An automated malaria cells detection from thin blood smear images using deep learning

@#Timely and rapid diagnosis is crucial for faster and proper malaria treatment planning. Microscopic examination is the gold standard for malaria diagnosis, where hundreds of millions of blood films are examined annually. However, this method’s effectiveness depends on the trained microscopist’s skills. With the increasing interest in applying deep learning in malaria diagnosis, this study aims to determine the most suitable deep-learning object detection architecture and their applicability to detect and distinguish red blood cells as either malaria-infected or non-infected cells. The object detectors Yolov4, Faster R-CNN, and SSD 300 are trained with images infected by all five malaria parasites and from four stages of infection with 80/20 train and test data partition. The performance of object detectors is evaluated, and hyperparameters are optimized to select the best-performing model. The best-performing model was also assessed with an independent dataset to verify the models’ ability to generalize in different domains. The results show that upon training, the Yolov4 model achieves a precision of 83%, recall of 95%, F1-score of 89%, and mean average precision of 93.87% at a threshold of 0.5. Conclusively, Yolov4 can act as an alternative in detecting the infected cells from whole thin blood smear images. Object detectors can complement a deep learning classification model in detecting infected cells since they eliminate the need to train on single-cell images and have been demonstrated to be more feasible for a different target domain.

Investigation of possible rickettsial infection in patients with malaria

@#Rickettsioses are a common health problem in many geographical areas, including rural areas in Southeast Asia. Co-infection of rickettsioses and malaria has been reported in Africa, where common reservoir and vectors are available. In this study, blood samples of Malaysian patients microscopically positive (n=148) and negative (n=88) for malaria parasites (Plasmodium knowlesi, Plasmodium malariae, Plasmodium falciparum, and Plasmodium vivax) were screened for the presence of rickettsial DNA, using PCR assays targeting specific genes. A partial fragment of rickettsial ompB gene was successfully amplified and sequenced from a patient microscopically positive for Plasmodium spp. and PCR-positive for P. vivax. BLAST analysis of the ompB sequence demonstrated the highest sequence similarity (99.7% similarity, 408/409nt) with Rickettsia sp. RF2125 (Genbank accession no. JX183538) and 91.4% (374/409 nt) similarity with Rickettsia felis URRWXCal2 (Genbank accession no. CP000053). This study reports rickettsial infection in a malaria patient for the first time in the Southeast Asia region.

Genetic diversity of Merozoite Surface Protein-1 gene block 2 allelic types in Plasmodium falciparum isolates from Malaysia and Thailand

@#Malaria is the most common vector-borne parasitic disease in Malaysia and Thailand, especially in Malayan Borneo and along the Thailand border areas, but little is known about the genetic diversity of the parasite. Present study aims to investigate the genetic diversity of Plasmodium falciparum isolates in these two countries and eventually contributes to more effective malaria control strategies, particularly in vaccine and antimalarial treatment. One hundred and seventy three P. falciparum isolates were collected from Malaysia (n = 67) and Thailand (n = 106) and genotyped using nested PCR targeting the polymorphic region of MSP-1, block 2. Sequence analysis was conducted to investigate the allele diversity of the isolates. Three allelic families were identified in Malaysian and Thailand P. falciparum isolates, MAD20, K1 and RO33. Sequence analysis revealed that there were 5 different MAD20, 1 K1 and 2 different RO33 for Malaysian isolates. Thailand isolates exhibited greater polymorphism because there were 13 different MAD20, 6 different K1 and 2 different RO33 identified in this study. Multiclonal infections were observed for the isolates in both countries, however, low multiplicity of infection (MOI) was observed for Malaysian (1.1) and Thailand (1.2) isolates. Phylogenetic analysis showed that P. falciparum isolates of Malaysia and Thailand were clustered in the same group for all the allelic families. Population structure of P. falciparum isolates in Malaysia and Thailand exhibit extensive genetic polymorphism but showed high similarities as well as comparable MOI.

Histopathology of Brugia pahangi and Plasmodium berghei ANKA co-infection in the Gerbil (Meriones unguiculatus)

@#Co-infection with multiple different parasites is a common phenomenon in both human and animals. Among parasites that frequently co-infect the same hosts, are the filarial worms and malaria parasites. Despite this, the mechanisms underlying the interactions between these parasites is still relatively unexplored with very few studies available on the resulting pathologies due to co-infection by filarial nematodes and malaria parasites. Hence, this study investigated the histopathological effect of Brugia pahangi and Plasmodium berghei ANKA (PbA) infections in gerbil host. Gerbils grouped into B. pahangi-infected, PbA-infected, B. pahangi and PbA-coinfected, and uninfected control, were necropsied at different time points of post PbA infections. Brugia pahangi infections in the gerbils were first initiated by subcutaneous inoculation of 50 infective larvae, while PbA infections were done by intraperitoneal injection of 106 parasitized red blood cells after 70 days patent period of B. pahangi. Organs such as the lungs, kidneys, spleen, heart and liver were harvested aseptically at the point of necropsy. There was significant hepatosplenomegaly observed in both PbA-infected only and coinfected gerbils. The spleen, liver and lungs were heavily pigmented. Both B. pahangi and PbA infections (mono and coinfections) resulted in pulmonary edema, while glomerulonephritis was associated with PbA infections. The presence of both parasites induced extramedullary hematopoiesis in the spleen and liver. These findings suggest that the pathologies associated with coinfected gerbils were synergistically induced by both B. pahangi and PbA infections.

Low efficacy of delthamethrin-treated net against Singapore Aedes aegypti is associated with kdr-type resistance

There has been a worldwide surge in the number and severity of dengue in the past decades. In Singapore, relentless vector control efforts have been put in to control the disease since the 1960’s. Space spraying, fogging, chemical treatment and source reduction are some commonly used methodologies for controlling its vectors, particularly Aedes aegypti. Here, as we explored the use of a commercially available delthamethrin-treated net as an alternative strategy and the efficacy of the treated net was found to be limited. Through bioassays and molecular studies, the failure of the treated net to render high mortality rate was found to be associated with the knockdown resistance (kdr) mutation. This is the first report of kdr- mutations in Singapore’s Ae. aegypti. At least one point mutation, either homozygous or heterozygous, at amino acid residue V1016G of DIIS6 or F1269C of DIIIS6 was detected in 93% of field strains of Ae. aegypti. Various permutations of wild type and mutant amino acids of the four alleles were found to result in varying degree of survival rate among local field Ae. aegypti when exposed to the deltamethrin treated net. Together with the association of higher survival rate with the presence of both V1016G and F1269C, the data suggest the role of these mutations in the resistance to the deltamethrin. The high prevalence of these mutations were confirmed in a country wide survey where 70% and 72% of the 201 Ae. aegypti analysed possessed the mutations at residues 1016 and 1269 respectively. The highest mutated frequency combination was found to be heterozygous alleles (VG/FC) at both residues 1016 and 1269 (37.8%), followed by homozygous mutation at allele 1269 (24.4%) and homozygous mutation at allele 1016 (22.9%). The kdr- type of resistance among the vector is likely to undermine the effectiveness of pyrethroids treated materials against these mosquitoes.

Endemic malaria in four villages in Attapeu Province, Lao PDR.

A study was conducted in four villages in Attapeu Province, Lao PDR in 2002 to determine malaria endemicity. The study villages were Mixay, Beng Phoukham, Phou Vong and Pier Geo. Mass blood surveys were conducted in May, August, and October. Finger prick blood was collected for thick and thin blood film as well as for dipstick. The slide positivity rate was highest in Phou Hom in October (41.7%). Plasmodium falciparum was the dominant species comprising more than 80% of the cases. As a whole, the distribution of malaria was similar among males and females. Children below 15 years accounted for a large percentage of the cases. The sensitivity of the optimal dipstick was 62.36 and the specificity was 61.7. Microscopy was taken as the gold standard. Anopheles dirus was found to be the main vector and the vectorial capacity correlated well with the cases.

Malaria transmission by Anopheles dirus in Attapeu Province, Lao PDR.

A study was carried out in four malaria-endemic villages in Attapeu Province, in the southern region of Lao PDR. All-night human landing collections were carried out in May, August, and October 2002, to determine malaria vectors. At the same time, mass blood surveys were also carried out in the same villages. Anopheles dirus was the predominant species in three of the study villages. Sporozoites were found only in An. drius from Phou Hom. However, in Beng Phoukham, An. dirus was positive for oocysts. The distribution of malaria cases was highest in Phou Hom and this correlated well with the vectorial capacity of An. dirus. The risk for infection from An. dirus was also high, at 0.99.

Preliminary studies of Anopheles mosquitos in eight provinces in Lao PDR.

Malaria vector surveys were carried out in 8 provinces in Lao PDR in 1999. The surveys were conducted in 4 provinces - Savannakhet, Champasak, Luang Perbang and Sayaboury in May and in another 4 provinces - Bolikhamsay, Sarvan, Sekong and Vientiane in December 1999. Bare leg collection were carried out indoors and outdoors from 6 pm to 5 am. All anopheline mosquitos were identified, dissected and the gut, gland and ovaries were examined. A total of 438 Anopheles mosquitos belonging to 19 species were obtained. Of these only 3 species were found to be infected with oocysts - An. maculatus, An. dirus and An. minimus. All these species were found biting both indoors and outdoors. An. aconitus was the predominant species obtained in the December collection but its vectorial status remains unknown.

A highly sensitive, nested polymerase chain reaction based method using simple dna extraction to detect malaria sporozoites in mosquitos.

Dried Anopheles farauti mosquitos caught in Solomon Islands in 1990 were examined for malaria sporozoites by ELISA and nested polymerase chain reaction (PCR). Only heads and thoraces were used. Plasmodium genus-specific nested PCR amplifications were carried out on all samples. Of the 402 pools of mosquitos that were processed, 30 were positive for malaria. Nest 1 products of positive samples were subjected to further PCR amplifications with species-specific primers for P. falciparum and P. vivax. Twenty pools were positive for P. vivax by PCR while only 7 were positive by ELISA. For P. falciparum 2 pools were positive by both ELISA and PCR, and one of these was a pool which was positive for P. vivax by PCR and ELISA. Thus the sensitivity of PCR for P. vivax was 100% while the specificity was 96.7%. For P. falciparum the sensitivity and specificity were 100%. The PCR technique is highly sensitive and can be used on dried mosquitos which makes it a valuable tool for determining sporozoite rates of mosquitos, even in remote areas.

Laboratory evaluation of lambda-cyhalothrin a microencapsulated formulation on mosquito nets for control of vector mosquitos.

Two formulations of lambda-cyhalothrin (EC-Emulsion concentrate and MC-Microencapsulated) were impregnated into bednets made of polyethylene and polyester. The nets were treated at a dosage of 15 mg/m2. For bioassay of insecticidal efficacy, female Anopheles maculatus and Aedes aegypti were exposed to the nets for two minutes and mortality was scored 24 hours later. The nets were also tested after repeated washings with water and with soap and water. Microencapsulated (2.5CS) formulation was more effective than emulsion concentrate (2.5EC) formulation on both net materials--polyethylene and polyester. Repeated washing with water and soap reduces the efficacy of all bednet treatment combinations. Microencapsulated formulation on polyethylene gave best results; it could sustain up to five washes with water and two with soap and water.

Cockroaches from urban human dwellings: isolation of bacterial pathogens and control.

A study was carried out to determine the distribution of cockroaches in two different housing areas with central sewerage or individual septic tanks in an urban area in Kuala Lumpur, Malaysia. Six species of cockroaches were present and of these Periplaneta americana and Periplaneta brunnea were found in greater abundance. Seventeen species of bacteria were isolated and of these Escherichia coli and Klebsiella p. pneumoniae were isolated in greatest numbers. Control measures carried out using lambda cyhalothrin showed that there was no significant difference between treated and control sites.

Anopheles donaldi incriminated as a vector of periodic Brugia malayi in Grik, Perak, Malaysia.

Studies were carried out to observe the species composition of mosquitos and to determine the vectors responsible for the transmission of filariasis in Grik, Perak, Malaysia. A total of 2,155 mosquitos belonging to 7 genera and 30 species were collected. Anopheles donaldi comprised 24.1% of the collection. Twelve out of 519 An. donaldi were infected with L3 larvae of Brugia malayi. The peak biting time was around 23.00-24.00 hours. The infective bites per month ranged from 0 to 6.3.

The impact of permethrin impregnated bednets on the malaria vector Anopheles maculatus (Diptera: Culicidae) in aboriginal villages of Pos Betau Pahang, Malaysia.

The effect of permethrin impregnated bednets on Anopheles maculatus Theobald was studied in four villages in Pos Betau, Pahang, Malaysia from August 1990 to July 1992. Collections of mosquitos were carried out indoors and outdoors from 1900 to 0700 hours. All mosquitos were dissected for sporozoites and parity. In May 1991 two villages received bednets impregnated with permethrin at 0.5 g/m2 and two villages received placebo bednets. There was a significant difference in the sporozoite and parous rates between the treated and control villages after the distribution of bednets (p < 0.05). There was no significant difference in the bites/man/night of An. maculatus between the pre and post treatment periods in the control villages. However there was a significant difference in bites/man/night between pre and post treatment in the treated villages (p < 0.001).

Comparative susceptibility of Periplaneta americana (L) to five pyrethroid insecticides.

Five pyrethroids namely, lambda-cyhalothrin, permethrin, deltamethrin, cyfluthrin and alpha-cypermethrin were evaluated using adult male and female cockroaches, Periplaneta americana (L). The American cockroaches were exposed for 10 minutes to glass jars treated with different concentrations of the five pyrethroids. The cockroaches were susceptible to all five pyrethroids and the susceptibility based on LC50 and LC50 were observed to be in the following order: lambda-cyhalothrin > permethrin > deltamethrin > cyfluthrin > alpha-cypermethrin The results showed that lambda-cyhalothrin was the most effective and alpha-cypermethrin was the least effective against Periplaneta americana (L).

Studies on adult mosquito vectors of Japanese encephalitis in a pig farm in Selangor, Malaysia.

Mosquito collections were carried out for a period of one year from January to December 1992 in a pig farm in Sungai Pelek, Selangor, Malaysia. A total of 41,022 mosquitos belonging to 52 species and 20 genera were collected. Culex tritaeniorhynchus and Cx. gelidus, the important vectors, comprised 63% of all mosquitos collected. Both these species were collected in large numbers during the wet months of May and December. The other predominant species in that area were Cx. fuscocephala, Cx. quinquefasciatus, Cx. sitiens, Aedes butleri, and Armigeres subalbatus.

Residual activity of cyhalothrin 20% EC on cattle as determined by mosquito bioassays.

The residual effectiveness of 0.005mg/ml of cyhalothrin applied to cattle was determined against three species of mosquitos: Anopheles maculatus Theobald. Anopheles dirus Peyton and Harrison Mansonia uniformis Theobald. Twenty-four hour post exposure mortality and the degree of successful blood engorgement were determined by exposing mosquitos for 10 minutes to cattle. Three replicated assays were conducted and mortality determined at 1, 2, 7, 14 and 21 days after each treatment. An initial mortality of 92-94% for An. dirus and Ma. uniformis and 79% for An. maculatus was obtained. Percentage mortality declined to 10%, 18% and 31% for An. maculatus, An. dirus and Ma. uniformis respectively on day 7 post application. On day 21 post application, percentage mortality was 2-3% for the three species of mosquitos.

Studies on the effect of lambdacyhalothrin on Anopheles maculatus Theobald and its response to residual spraying at Jeram Kedah, Negeri Sembilan, Malaysia.

A field trial was carried out to study the effect of lambdacyhalothrin on Anopheles maculatus in trap huts in Jeram Kedah, Negeri Sembilan, Malaysia. Two trap huts were built, of which one was sprayed with lambdacyhalothrin at a dosage of 25 mg ai/m2 and the other served as control. Eight collectors commenced collecting mosquitos from 1900 to 2400 hours, two each indoors and outdoors. Bioassay was also carried out in the treated and control huts to determine susceptibility of adult mosquitos to lambdacyhalothrin. In the treated hut more mosquitos were present during the pre- spraying period. Lambdacyhalothrin gave a mortality of 100% against An. maculatus for 8 months.

Evaluation of carbon dioxide and 1-octen-3-ol as mosquito attractants.

CDC Light traps were used to study the attractant effect of CO2 and 1-octen-3-ol on trap catches of mosquito populations at three different locations in Malaysia. There was a significant increase in the number of mosquitos caught in traps baited with CO2 and CO2 with 1-octen-3-ol. The number of mosquitos caught in the CDC light trap and in the CDC light trap baited with 1-octen-3-ol alone were very few. 1-octen-3-ol and CO2 acted synergistically in attracting significantly greater numbers of Culex tritaeniorhynchus. However Anopheles sp. were not very attracted to light traps even with attractants added to them.

Adulticidal effect of cyfluthrin against mosquitos of public health importance in Malaysia.

The efficacy of two formulations, wettable powder and emulsifiable concentrate, of cyfluthrin sprayed on plywood [10 mg (ai)/m2] was assessed against six species of mosquitos. The bioassay followed the WHO standard method, with some modification for the bioassay of insecticidal deposits on wall surfaces. The results indicated that these two formulations of cyfluthrin were effective against Anopheles dirus and Mansonia uniformis, moderately toxic to Aedes aegypti and Ae. albopictus in decreasing mortality through out the study period. It was least effective against Culex quinquefasciatus and An. maculatus, respectively. There was no statistically significant difference between these two formulations.