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Epidemiological and Clinical Features of Plasmodium falciparum Malaria in United Nations Personnel in Western Bahr el Ghazal State, South Sudan  [PDF]
Dengming He, Yuqi Zhang, Xiaofeng Liu, Shimin Guo, Donghong Zhao, Yunjie Zhu, Huaidong Li, Li Kong
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0055220
Abstract: Western Bahr el Ghazal State is located in northwestern South Sudan, which is a tropical area subject to Plasmodium falciparum malaria epidemics. The aim of this study is to explore the epidemiological and clinical features of Plasmodium falciparum malaria in United Nations personnel stationed in this area. From July 2006 to June 2009, epidemiological data and medical records of 678 patients with Plasmodium falciparum malaria at the U.N. level 2 hospital were analyzed. The U.N. personnel were divided into individuals not immune to Plasmodium falciparum and individuals semi-immune to Plasmodium falciparum. The patients were divided into a chemoprophylaxis group (non-immune individuals who complied with the chemoprophylaxis regimen, 582 cases) and a no/incomplete chemoprophylaxis group (non-immune individuals who either did not fully comply with chemoprophylaxis or did not use it at all and semi-immune individuals who did not use chemoprophylaxis, 96 cases). Overall morbidity was about 11.3%. There was a significant difference in the morbidity of semi-immune and non-immune individuals (1.3% vs. 15.1%, P<0.001). Out of the total, 82.9% of cases occurred during the rainy season. The incidence of fever in the chemoprophylaxis group was significantly lower than in the no/incomplete chemoprophylaxis group (36.8% vs. 96.9%, P<0.001). Significant differences were observed between the two groups with respect to all other malaria-like symptoms except gastrointestinal symptoms, serum glucose level, platelet count, and alanine aminotransferase level. The incidence of complications was 1.2% (chemoprophylaxis group) and 44.8% (no/incomplete chemoprophylaxis group).The most common complication was thrombocytopenia, which was seen in 40.6% of the no/incomplete chemoprophylaxis group. In summary, Plasmodium falciparum malaria mainly occurred in rainy season. Gastrointestinal symptoms are an important precursor of malaria. Blood smears and rapid diagnostic tests should be performed after the onset of gastrointestinal symptoms. Appropriate chemoprophylaxis is necessary for reducing the severity of malaria.
Plasmodium vivax malaria presenting with severe thrombocytopenia
Makkar, Ravinder Pal Singh;Monga, Surabhi Mukhopadhyay Amitabh;Gupta, Ajay Kr.;
Brazilian Journal of Infectious Diseases , 2002, DOI: 10.1590/S1413-86702002000500008
Abstract: plasmodium falciparum and plasmodium vivax malaria are endemic infections in india and are commonly associated with mild hematological abnormalities. severe thrombocytopenia is common in isolated falciparum and mixed falciparum/vivax malaria, but is very rare in isolated p.vivax infection. we hereby report a case of severe thrombocytopenia (platelet count of 8x109/l) in a case of vivax malaria. this is only the second case ever reported in the literature of such profound thrombocytopenia in a case of isolated p.vivax malaria.
Plasmodium vivax malaria presenting with severe thrombocytopenia  [cached]
Makkar Ravinder Pal Singh,Monga Surabhi Mukhopadhyay Amitabh,Gupta Ajay Kr.
Brazilian Journal of Infectious Diseases , 2002,
Abstract: Plasmodium falciparum and Plasmodium vivax malaria are endemic infections in India and are commonly associated with mild hematological abnormalities. Severe thrombocytopenia is common in isolated falciparum and mixed falciparum/vivax malaria, but is very rare in isolated P.vivax infection. We hereby report a case of severe thrombocytopenia (platelet count of 8x10(9)/L) in a case of vivax malaria. This is only the second case ever reported in the literature of such profound thrombocytopenia in a case of isolated P.vivax malaria.
Identifying Residual Foci of Plasmodium falciparum Infections for Malaria Elimination: The Urban Context of Khartoum, Sudan  [PDF]
Amal B. Nourein,Mohammed A. Abass,Abdel Hameed D. Nugud,Ibrahim El Hassan,Robert W. Snow,Abdisalan M. Noor
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0016948
Abstract: Identifying the location and size of residual foci of infections is critical where malaria elimination is the primary goal. Here the spatial heterogeneity of Plasmodium falciparum infections within the urban extent of Khartoum state in Sudan is investigated using data from cross-sectional surveys undertaken from 1999 to 2008 to inform the Khartoum Malaria Free Initiative (KMFI).
Prevalence and risk factors for Plasmodium falciparum malaria in pregnant women of eastern Sudan
Ishag Adam, Amar H Khamis, Mustafa I Elbashir
Malaria Journal , 2005, DOI: 10.1186/1475-2875-4-18
Abstract: The prevalence and possible risk factors for Plasmodium falciparum malaria were investigated in 744 pregnant Sudanese women attending the antenatal clinic of New Haifa Teaching Hospital, eastern Sudan, during October 2003-April 2004.A total 102 (13.7%) had P. falciparum malaria, 18(17.6%) of these were severe cases (jaundice and severe anaemia). Univariate and multivariate analysis showed that, age and parity were not associated with malaria. Women who attended the antenatal clinic in the third trimester were at highest risk for malaria (OR = 1.58, 95% CI = 1.02–2.4; P < 0.05).Women with malaria had significantly lower mean haemoglobin (9.4 g/dl, 95% CI 9.1–9.7 versus 10.7, CI 10.6–10.8, P < 0.05). A significantly lower haemoglobin was observed in those with severe falciparum malaria compared to non-severe form (8.3 g/dl, 95% CI 7.6–9.1 versus 9.4, 95% CI 9.1–9.7, P = < 0.05).The results suggest that P. falciparum malaria is common in pregnant women attending antenatal care and that anaemia is an important complication. Preventive measures (chemoprophylaxis and insecticide-treated bednets) may be beneficial in this area for all women irrespective of age or parity.Pregnant women are more susceptible to malaria, which causes serious adverse effects including abortion, low birth weight and maternal anaemia. It is the leading cause maternal mortality in Sudan [1-7].The presentation of malaria during pregnancy varies according to the pre-existing immunity of the mother. Women living in areas of low transmission have little immunity to malaria which can cause severe syndromes, such as cerebral malaria and pulmonary oedema. In contrast, those who live in areas of stable malaria transmission enjoy greater immunity and experience fewer symptoms during episodes of malaria, although they commonly develop severe anaemia as consequence of the infection [1,2,5,8,9].Understanding the epidemiology of malaria during pregnancy provides important insight into relevant immunological pr
Artesunate plus sulfadoxine-pyrimethamine for treatment of uncomplicated Plasmodium falciparum malaria in Sudan
Sakina B Elamin, Elfatih M Malik, Tarig Abdelgadir, Ammar H Khamiss, Mamoun M Mohammed, Elderderi S Ahmed, Ishag Adam
Malaria Journal , 2005, DOI: 10.1186/1475-2875-4-41
Abstract: During late 2004, the efficacy of artesunate (4 mg/kg. day, on days 0–2) plus sulfadoxine-pyrimethamine (25 mg/kg, on day 0) for the treatment of uncomplicated Plasmodium falciparum malaria was investigated in four sentinel areas in Sudan, with different malaria transmission (Damazin, Kassala, Kosti, and Malakal).Two hundreds and sixty-nine patients completed the 28-day follow-up. On day one, 60 (22.3%) patients were febrile and 15 (5.5%) patients were parasitaemic. On day three, all the patients were afebrile and aparasitaemic. While two patients (0.7%, Kassala) showed late Clinical and Parasitological Failures, the rest (99.3%) of the patients demonstrated Adequate Clinical and Parasitological Response. A gametocytaemia were detected during the follow-up in one patient (0.37%, Kassala). Adverse drug effects were detected in 32 (11.9%) patientsThe study showed that AS plus SP is an effective, safe drug in the treatment of uncomplicated P. falciparum malaria in Sudan.There are almost 515 (range 300–660) million episodes of clinical Plasmodium falciparum malaria infections [1]. Drug-resistant malaria is spreading in Africa and countries with high levels of resistance have witnessed increased morbidity and mortality [2]. Early diagnosis and effective treatment with an appropriate drug form the main components of the World Health Organization's strategy to reduce malaria-related mortality [3].The few available drugs might be safeguarded if combined with artesunate. The addition of artesunate to standard antimalarial treatments substantially reduces treatment failure, recrudescence and gametocyte carriage, preventing the emergence and spread of drug resistance and interrupting the transmission of P. falciparum. Coupled with early detection and confirmed diagnosis, this strategy represents the only way forward in the chemotherapy of malaria [4-8].Malaria causes between 7.5 to 10 million cases and 35,000 deaths every year in Sudan [9]. Due to the spread of multidrug-resis
Monocytes and macrophages and placental malaria infections in an area of unstable malaria transmission in eastern Sudan
Magdi M Salih, Amal H Mohammed, Ahmed A Mohmmed, Gamal K Adam, Mustafa I Elbashir, Ishag Adam
Diagnostic Pathology , 2011, DOI: 10.1186/1746-1596-6-83
Abstract: Ninety three placentae were investigated for malaria histological changes and immunohistochemical study for monocytes and macrophages (CD68).While 1(1.1%), 2(2.2%) and 20(21.5%) of the 93 placentae had acute, chronic and past malaria infections, 70(75.2%) had no malaria infections. Monocytes and macrophage (CD 68) were detected in 29 (31.2%) of these 93 placentae. Significantly higher rate of monocytes and macrophage were detected in placentae with malaria infections [11/23 (47.8%) vs. 18/70 (25.7%); P = 0.047] especially in placentae with past malaria infections. Placental malaria infections and monocytes and macrophages cells infiltration were not different between primiparae and multiparae. There was no significant difference in the birth weight between the women with placental malaria infections/monocytes and macrophages cells infiltration and those who had no placental malaria infections/cellular infiltrations.Significantly higher rate of monocytes and macrophage were detected in placentae with malaria infections. Neither placental malaria infections nor cellular infiltrates were associated with parity or lead to reduction of birth weight.Malaria during pregnancy is a major public health problem in tropical and subtropical regions; each year 25 million African women become pregnant in malaria endemic areas [1]. Pregnant women are more susceptible to malaria than their non-pregnant counterparts [2]. Malaria infections are associated with poor maternal and fetal outcomes [3,4]. Malaria during pregnancy is a huge burden in Sudan [3,5] and it is one of the leading causes of maternal mortality [6].During pregnancy, adhesion of Plasmodium falciparum-infected erythrocytes to syncytiotrophoblast leads to parasite sequestration in the intervillous space. The parasite adheres specifically to chondroitin sulfate-A expressed on syncytiotrophoblast [7]. The increased susceptibility of pregnant women to malaria was thought to result from pregnancy-related immunomodulation an
Efficacy of two artemisinin combination therapies for uncomplicated falciparum malaria in children under 5 years, Malakal, Upper Nile, Sudan
Ingrid van den Broek, Ribka Amsalu, Manica Balasegaram, Pamela Hepple, Engudaye Alemu, El Badri Hussein, Muhammed Al-Faith, Jacqui Montgomery, Francesco Checchi
Malaria Journal , 2005, DOI: 10.1186/1475-2875-4-14
Abstract: Clinical trial to assess the efficacy of 2 antimalarial therapies to treat P. falciparum infections in children aged 6–59 months, in a period of 42 days after treatment.A total of 269 children were followed up to 42 days. Artesunate plus Sulfadoxine/Pyrimethamine (AS+SP) and Artesunate plus Amodiaquine (AS+AQ) were both found to be efficacious in curing malaria infections by rapid elimination of parasites and clearance of fever, in preventing recrudescence and suppressing gametocytaemia. The combination of AS+SP appeared slightly more efficacious than AS+AQ, with 4.4% (4/116) versus 15% (17/113) of patients returning with malaria during the 6-week period after treatment (RR = 0.9, 95% CI 0.81–0.96). PCR analysis identified only one recrudescence which, together with one other early treatment failure, gave efficacy rates of 99.0% for AS+AQ (96/97) and 99.1% for AS+SP (112/113). However, PCR results were incomplete and assuming part of the indeterminate samples were recrudescent infections leads to an estimated efficacy ranging 97–98% for AS+SP and 88–95% for AS+AQ.These results lead to the recommendation of ACT, and specifically AS+SP, for the treatment of uncomplicated falciparum malaria in this area of Sudan. When implemented, ACT efficacy should be monitored in sentinel sites representing different areas of the country.The health situation in Sudan continues to be affected by long-lasting conflict and related humanitarian emergencies such as food crises and epidemics. Malaria is one of the major causes of morbidity and mortality. In Sudan, an estimated 7.5 million patients suffer from malaria each year and 35,000 die from this disease, which accounts for up to 20% of hospital deaths [1]. The problem appears to have worsened in recent years due to increasing levels of Plasmodium falciparum resistance against the two most commonly used antimalarials: chloroquine (CQ) and sulfadoxine/pyrimethamine (SP). CQ resistance in the northern and central part of the Sudan is n
A fixed-dose 24-hour regimen of artesunate plus sulfamethoxypyrazine-pyrimethamine for the treatment of uncomplicated Plasmodium falciparum malaria in eastern Sudan
Ishag Adam, Mamoun Magzoub, Maha E Osman, Insaf F Khalil, Michael Alifrangis, Khalid A Elmardi
Annals of Clinical Microbiology and Antimicrobials , 2006, DOI: 10.1186/1476-0711-5-18
Abstract: the efficacy of fixed co-formulated (f) artesunate-sulfamethoxypyrazine-pyrimethamine (AS+SMP f) administered at time intervals of 12 hours for a 24-hour therapy was compared with the efficacy of the same drug given as a loose combination (AS+SMP l) with a dose interval of 24 hours for 3 days for the treatment of uncomplicated Plasmodium falciparum malaria in eastern Sudan.seventy-three patients (39 and 34 in the fixed and the loose regimen of AS+SMP respectively) completed the 28-days of follow-up. On day 3; all patients in both groups were a parasitaemic but one patient in the fixed group of AS+SMP f was still febrile.Polymerase chain reaction genotyping adjusted cure rates on day 28 were 92.3% and 97.1% (P > 0.05) for the fixed and loose combination of AS+SMP respectively.Three (4.1%) patients (one in the fixed and two patients in the loose group of AS+SMP) in the study suffered drug-related adverse effects.Gametocytaemia was not detected during follow-up in any of the patients.both regimens of AS+SMP were effective and safe for the treatment of uncomplicated P. falciparum malaria in eastern Sudan. Due to its simplicity, the fixed dose one-day treatment regimen may improve compliance and therefore may be the preferred choice.There are almost 515 million episodes of clinical Plasmodium falciparum malaria infections [1]. Malaria treatment and control have been undermined by emergence and spread of drug-resistant malaria worldwide hereby increasing morbidity and mortality. World Health Organization's strategies to reduce malaria-related mortality depend on early diagnosis and effective treatment with an appropriate drug and now artemisinin-based combination therapies (ACTs) are recommended [2,3]. Malaria causes up to 7.5 – 10 million cases and 35000 deaths every year in Sudan [4]. Due to the spread of multi-drug resistant Plasmodium falciparum malaria in Sudan [5], artesunate plus sulfadoxine-pyrimethamine (AS+SP) is at this moment the recommended first-line treatme
Polymerase chain reaction and histology in diagnosis of placental malaria in an area of unstable malaria transmission in Central Sudan
Haggar M Elbashir, Magdi M Salih, Elhassan M Elhassan, Ahmed A Mohmmed, Mustafa I Elbashir, Ishag Adam
Diagnostic Pathology , 2011, DOI: 10.1186/1746-1596-6-128
Abstract: A cross sectional study was conducted at Medani Hospital, which serves catchment area which is characterized by unstable malaria transmission. One hundred and seven placentae were investigated for malaria infection using polymerase chain reaction (PCR) and histology.out of 107 investigated placentae, 33 (30.8%) and 34 (31.8%) were positive for malaria by histology (two (2%) and 31(29.0%) were acute and past infections, respectively) and PCR, respectively. Out of 33 positive by histology, 15 were positive by the PCR while 18 were negative. The sensitivity of the PCR was 45.5% (95% CI: 29.2%- 62.5%). Out of 74 which were negative by histology, 19 were positive by the PCR. This is translated in specificity of 74.3% (95% CI: 63.5%- 83.3%). Of those tested positive by the PCR, 15 were positive by the histology, while 19 were negative. This is translated into a positive predictive value of 44.1% (95% CI: 28.3%- 61.0%). Of those 73 tested negative by the PCR, 55 were negative according to histology while 23 were positive. This is translated into a negative predictive value of 75.3% (95% CI: 64.5%-84.2%).PCR had low sensitivity and specificity in comparison to placental histology, perhaps because the vast majority of the placental infections were past infections. Further research is needed.Malaria during pregnancy is a major public health problem in tropical and subtropical regions of the world [1]. It has been estimated that, of 85.3 million pregnancies in areas with Plasmodium falciparum transmission, 54.7 million occurred in areas with stable transmission and 30.6 million in areas with unstable transmission [2]. In Sudan, malaria during pregnancy is a major health problem where pregnant women are more susceptible to malaria regardless to their age or parity [3-5]. Malaria has serious adverse effects on pregnancy and it is a leading cause of maternal and perinatal mortality in Sudan [6-8].During pregnancy, adhesion of P. falciparum-infected erythrocytes to syncytiotrophob
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