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      Missed Plasmodium falciparum and Plasmodium vivax Mixed Infections in Ethiopia Threaten Malaria Elimination

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          ABSTRACT.

          Plasmodium falciparum and Plasmodium vivax are co-endemic in Ethiopia. This study investigated whether mixed infections were missed by microscopy from a 2017 therapeutic efficacy study at two health facilities in Ethiopia. All patients ( N = 304) were initially classified as having single-species P. falciparum ( n = 148 samples) or P. vivax infections ( n = 156). Dried blood spots were tested for Plasmodium antigens by bead-based multiplex assay for pan- Plasmodium aldolase, pan- Plasmodium lactate dehydrogenase, P. vivax lactate dehydrogenase, and histidine-rich protein 2. Of 304 blood samples, 13 (4.3%) contained both P. falciparum and P. vivax antigens and were analyzed by polymerase chain reaction for species-specific DNA. Of these 13 samples, five were confirmed by polymerase chain reaction for P. falciparum/ P. vivax co-infection. One sample, initially classified as P. vivax by microscopy, was found to only have Plasmodium ovale DNA. Plasmodium falciparum/P. vivax mixed infections can be missed by microscopy even in the context of a therapeutic efficacy study with multiple trained readers.

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          Rapid diagnostic tests for malaria parasites.

          Anthony Moody (2002)
          Malaria presents a diagnostic challenge to laboratories in most countries. Endemic malaria, population movements, and travelers all contribute to presenting the laboratory with diagnostic problems for which it may have little expertise available. Drug resistance and genetic variation has altered many accepted morphological appearances of malaria species, and new technology has given an opportunity to review available procedures. Concurrently the World Health Organization has opened a dialogue with scientists, clinicians, and manufacturers on the realistic possibilities for developing accurate, sensitive, and cost-effective rapid diagnostic tests for malaria, capable of detecting 100 parasites/microl from all species and with a semiquantitative measurement for monitoring successful drug treatment. New technology has to be compared with an accepted "gold standard" that makes comparisons of sensitivity and specificity between different methods. The majority of malaria is found in countries where cost-effectiveness is an important factor and ease of performance and training is a major consideration. Most new technology for malaria diagnosis incorporates immunochromatographic capture procedures, with conjugated monoclonal antibodies providing the indicator of infection. Preferred targeted antigens are those which are abundant in all asexual and sexual stages of the parasite and are currently centered on detection of HRP-2 from Plasmodium falciparum and parasite-specific lactate dehydrogenase or Plasmodium aldolase from the parasite glycolytic pathway found in all species. Clinical studies allow effective comparisons between different formats, and the reality of nonmicroscopic diagnoses of malaria is considered.
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            Mixed-species malaria infections in humans.

            Mayfong Mayxay, Sasithon Pukrittayakamee, Paul N. Newton … (2004)
            Article 0 comments Cited 111 times – based on 0 reviews     Review now
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              A social network analysis on immigrants and refugees access to services in the malaria elimination context

              Ensiyeh Jamshidi, Hassan Eftekhar Ardebili, Reza Yousefi-Nooraie … (2019)
              Background There has been significant progress in eliminating malaria in Iran. The aim of this study is to investigate the structure of inter-organizational collaboration networks in the field of unauthorized immigrants and refugees access to services in order to eliminate malaria. Methods This study employed social network analysis, in which nodes represented stakeholders associated with providing access of immigrants and refugees to services in the field of malaria elimination, and ties indicated the level of collaboration. This study adopted socio-centric analysis and the whole network was studied. In this regard, 12 districts of the malaria-endemic area in Iran were selected. Participants included 360 individuals (30 representatives of the organization/group in each district). The data were gathered by interview, using the levels of collaboration scale. UCINET 6 was used for data analysis. The indices of density, centralization, reciprocity, and clustering were investigated for each twelve network and at each level of collaboration. Results The average density of the networks was 0.22 (SD: 0.04). In districts with a high incidence of imported malaria, the values of network density and centralization were high and the networks comprised of a larger connected component (less isolated clusters). There were significant correlations between density of network (r = 0.66, P = 0.02), degree centralization (r = 0.65, P = 0.02), betweenness centralization (r = 0.76, P = 0.004), and imported malaria cases. In general, the degree centrality and betweenness centrality of the organizations of health, district governor, and foreign immigrants’ affairs were higher. In all networks, 60% of the relationships were bilateral. At a higher level of collaboration, the centralization declined and reciprocity increased. The average of betweenness centralization index was 22.76 (SD = 3.88). Conclusions Higher values of network indices in border districts and districts with more cases of imported malaria, in terms of density and centralization measures, can propose the hypothesis that higher preparedness against the issue and centralization of power can enable a better top-down outbreak management, which needs further investigations. Higher centrality of governmental organizations indicates the need for involving private, non-governmental organizations and representatives of immigrant and refugee groups. Recognition of the existing network structure can help the authorities increase access to malaria prevention, diagnosis, and treatment services among immigrants and refugees. Electronic supplementary material The online version of this article (10.1186/s12936-018-2635-4) contains supplementary material, which is available to authorized users.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Am J Trop Med Hyg
                Journal ID (iso-abbrev): Am J Trop Med Hyg
                Journal ID (publisher-id): tpmd
                Journal ID (hwp): tropmed
                Title: The American Journal of Tropical Medicine and Hygiene
                Publisher: The American Society of Tropical Medicine and Hygiene
                ISSN (Print): 0002-9637
                ISSN (Electronic): 1476-1645
                Publication date (Print): February 2022
                Publication date (Electronic): 30 November 2021
                Publication date PMC-release: 30 November 2021
                Volume: 106
                Issue: 2
                Pages: 667-670
                Affiliations
                [ 1 ]Malaria Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia;
                [ 2 ]Ethiopia Public Health Institute, Addis Ababa, Ethiopia;
                [ 3 ]ICAP at Columbia University, Addis Ababa, Ethiopia;
                [ 4 ]U.S. President’s Malaria Initiative, Malaria Branch, Centers for Disease Control and Prevention, Atlanta, Georgia;
                [ 5 ]U.S. President’s Malaria Initiative, USAID, Addis Ababa, Ethiopia;
                [ 6 ]Infectious Disease Ecology and Epidemiology Lab, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
                Author notes
                [* ]Address correspondence to Eric Rogier, Centers for Disease Control and Prevention, Division of Parasitic Diseases and Malaria, 1600 Clifton Rd., Atlanta, GA 30329. E-mail: erogier@ 123456cdc.gov

                Financial support: This research was supported in part by an appointment to the Research Participation Program at the Centers for Disease Control and Prevention administered by the Oak Ridge Institute for Science and Education. Financial support for this study was provided by the U.S. President’s Malaria Initiative (PMI) and the Global Fund through the Ministry of Health, WHO, and PMI Ethiopia offices.

                Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention or the U.S. Agency for International Development.

                Authors’ addresses: Colleen M. Leonard, Jessica N. McCaffery, Doug Nace, and Eric Rogier, Malaria Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA, E-mails: cleonard@ 123456cdc.gov , oda3@ 123456cdc.gov , ddn4@ 123456cdc.gov , and erogier@ 123456cdc.gov . Hussein Mohammed, Ethiopia Public Health Institute, Addis Ababa, Ethiopia, E-mail: hussein_ehnri@ 123456yahoo.com . Mekonnen Tadesse, ICAP at Columbia University, Addis Ababa, Ethiopia, E-mail: mt2758@ 123456cumc.columbia.edu . Eric S. Halsey and Jimee Hwang, Malaria Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA, and U.S. President’s Malaria Initiative, Malaria Branch, Centers for Disease Control and Prevention, Atlanta, GA, E-mails: ycw8@ 123456cdc.gov and gdq1@ 123456cdc.gov . Samuel Girma, U.S. President’s Malaria Initiative, USAID, Addis Ababa, Ethiopia, E-mail: sagirma@ 123456usaid.gov . Ashenafi Assefa, Ethiopia Public Health Institute, Addis Ababa, Ethiopia, and Infectious Disease Ecology and Epidemiology Lab, University of North Carolina at Chapel Hill, Chapel Hill, NC, E-mail: ashyaega@ 123456yahoo.com .

                Article
                Publisher ID: tpmd210796
                DOI: 10.4269/ajtmh.21-0796
                PMC ID: 8832938
                PubMed ID: 34847530
                SO-VID: 53cd0a1b-ad7a-4871-b265-d9418ea62f2d
                Copyright © © 2022 by The American Society of Tropical Medicine and Hygiene
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution (CC-BY) License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                Date received : 15 July 2021
                Date accepted : 12 October 2021
                Page count
                Pages: 4
                Categories
                Subject: Short Report

                ScienceOpen disciplines: Infectious disease & Microbiology
                Data availability:
                ScienceOpen disciplines: Infectious disease & Microbiology

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