RESUMO
The identification and management of low parasitemia infections have become increasingly challenging for malaria control and elimination. Submicroscopic Plasmodium infections and G6PD deficiency among febrile patients require more sensitive diagnostic methods to improve detection and careful treatment regime of these infections. In Ethiopia, information on the low density submicroscopic malarial infections and frequency of G6PD deficiency (G6PDd) is scarce. In this study, 297 malaria suspected febrile patient samples were collected from health facilities of Bonga town in southwestern Ethiopia. The positivity rates of Plasmodium infection were determined by microscopy and quantitative PCR. G6PD activity level was determined by careSTART™ G6PD biosensor and the frequency of three common variants: G6PD*A (A376G), G6PD*A- (G202A) and Mediterranean (C563T) were investigated. G6PD gene sequencing was performed to detect mutations in exons 2-11 for both G6PD normal and deficient samples based on the phenotypic assay. More than twice Plasmodium infected samples was detected by qPCR (52/297; 17.4%) than microscopy (21/297; 7.0%). About 31 (10%) of the infections were submicroscopic. Bednet usage and age had a significant association with Plasmodium infection. Of the 271 participants who were tested for G6PD phenotype, 19 (7.0%) had low G6PD level. No mutations were observed in A376G, G202A, and C563T in the G6PDd samples, but three novel non-synonymous mutations in exon 2 including a C to T transition at position ChrX:6504 (Arg to Thr), G to T at ChrX:6369 (Ser to IIe), and G to C at ChrX:6664 (Gln to His) were detected. A high number of submicroscopic Plasmodium infections observed in this study pose a challenge for accurate and timely diagnosis, which could hinder malaria control efforts. G6PD deficiency in malaria patients pose danger when treating patients with primaquine. The three novel mutations detected in exon 2 of the G6PD gene merit further investigation on the hemolytic risk when exposed to oxidative antimalarials, their prevalence, and clinical significance.
RESUMO
BACKGROUND: Tuberculosis is an infectious airborne disease caused by Mycobacterium tuberculosis. It still remains a major public health problem which affects all age groups. Risk of exposure is higher in household contact than members of the general population. OBJECTIVE: The aim of this study was to assess the prevalence and associated factors of tuberculosis among adult household contacts of smear positive pulmonary tuberculosis in Haramaya district, Oromia Region, Eastern Ethiopia from February to March, 2019. METHOD: A community based cross-sectional study design was conducted. A total of 454 study participants were selected using systematic sampling method from all adult household contacts of smear positive pulmonary tuberculosis patients treated from July 2017 to December 2018. Data were collected using a pretested and structured questionnaire; and laboratory examination was processed using fluorescent smear microscope. Logistic regression analysis was used to identify the factors associated with the infection of pulmonary tuberculosis and a statistically significant association was declared at P-value < 0.05. RESULT: The overall prevalence of pulmonary tuberculosis among adult household contacts was 7.8% (95% CI: 5.8-10.0). The risk factors for tuberculosis infection among household contacts were eating meals less than three times per day (AOR = 4.31; 95% CI: 1.61, 11.55), drinking raw milk (AOR = 4.12; 95% CI: 1.43, 11.90), having family history of tuberculosis with more than one index case (AOR = 2.7; 95% CI: 1.02, 6.92), living in poor ventilated houses (AOR = 4.02; 95% CI: 1.38, 11.76), and living in inadequate size of living room (AOR = 3.4; 95% CI: 1.30, 8.86). CONCLUSION: In this study, the prevalence of tuberculosis among adult household contacts of smear positive pulmonary tuberculosis is high. Eating meals less than three times per day, drinking raw milk, living in poor ventilated houses, and inadequate sizes of the rooms were identified as contributing factors. Therefore, we recommend that the transmission of tuberculosis can potentially be reduced by a better contact tracing and treatment strategies along with appropriate health education.
