Estimation of parasitaemia in imported falciparum malaria using the results of a combined rapid diagnostic test. No big help from haematological parameters.

BACKGROUND: Microscopy continues to be the mainstay for the evaluation of parasitaemia in malaria but requires laboratory support and microbiological experience. Other fast and simple methods are necessary. METHODS: A retrospective observational study of imported malaria treated from July-2007 to December-2020 was carried out to evaluate the association between the degree of parasitaemia and both rapid diagnostic tests (RDT) reactivity patterns and haematological parameters. Plasmodium falciparum monoinfections diagnosed by peripheral blood smear and/or polymerase chain reaction (PCR),which also had a positive RDT result in the same blood sample, were included in the study. RESULTS: A total of 273 patients were included. Most of them were male (n = 256; 93.8%) and visiting friends and relatives (VFR) travellers (n = 252; 92.3%). Patients with plasmodial lactate dehydrogenase (pLDH) or aldolase and histidine-rich protein 2 (HRP-2) co-reactivity (Pan/Pf pattern) had a parasitaemia range between 0 and 37% while those with just HRP-2 reactivity (P. falciparum pattern) had ranges between 0 and 1%. Not a single case of P. falciparum pattern was found for parasitaemia ranges greater than 1%, showing a negative predictive value of 100% for high parasitaemia. All the correlations between haematological parameters and parasitaemia resulted to be weak, with a maximum rho coefficient of -0.35 for lymphocytes and platelets, and of 0.40 for neutrophils-to-lymphocytes count ratio. Multivariate predictive models were constructed reflecting a poor predictive capacity. CONCLUSIONS: The reactivity pattern of RDT allows a rapid semi-quantitative assessment of P. falciparum parasitaemia in travellers with imported malaria, discriminating patients with lower parasite loads. Haematological parameters were not able to estimate parasitaemia with sufficient precision.

Migration-associated malaria from Africa in southern Spain.

BACKGROUND: The western area of the province of Almeria, sited in southern Spain, has one of the highest immigrant population rates in Spain, mainly dedicated to agricultural work. In recent years, there has been a significant increase in the number of cases of imported malaria associated with migrants from countries belonging to sub-Saharan Africa. The objective of our study is to describe the epidemiological, clinical and analytical characteristics of malaria patients treated in a specialized tropical unit, paying special attention to the differences between VFR and non-VFR migrants and also to the peculiarities of microscopic malaria cases compared to submicroscopic ones. METHODS: Retrospective observational study of migrants over 14 years of age with imported malaria treated from October 2004 to May 2019. Characteristics of VFR and non-VFR migrants were compared. Malaria cases were divided into microscopic malaria (MM) and submicroscopic malaria (SMM). SMM was defined as the presence of a positive malaria PCR test together with a negative direct microscopic examination and a negative rapid diagnostic test (RDT). Microscopic malaria was defined as the presence of a positive RDT and/or a positive smear examination. RESULTS: Three hundred thirty-six cases of malaria were diagnosed, 329 in sub-Saharan immigrants. Of these, 78.1% were VFR migrants, in whom MM predominated (85.2% of cases). In non-VFR migrants, SMM represented 72.2% of the cases. Overall, 239 (72.6%) patients presented MM and 90 (27.4%) SMM. Fever was the most frequent clinical manifestation (64.4%), mainly in the MM group (MM: 81.1% vs SMM: 20.0%; p < 0.01). The most frequent species was P. falciparum. Patients with SMM presented fewer cytopenias and a greater number of coinfections due to soil-transmitted helminths, filarial and intestinal protozoa compared to patients with MM. CONCLUSIONS: Imported malaria in our area is closely related to sub-Saharan migration. VFR migrants are the main risk group, highlighting the need for actions aimed at improving disease prevention measures. On the other hand, almost a third of the cases are due to SMM. This fact could justify its systematic screening, at least for those travelers at greater risk.

Diagnóstico de doble heterocigosis hemoglobina O-Arab y alfa-talasemia tras detección de variante de hemoglobina inusualmente baja / Diagnosis of a double heterozygous Hb O-Arab and alpha-thalassaemia after the detection of an unusually low haemoglobin variantc

Las hemoglobinopatías constituyen los trastornos monogénicos más frecuentes, sobre todo en determinadas razas y áreas, por su efecto protector frente a la malaria. Los cambios migratorios están provocando un aumento de estas alteraciones en el mundo occidental. La cromatografía líquida de alta resolución (HPLC) es el método de elección actual para la detección de hemoglobinopatías estructurales y cuantificación de hemoglobina A2 y fetal. Describimos un caso clínico donde se identificó una doble heterocigosis Hb O-Arab y α-talasemia tras detección de microcitosis y una variante anómala de hemoglobina de menor valor del esperado, destacando la idoneidad del estudio multidisciplinar de este tipo de enfermedades (AU)

Haemoglobinopathies are the most frequent monogenic disorders, particularly in certain races and areas, because of their protective effect against malaria. Migratory changes are leading to an increase in these conditions in the western world. High Performance Liquid Chromotography (HPLC) is nowadays a method of choice in detecting structural haemoglobinopathies and in the quantification of foetal and haemoglobin (Hb) A2. A clinical case is described in which a double heterozygous Hb O-Arab and α-thalassaemia was identified following the detection of microcytosis and an anomalous haemoglobin variant, which was lower than expected - highlighting the appropriateness of a multidisciplinary study for these types of pathologies (AU)

[Typification and screening of irregular antibodies. Establishing its use at a urology department]. / Tipificación y detección de anticuerpos irregulares (type and screen). Implantación de su uso en una unidad de urología.

OBJECTIVES: To achieve a better use of the packed red blood cells stock at our centre's blood bank, and to analyse cost-savings associated with the implementation of the type and screen (T/S) technology. METHODS: We analyse the results, complications and cost-savings achieved with the use of T/S at the Urology Department in our centre, for the transurethral resection of bladder tumour and prostate. RESULTS: A total of 232 T/S were performed; 3 patients required blood transfusions (1.3%). No complications appeared. Total cost-savings from December 1999 to December 2001 were 7.620 Euros (1,267,861.3 pesetas). CONCLUSIONS: T/S is a safe procedure allowing a better use of blood stocks in a hospital with a substantial economic saving.

Tipificación y detección de anticuerpos irregulares (Type and Screen). Implantación de su uso en una unidad de urología / Blood typing and screening of irregular antibodies. Implementation of its use in an Urology department

OBJETIVOS: Conseguir una mejor utilización del stock de hematíes del Depósito de Sangre de nuestro centro y analizar el ahorro conseguido con la implantación de la metodología de Type and Screen (T/S).MÉTODOS: Analizamos los resultados de la utilización de T/S en la Unidad de Urología de nuestro centro en los procedimientos de resección transuretral de vejiga y próstata, las complicaciones presentadas y el ahorro conseguido. RESULTADOS: Se realizaron un total de 232 T/S, hubo que transfundir a 3 pacientes (1,3 per cent). No se presentó ninguna complicación. El ahorro conseguido fue de 7.620 E (1.267.861,3 pesetas) desde diciembre de 1999 a diciembre del 2001.CONCLUSIONES: El T/S es un procedimiento seguro que permite una mejor utilización de los depósitos de sangre de un hospital con un ahorro económico considerable (AU)