Late relapse of imported Plasmodium ovale malaria: a case report

We report the first case of an imported Plasmodium ovale relapse in a Tunisian man who developed malaria three years after leaving sub- Saharan Africa. A 29-year-old Tunisian man consulted in September 2011 because of a fever, myalgia, and headache that had begun eight days earlier and persisted despite treatment with oral antibiotics. On questioning, the patient stated that he had resided three years ago for six months in Ivory Coast, where he acquired malaria. He was treated with artemether-lumefantrine. The patient said he had no recent travel to any other malaria-endemic area and had not received a blood transfusion. A first microscopy of peripheral blood smears was negative for malaria parasites. The diagnosis was established 17 days after onset of symptoms. A repeat microscopic examination of blood smears confirmed the presence of Plasmodium ovale with a parasitemia lower than 0.1%. The patient was treated with artemether-lumefantrine, followed by primaquine. This case emphasizes the possibility of relapse of some plasmodial species. It highlights the importance of repeating microscopic examination of blood when the diagnosis of malaria is suspected

[Evolution of the prevalence of intestinal parasitosis in the region of Tunis from 1996 at 2012]

Background: The prevalence of intestinal parasitosis is very different according to countries. Therefore, it is always interesting to update the data in Tunisia to better direct control measures

Aim: The objectives of this survey were to estimate the prevalence of intestinal parasitosis in the region of Tunis, to study their evolution and to establish various combinations of intestinal protozoa

Methods: This is a retrospective study carried out over a period of 17 years from 1996 at 2012 and which involved 20033 individuals. Each subject had one or more stool examination which included a direct microscopic examination and a concentration by modified Ritchie technique

Results: The prevalence of intestinal parasitosis was 12.55%. Entamoeba histolytica/dispar and Giardia intestinalis accounted respectively a prevalence of 0.51% and 1.48%. Hymenolepis nana was the most predominant helminth with a prevalence rate of 0.53%, followed by Enterobius vermicularis [0.21%]. Two cases of Hookworms and seven cases of Strongyloides stercoralis were diagnosed. Polyparasitism concerned 16.59% of infected individuals. Significant combinations occured mainly for amoeba in particular Entamoeba histolytica/dispar and Entamoeba coli [r=0.232]

Conclusion: Our study confirms the decrease of the prevalence of giardiasis and amebiasis, whereas helminthiases with direct transmission remain frequent

[Contribution of polymerase chain reaction for detection of malaria in Tunisia]

Background: In Tunisia, detection of Plasmodium in asymptomatic individuals from endemic countries is a critical measure in national program of malaria eradication. The screening is based on microscopic examination of thick and thin blood smears. However, the performance of this diagnosis is closely related to the experience of biologist and the parasitaemia

Aim: The objective of this study was to evaluate the contribution of the PCR in the screening of malaria

Methods: This prospective study involved 260 students from malaria endemic areas who were screened for malaria between september 2011 and june 2013. Each subject had a blood sample which was examined for malaria by microscopy and nested multiplex PCR

Results: PCR detected the presence of Plasmodium in 13 blood samples [5%]. While microscopy was positive only in nine cases [3.5%]. The discordances involved five negative samples at microscopy and which were positive in PCR and a negative sample in PCR which was positive at microscopy. A mixed infection with Plasmodium falciparum and Plasmodium malariae was identified by PCR. For this case, microscopy diagnosed only Plasmodium falciparum specie

Conclusion: PCR is more efficient than microscopy in detecting low parasitaemia ; particularly observed in asymptomatic subjects. This technique allows to reduce asymptomatic carriage of Plasmodium and reduce the risk of a resumption of transmission of malaria in our country

Difficulty in dating primary infections by Toxoplasma Gondii in pregnant women in Tunisia

In Tunisia, serological diagnosis of toxoplasmosis in pregnant women is generally ordered on the first prenatal consultation. As primary tools, IgG and IgM tests are done. Subsequent serological testing is performed to date infection in case of IgM positivity. IgG avidity measurement was done in 156 sera with IgM. The kit [Toxo Avidite] from SFRI was used. This commercial assay permits to rule out an infection acquired in the last 12 months in case of avidity index [AI]>0.6 and to suspect a recent infection acquired in the last 3 months in case of AI<0.3. 57.1% of pregnant women had an AI>0.6; 17.9% an AI<0.3 and 25% an intermediate AI. The high and middle IgG titles were frequently associated with an AI>0.6 whereas low titles were generally associated with an AI<0.6 [p<0.01] and particularly an IA<0.3. If an AI>0.6 is an indicator against primary infection during pregnancy and an AI<0.3 permits to order amniotic sampling for PCR, intermediate avidity dols not permit to conclude mainly because a great proportion of pregnant women do not lave their first prenatal consultation befoe the second trimester of pregnancy. In these cases search for IgA and follow up samples can be useful. To facilitate serological interpretation, the antibody status of pregnant women should be obtained in Tunisia, before or early in pregnancy.