínicas de 11 pacientes adultos -cinco turistas y seis marineros mercantes- no oriundos de área endémica, sin condición inmunosupresora, ni morbilidad asociada, internados entre 1993 y 2007. El rango de edad fue de 21 a 48 años; nueve hombres y dos mujeres. Los pacientes fueron clasificados retrospectivamente en malaria grave (seis) o no grave (cinco) según cumplieran con uno o más de los criterios de gravedad de la Organización Mundial de la Salud. Todos presentaron fiebre como signo más significativo. Como complicaciones graves se observaron casos de insuficiencia renal, epistaxis, hemoglobinuria, hipoglucemia, edema pulmonar, acidosis y coma. Tres pacientes requirieron internación en la unidad de terapia intensiva. Todos sobrevivieron y solamente tres habían recibido la quimioprofilaxis correcta antes de viajar. El tratamiento se realizó con una o más de las siguientes drogas: mefloquina, quinidina, clindamicina y cotrimoxazol.

The purpose of this paper is to present the cases of malaria caused by Plasmodium falciparum in travelers coming from tropical Africa, who were treated at the Hospital Alemán (Buenos Aires). African malaria was defined as an infection acquired in any country within Africa, diagnosed and treated in Argentina. Diagnostic tools included clinical features and optic microscopy with Giemsa stained peripheral blood films. We reviewed the medical records of 11 adult patients -five tourists and six sailors- with no history of malaria, immunosuppressive condition or associated morbidity, admitted from 1993 to 2007. The age ranged from 21 to 48 years old, nine of them were males and two females. The patients were retrospectively classified into severe malaria -six of them- or mild malaria -five of them- according to severity criteria established by the World Health Organization, within the first three days of the beginnings of the symptoms. All patients presented fever; severe complications included encephalitis, renal failure, bleeding, haemoglobinuria, hypoglycemia, and pulmonary edema. Three patients required admission at the intensive care unit; no patient died. Only three off them had received properly chemoprophylaxis before traveling; all received treatment with at least one of the following drugs: mefloquine, quinidine, clyndamicine and cotrimoxazol.

Some features of primary and recrudescent amodiaquine-resistant Plasmodium falciparum infections in Nigerian children

Characteristics of primary and recrudescent Plasmodium falciparum infections were evaluated in 25 children who did not recover after amodiaquine (AQ) treatment. Recrudescence was detected by a thick blood smear and confirmed by polymerase chain reaction. Over half of recrudescent events occurred after 14 days of initiation of treatment and were associated with relatively low asexual parasitaemia. We examined the gametocyte sex ratio (GSR) in these children and in age and gender-matched controls that had AQ-sensitive (AQ-S) infections (n = 50). In both AQ-S and AQ-resistant (AQ-R) infections, the GSR was female-biased pre-treatment and became male-biased by the third day after treatment initiation. However, gametocyte males persisted after this period in children with AQ-R infections. AQ-recrudescent infections are relatively low (25 of 612.4 percent) in children from this endemic area.

Malaria control and treatment strategies among school children in semi-urban tropical communities / Estrategias de control y tratamiento de la malaria entre escolares de comunidades tropicales semiurbanas

BACKGROUND: Plasmodium infections among school children in Igbo-Eze South Local Government of Enugu State, Nigeria, were studied between July and December 2005. The relationship between the use of malaria control measures and the prevalence of Plasmodium infections was investigated. METHODS: Blood smears were obtained from 1296 school children (ages 4-15 years) from six schools randomly sampled from the study area. Drugs were given to infected children. Epidemiological questionnaires were administered to the children. RESULTS: Out of 1296 school children examined, 270 (20.8%) had Plasmodium falciparum infections. The prevalence of these parasitic infections varied significantly (p < 0.05) among schools, with Central School, Ovoko (30.1% P falciparum) and Community primary school, Itchi (13.9%), having the highest and lowest prevalence rates respectively. Furthermore, the prevalence of P falciparum infections also varied significantly (p < 0.05) among the age groups, with age groups 4 - 6 (35.1%) and 10-12 (14.2%) having the highest and lowest prevalence rates respectively. Males (23.1%) had a significantly higher prevalence rate than females (18.5%). The prevalence of malaria was significantly lower among pupils using preventive measures; 5.9% among pupils using mosquito bed net as against 21.2% among those not using bed nets and 4.6% for pupils living in screened houses as against 24.1% for those not living in screened houses. CONCLUSION: The study revealed that malaria is a major public health problem among pupils in a Nigerian local community. Prevalence rates among pupils varied among location of schools, age and gender. Preventive measures favoured the use of bed nets and living in screened houses.

ANTECEDENTES: Las infecciones por Plasmodium entre escolares de Igbo-Eze del Gobierno Local Sur del Estado de Enugu, Nigeria, fueron objeto de estudio entre julio y diciembre del 2005. Se investigó la relación entre la aplicación de medidas de control de la malaria y la prevalencia de infecciones por Plasmodium. MÉTODOS: Se obtuvieron frotis sanguíneos de 1296 escolares (4-15 años de edad) de seis escuelas, escogidas de manera aleatoria en el área de estudio. Se le dio medicamentos a los niños infectados. Se administraron encuestas epidemiológicas a los niños. RESULTADOS: De 1296 escolares examinados, 270 (20.8%) estaban infectados por Plasmodium falciparum. La prevalencia de estas infecciones parasitarias varió significativamente (p < 0.05) entre las escuelas, teniendo la Escuela Central, Ovoko (30.1% P falciparum) y la escuela primaria de la comunidad, Itchi (13.9%), las tasas de prevalencia más altas y más bajas respectivamente. Además, la prevalencia de infecciones por P falciparum también varió significativamente (p < 0.05) entre los grupos etarios, teniendo los grupos de edades 4-6 (35.1%) y 10-12 (14.2%) las tasas de prevalencia más alta y más baja respectivamente. Los varones (23.1%) tuvieron una tasa de prevalencia significativamente más alta que las hembras (18.5%). La prevalencia de malaria fue significativamente más baja entre alumnos que aplicaron medidas preventivas: 5.9% entre alumnos que usaban mosquitero, frente al 21.2% entre aquéllos que no usaban mosquiteros y 4.6% para alumnos que vivían en casas protegidas con malla metálica en las ventanas, frente al 24.1% para aquéllos que no vivían en casas protegidas con malla metálica. CONCLUSIÓN: El estudio reveló que la malaria es uno de los mayores problemas de salud pública entre los alumnos en una comunidad local Nigeriana. Las tasas de prevalencia entre los alumnos varió con el lugar, la edad y el género. Las medidas preventivas favorecieron el uso de mosquiteros en los dormitorios y mallas metálicas en las casas.

Eradication of transfusion-induced malaria by in vitro processing

To determine the lethal dose of chloroquine to be added to donors' blood in vitro for eradication of transfusion-induced malaria and to study the unfavorable effects of this dose on the constituents of the stored blood. A total of 4484 blood donors, recruited for this study, were screened for malaria parasites microscopically using Giemsa' staining technique. Only 30 blood samples [200ml of blood each] satisfied the inclusion criteria of the study. Each of these blood samples was subdivided equally into four sub-samples to obtain 120 sub-samples. Three different concentrations of chloroquine were added to 90 specimens [30 samples represent each dose] while 30 specimens [control] were left without the drug. Blood specimens were then tested by parasitic, hematological and biochemical techniques on the day of collection and after 24 and 48 hours storage in blood bank refrigerator. The numbers of malaria parasites killed were proportional to chloroquine doses added to donors' blood. No parasites were killed among the control donors' blood samples. The determined lethal dose of chloroquine was safe to all constituents of the stored blood. For eradication of transfusion induced malaria by in vitro processing of donors blood, chloroquine is effective and safe drug. We recommend application of the optimal dose of chloroquine [626.1micro g/L] to the components of the blood bags prior to phlebotomy

A new challenge for malaria control in Brazil: asymptomatic Plasmodium infection - a review

The evolution of malaria in Brazil, its morbidity, the malaria control programs, and the new challenges for these programs in the light of the emergence of asymptomatic infection in the Amazon region of Brazil were reviewed. At least six Brazilian research groups have demonstrated that asymptomatic infection by Plasmodium is an important impediment to malaria control, among mineral prospectors in Mato Grosso and riverside communities in Rondônia and, in our group, in the middle and upper reaches of the Negro river, in the state of Amazonas. Likewise, other researchers have studied the problem among indigenous communities in the Colombian, Peruvian, and Venezuelan parts of the Amazon basin, adjacent to Brazil. The frequency of positive results from the polymerase chain reaction (PCR) among asymptomatic individuals has ranged from 20.4 to 49.5 percent, and the presence of Plasmodium in the thick blood smears, from 4.2 to 38.5 percent. Infection with Anopheles darlingi has also been demonstrated by xenodiagnosis among asymptomatic patients with positive PCR results. If a mean of 25 percent is taken for the asymptomatic infection caused by Plasmodium sp. in the Amazon region of Brazil, malaria control will be difficult to achieve in that region with the measures currently utilized for such control.

The efficacy of different mosquito trapping methods in a forest-fringe village, Yunnan Province, Southern China.

Despite a control program, malaria incidence in Yunnan has increased and knowledge of vector bionomics is needed for efficient control. Multi-drug resistant Plasmodium falciparum necessitates alternatives to human landing catches as a means of studying vectors. Therefore CDC light traps with UV or ordinary incandescent bulbs were tested for 57 trap nights. 2,703 mosquitos were caught, including the vector species An. minimus and An. sinensis and the suspected vector An. maculatus. Larval An. dirus were found around the village but no adults were trapped. UV light traps caught more mosquitos than the traps with incandescent bulbs, but caught many insects other than mosquitos requiring time-consuming separation, and were unpopular with villagers. Traps placed in living areas of houses caught more mosquitos than those placed beside bednets and the catch mainly comprised species that were active in the early evening. Encephalitis Vector Surveillance (EVS) traps hung outdoors and baited with CO2 caught few mosquitos. CDC traps in the same position baited with CO2 or lactic acid caught large numbers of Culex tritaeniorhynchus. Indoor spray catches recovered human fed An. vagus and An. minimus. This work confirmed that CDC light traps could be used to trap local vectors, and the abundance of early active mosquitos in the living area suggests that personal protection measures may be required in the evening, to supplement bed net use.