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Background: Falciparum malaria is a common disease in our area. Apart from its classical presentation, at times it may present with refractory anemia or pancytopenia. The aim of this study was to determine the refractory anemia and pancytopenia as complications of falciparum malaria and apart from peripheral blood smears the significance of rapid antigen tests and bone marrow examination in the diagnosis of falciparum malaria. Material & Methods: The descriptive study included 200 consecutive cases of fever and refractory anemia or pancytopenia from 2011 to 2014. Stratification of patients according to the clinical scenario included Group-A having fever with refractory anemia and Group-B with fever and pancytopenia. A detailed history, thorough clinical examination, and pertinent laboratory tests were performed. All patients were treated with antimalarial drugs and followed-up for eight weeks. The pre and post treatment hematologic parameters were compared. Results: Among the 200 patients, 85 were males and 115 females. The age ranged from 15 to 55 years. Stratification of patients on clinical scenario revealed 175(87.5%) patients with fever and refractory anemia (Group-A). Among these, 125(62.5%) patients were reported smear positive for P. falciparum. In the remaining 50 smear negative patients rapid antigen tests were performed and all were reported positive. In 25 patients of Group B with fever and pancytopenia, the peripheral smear for malaria was positive only in 5 patients. In the remaining 20 cases both the peripheral blood smears and rapid antigen tests were reported negative. Bone marrow examination was planned to confirm the bone marrow suppression as the cause of peripheral pancytopenia, to exclude leukemia and to identify P. falciparum. The bone marrow examination revealed P. falciparum in all these cases. All the patients had a dramatic response to treatment with antimalarials in terms of disappearance of fever and correction of anemia and bone marrow rescue with reversal of pancytopenia to normal counts. Conclusion: Plasmodium falciparum should be considered in all cases of prolonged fever with refractory anemia or pancytopenia in malaria endemic areas, even with negative smear and rapid antigen tests. Bone examination is mandatory for the diagnosis in such cases. There is dramatic response of such patients to treatment with antimalarial drugs and hematinics.

Abstract Background The development and spread of artemisinin-resistant Plasmodium falciparum malaria in Greater Mekong Subregion has created impetus for continuing global monitoring of efficacy of artemisinin-based combination therapies (ACTs). This post analyses is aimed to evaluate changes in early treatment response markers 10 years after the adoption of ACTs as first-line treatments of uncomplicated falciparum malaria in Nigeria. Methods At 14 sentinel sites in six geographical areas of Nigeria, we evaluated treatment responses in 1341 children under 5 years and in additional 360 children under 16 years with uncomplicated malaria enrolled in randomized trials of artemether-lumefantrine versus artesunate-amodiaquine at 5-year interval in 2009–2010 and 2014–2015 and at 2-year interval in 2009–2010 and 2012–2015, respectively after deployment in 2005. Results Asexual parasite positivity 1 day after treatment initiation (APPD1) rose from 54 to 62% and 2 days after treatment initiation from 5 to 26% in 2009–2010 to 2014–2015 (P = 0.002 and P 75 000 μl− 1, haematocrit > 27% 1 day post-treatment initiation, treatment with artemether-lumefantrine and enrolment in 2014–2015 independently predicted APPD1. In parallel, Kaplan-Meier estimated risk of recurrent infections by day 28 rose from 8 to 14% (P = 0.005) and from 9 to 15% (P = 0.02) with artemether-lumefantrine and artesunate-amodiaquine, respectively. Mean asexual parasitaemia half-life increased significantly from 1.1 h to 1.3 h within 2 years (P

Abstract Background The World Health Organization recommends regular therapeutic efficacy studies (TES) to monitor the performance of first and second-line anti-malarials. In 2016, efficacy and safety of artemether-lumefantrine (AL) for the treatment of uncomplicated falciparum malaria were assessed through a TES conducted between April and October 2016 at four sentinel sites of Kibaha, Mkuzi, Mlimba, and Ujiji in Tanzania. The study also assessed molecular markers of artemisinin and lumefantrine (partner drug) resistance. Methods Eligible patients were enrolled at the four sites, treated with standard doses of AL, and monitored for 28 days with clinical and laboratory assessments. The main outcomes were PCR corrected cure rates, day 3 positivity rates, safety of AL, and prevalence of single nucleotide polymorphisms in Plasmodium falciparum kelch 13 (Pfk13) (codon positions: 440–600) and P. falciparum multi-drug resistance 1 (Pfmdr1) genes (codons: N86Y, Y184F and D1246Y), markers of artemisinin and lumefantrine resistance, respectively. Results Of 344 patients enrolled, three withdrew, six were lost to follow-up; and results were analysed for 335 (97.4%) patients. Two patients had treatment failure (one early treatment failure and one recrudescent infection) after PCR correction, yielding an adequate clinical and parasitological response of > 98%. Day 3 positivity rates ranged from 0 to 5.7%. Common adverse events included cough, abdominal pain, vomiting, and diarrhoea. Two patients had serious adverse events; one died after the first dose of AL and another required hospitalization after the second dose of AL (on day 0) but recovered completely. Of 344 samples collected at enrolment (day 0), 92.7% and 100% were successfully sequenced for Pfk13 and Pfmdr1 genes, respectively. Six (1.9%) had non-synonymous mutations in Pfk13, none of which had been previously associated with artemisinin resistance. For Pfmdr1, the NFD haplotype (codons N86, 184F and D1246) was detected in 134 (39.0%) samples; ranging from 33.0% in Mlimba to 45.5% at Mkuzi. The difference among the four sites was not significant (p = 0.578). All samples had a single copy of the Pfmdr1 gene. Conclusion The study indicated high efficacy of AL and the safety profile was consistent with previous reports. There were no known artemisinin-resistance Pfk13 mutations, but there was a high prevalence of a Pfmdr1 haplotype associated with reduced sensitivity to lumefantrine (but no reduced efficacy was observed in the subjects). Continued TES and monitoring of markers of resistance to artemisinin and partner drugs is critical for early detection of resistant parasites and to inform evidence-based malaria treatment policies. Trial Registration ClinicalTrials.gov NCT03387631

Background: Hematological abnormalities are common features in falciparum malaria but vary among different populations across countries. Therefore, we compared hematological indices and abnormalities between Plasmodium falciparum-infected patients and malaria-negative subjects in Kosti city of the White Nile State, Sudan.Methods: A comparative, cross-sectional study was conducted at the Clinical Laboratory Unit of Kosti Teaching Hospital from June to December 2018. A total of 392 participants (192 P. falciparum-infected patients and 200 malaria-negative subjects) were recruited in the study. Hematological indices of hemoglobin (Hb), red blood cells (RBCs), white blood cells (WBCs) and platelets were measured, and their median values were statistically compared.Results: The majority of P. falciparum-infected patients (67.6%) showed a low-level parasitemia. The median values of Hb concentration, RBC count, mean corpuscular volume (MCV), mean corpuscular Hb (MCH) and mean corpuscular Hb concentration (MCHC) were significantly lower in P. falciparum-infected patients, while the median red cell distribution width (RDW) was significantly higher in the patients compared to malaria-negative subjects. Anemia, low MCV, low MCH, low MCHC and high RDW were significantly associated with falciparum malaria, but parasitemia level was not significantly associated with anemia severity. The median total WBC count was non-significantly higher in P. falciparum-infected patients, with neutropenia being significantly associated with falciparum malaria. The median platelet count was significantly lower in P. falciparum-infected patients, with thrombocytopenia being significantly associated with falciparum malaria.Conclusions: Falciparum malaria among patients in Kosti city of the White Nile State, Sudan is predominantly of low-level parasitemia. It is significantly associated with anemia, low MCV, low MCH, low MCHC, high RDW, thrombocytopenia and neutropenia. However, parasitemia level is not a significant predictor of anemia severity. On the other hand, leucopenia is not useful to predict falciparum malaria. Further large-scale studies in community and healthcare settings and inclusion of patients with complicated or severe malaria and those with high parasite densities are recommended. [ABSTRACT FROM AUTHOR]

Background: Malaria and hypertensive disorders of pregnancy (HDoP) affect millions of pregnancies worldwide, particularly those of young, first-time mothers. Small case-control studies suggest a positive association between falciparum malaria and risk of pre-eclampsia but large prospective analyses are lacking.Methods: We characterized the relationship between malaria in pregnancy and the development of HDoP in a large, prospectively followed cohort. Pregnant women living along the Thailand-Myanmar border, an area of low seasonal malaria transmission, were followed at antenatal clinics between 1986 and 2016. The relationships between falciparum and vivax malaria during pregnancy and the odds of gestational hypertension, pre-eclampsia, or eclampsia were examined using logistic regression amongst all women and then stratified by gravidity.Results: There were 23,262 singleton pregnancies in women who presented during the first trimester and were followed fortnightly. Falciparum malaria was associated with gestational hypertension amongst multigravidae (adjusted odds ratio (AOR) 2.59, 95%CI 1.59-4.23), whereas amongst primigravidae, it was associated with the combined outcome of pre-eclampsia/eclampsia (AOR 2.61, 95%CI 1.01-6.79). In contrast, there was no association between vivax malaria and HDoP.Conclusions: Falciparum but not vivax malaria during pregnancy is associated with hypertensive disorders of pregnancy. [ABSTRACT FROM AUTHOR]

Falciparum malaria is clinically heterogeneous and the relative contribution of parasite and host in shaping disease severity remains unclear. We explored the interaction between inflammation and parasite variant surface antigen (VSA) expression, asking whether this relationship underpins the variation observed in controlled human malaria infection (CHMI). We uncovered marked heterogeneity in the host response to blood challenge; some volunteers remained quiescent, others triggered interferon-stimulated inflammation and some showed transcriptional evidence of myeloid cell suppression. Significantly, only inflammatory volunteers experienced hallmark symptoms of malaria. When we tracked temporal changes in parasite VSA expression to ask whether variants associated with severe disease rapidly expand in naive hosts, we found no transcriptional evidence to support this hypothesis. These data indicate that parasite variants that dominate severe malaria do not have an intrinsic growth or survival advantage; instead, they presumably rely upon infection-induced changes in their within-host environment for selection.

Introduction: Prognostic scoring system in Intensive Care Unit (ICU) can be generic, which can be applied to any critical illness for which patients are admitted in critical wards or can be disease specific. Malaria Severity Score (MSS) is a disease specific prognostic scoring system. Aim: To study the role of MSS in patients having malaria who were critically ill having multi organ dysfunction and to correlate the score with risk of mortality. Materials and Methods: This longitudinal study was conducted at the Department of General Medicine, SBKSMI & RC, Sumandeep Vidyapeeth, Vadodara, Gujarat, India. Adult patients (>18 years) with falciparum as well as vivax malaria, who had positive peripheral smear malaria and were admitted in ICU/Casualty (Emergency) ward, were taken in the study. The score was calculated on day of admission, day 2 and day 7. The score was analysed between two groups: survivors and nonsurvivors. Appropriate statistical tests were applied (z-test for two population proportion and Chi-square test for categorical values). The p-value

Introduction: Prognostic scoring system in Intensive Care Unit (ICU) can be generic, which can be applied to any critical illness for which patients are admitted in critical wards or can be disease specific. Malaria Severity Score (MSS) is a disease specific prognostic scoring system. Aim: To study the role of MSS in patients having malaria who were critically ill having multi organ dysfunction and to correlate the score with risk of mortality. Materials and Methods: This longitudinal study was conducted at the Department of General Medicine, SBKSMI & RC, Sumandeep Vidyapeeth, Vadodara, Gujarat, India. Adult patients (>18 years) with falciparum as well as vivax malaria, who had positive peripheral smear malaria and were admitted in ICU/Casualty (Emergency) ward, were taken in the study. The score was calculated on day of admission, day 2 and day 7. The score was analysed between two groups: survivors and nonsurvivors. Appropriate statistical tests were applied (z-test for two population proportion and Chi-square test for categorical values). The p-value <0.05 was considered as significant. Results: Out of 60 patients, 41 survived and 19 died due to malaria. Mean age of survivors was 38.56±2.27 and of nonsurvivors 40.21±5.6 years (p=0.718). There were 27 patients of P.vivax, 30 of P. falciparum and three patients of mixed infection; mortality was in 09, 08, 02 patients, respectively. On admission, out of total 60 patients, 10 (16.67%) had 1+, 20 (33.33%) had 2+, 24 (40%) had 3+ and 6 (10%) had 4+ parasite count. There were no patients in 1+ parasite count group, two (10%) in 2+, eleven (45.8%) in 3+ and six (100%) in 4+ parasite count group. Mean MSS was not significantly different on day 0 and day 2 but was higher on day 7 in non-survivor group than in survivors group (p=0.005). Mortality prediction score cut-off was ≥9, which was obtained by plotting Receiver Operating Characteristic (ROC) curve. Mean MSS in non-survivor group was 7.37 on day 0, 6.58 on day 2 and 9.11 on day 7. Thus, MSS score of day 7 gave `prediction reaching cut-off value of ≥9. Conclusion: MSS was found to be a useful prognostic score in severe falciparum/vivax malaria who needs intensive care treatment as sequential score gives significant difference in survivors and non-survivors on seventh day. [ABSTRACT FROM AUTHOR]

• Children with severe malaria commonly have a concomitant invasive bacterial infection. • Empirical antibacterial therapy is therefore recommended in these children. • Recent data have challenged the dogma that bacterial co-infection is rare in adults. • It is difficult to confidently exclude bacterial co-infection in adults with malaria. • Empirical antibiotics should also be considered in critically ill adults with malaria. Children with severe falciparum malaria in malaria-endemic regions are predisposed to developing life-threatening bacterial co-infection. International guidelines therefore recommend empirical broad-spectrum antibacterial therapy in these children. Few studies have examined co-infection in adults, although it has been believed to be relatively rare; antibacterial therapy is therefore not routinely recommended in adults with falciparum malaria. However, the fundamental pathophysiology of falciparum malaria in adults and children is the same; it is therefore unclear why adults would not also be predisposed to bacterial infection. Indeed, recent studies have identified bacteraemia in >10% of adults hospitalized with malaria. Some have suggested that these adults probably had bacterial sepsis, with the parasitaemia an incidental finding. However, it is usually impossible in resource-limited settings to determine–at presentation–whether critically ill, parasitaemic adults have severe malaria, bacterial sepsis, or both. Given the significant case-fatality rates of severe malaria and bacterial sepsis, the pragmatic initial approach would be to cover both possibilities. Life-threatening bacterial co-infection may be more common in critically ill adults with malaria than previously believed. While further prospective data are awaited to confirm these findings, it might be more appropriate to provide empirical aantibacterial cover in these patients than current guidelines suggest. [ABSTRACT FROM AUTHOR]

Objective To analyze the epidemiological characteristics of imported malaria in Mianyang during the 2009-2019 period, and we provide scientific basis for the control of imported malaria. Methods The epidemic situation was collected from the infectious disease reporting information system and the epidemiological investigation data of imported malaria during 2009 -2019 in Mianyang . The data were analyzed by descriptive epidemiological. Results A total of 169 imported malaria cases were reported during 2009-2019 in Mianyang, all were laboratory confirmed cases, with an average annual incidence rate of 0.43/100 000. There were 64 cases (37.876%) of vivax malaria,91 cases ( 53.85%) of falciparum malaria, 5 cases (2.96%) of ovale malaria, 1 case (0.59%) of quartan malaria and 8 cases (4.73%) of mixed infections. Imported cases were reported all the year round, June and July had the most cases, with 22 cases each, accounting for 26.04% of the whole year. There were 10 cases (5.92%) imported from other province in China, 38 cases (22.49%) imported from 6 countries in Asia, 121 cases (71.60%) imported from 24 countries in Africa. Imported malaria cases have been reported in 10 counties. The average age of the cases was (38.45±11.74) years. Malaria cases were majorly young men working as peasant and migrant workers. The average time from symptom appearing to being diagnosed was 4.18 d, 39.05% and 56.21% of the patients were diagnosed in municipal and county medical treatment units, respectively. Conclusion The situation of imported malaria from overseas is still serious in Mianyang. It is important to improve the malaria diagnosis and treatment, and strengthen the health education of migrant workers and their families in order to achieve better prevention and control of imported malaria in the area and put an end to secondary cases. [ABSTRACT FROM AUTHOR]

Objective To analyze the epidemiological characteristics of 258 imported malaria cases of Huai' an city, and we provide scientific basis for improving malaria diagnosis and monitoring capacity, preventing secondary transmission of imported malaria, and consolidating the achievements of malaria elimination work. Methods Descriptive analysis was conducted by collecting the epidemiological survey data, basic situation table of epidemic spot, report of epidemic investigation and medical record data related to malaria diagnosis and treatment in hospital in Huai'an city from 2012 to 2019. Results All the types of malaria were detected in Huai'an city, including 203 cases of falciparum malaria, 4 cases of vivax malaria, 39 cases of ovale malaria, 8 cases of quartan malaria and 4 cases of mixed infection. These cases had a wide range of importing countries (22 countries). There were 255 cases from Africa, 2 cases from Oceania,and 1case from Southeast Asia,corresponding to the proportion of 98.83%,0.78% and 0.39% respectively. The number of living days abroad ranged from 15 to 2 990 days, and the number of onset times from 0 to 30. Before the Spring Festival, before the wheat harvest and before the autumn harvest were the three peaks of cases returning to China, accounting for 72.48% (187 / 258). Most of the reported cases are from District Qingjiangpu, which were 109 cases accounting for 42.25%. The young adults aging from 20 to 49 years old account for 83.33% (215 cases). There are 131 cases detected in the group of the migrant workers, accounting for 50.78%. The average time interval from returning home to onset was 9.5 days, and the longest was 634 days. Among them, 93.10% (189 / 203) of patients with falciparum malaria became ill within 30 days. The average interval between onset and diagnosis of patients was 2 days, and 254 cases were diagnosed within 30 days (98.45%). Conclusion Since 2012, all the reported malaria cases were imported. The health education for personnel shuttling between high malaria areas and screening for malaria among returnees should be strengthened. We should improve the ability of malaria diagnosis and treatment of medical institutions above the county level to review blood tablets. These methods can avoid the death cases and the secondary spread of the imported malaria, and consolidate the achievements in the elimination of the malaria. [ABSTRACT FROM AUTHOR]

Objective To analyze the imported malaria epidemic characteristics in Shanglin county, from 2010 to 2019, we provide reference basis for the formulation of prevention and control strategies. Methods The data of imported malaria were collected in Shanglin County, Guangxi, from 2010 to 2019, and descriptive analysis on the epidemical distribution of imported malaria case survey date, species, source of infection, three-dimensional distribution were conducted. Results A total of 2 319 cases of malaria were reported in Shanglin County, Guangxi, from 2010 to 2019, all of which were imported from abroad, with the largest number of cases detected in 2013 (1 052 cases, 45.4%). It included 1 774 cases (76.5%) with falciparum malaria, 112 cases (4.8%) with vivax malaria, 372 cases (16.0%) with ovale malaria, 26 cases (1.1%) with quartan malaria, and 35 cases(1.5%) with mixed infections. Most malaria cases were young men, and 2 286 cases (98.6%) were male, the ratio of males to females was 69:1; while 2 205 cases (95.1%) were at ages of 20 to 55 years. Gold mining was the predominant occupation (2 314 cases, 99.8%), the malaria cases were reported in each month across the year, with the largest number of cases detected in June (608 cases, 26.2%), followed by July (405 cases, 17.5%); The cases were distributed in 11 towns, with the largest number of cases detected in Mingliang town (870 cases, 37.5%), followed by Dafeng town (544 cases, 23.5%), and Xiangxian town (496 cases, 21.4%). The malaria cases were originated from 16 countries in Africa (2 293 cases, 98.9%), 3 countries in Southeast Asia (26 cases, 1.1%). The main species were falciparum malaria (1 766 cases, 77.0%) in Africa, and most malaria cases were from Ghana (1 761 cases, 76.8%); the main species were vivax malaria (14 cases, 53.8%) in Southeast Asia, most malaria cases were from Indonesia (53.8%). Conclusions The situation of prevention and control of imported malaria abroad is very serious in Shanglin county, strengthening the surveillance and management of migrant labors is the key to consolidate the achievements of malaria elimination. [ABSTRACT FROM AUTHOR]

Objective To understand epidemiological characteristics of malaria cases reported in Shanghai, so as to provide scientific evidence for better prevention and control of malaria. Methods The data of malaria reported in Shanghai during 2016-2019 were collected from the Information Management System for Infection Disease Report and Information Management System for Parasitic Disease Control and Prevention, and the clinical manifestation, diagnosis and treatment were collected and statistically analyzed by SPSS22.0. Results Totally 183 malaria cases were reported in Shanghai during 2016- 2019,all of them were laboratory confirmed cases, including 139 P.falciparum cases (76.0%), 23 P.ovale cases (12.6%), 11 P. vivax cases (6.0%), and 10 P. malariae cases (5.5%). All the cases were imported from Africa (n=178, 97.3%) and southeast Asian(n=5, 2.73%). Most of the cases fell into the age range of 30-<40 years (n=59, 32.2%) with a male-to-female ratio of 10.4:1. There were significant differences (P<0.01) in the rate of misdiagnosis and the rate of over 3 days diagnosis between severe malaria (51.6%, 16/31; 38.7%, 12/31) and non-severe malaria (27.0%, 41/152; 13.8%, 21/152). One severe malaria case was finally dead. Conclusions Imported cases were still existed in Shanghai after malaria elimination. Misdiagnosis and delayed diagnosis were the main factors for the occurrence of severe malaria. It is suggested to carry out health education, active screening and skill training of diagnosis and treatment to achieve "early detection, early diagnosis and early treatment", so as to avoid the occurrence of malaria deaths. [ABSTRACT FROM AUTHOR]

Objective To elaborate the epidemic of imported malaria in Jiangsu province from 2015 to 2019, and to prevent the importation and re-transmission of malaria, and we provide information for malaria control and elimination. Methods Data on imported malaria cases in Jiangsu Province from 2015-2019 were collected and sorted through the National Infectious Diseases Information Reporting Management System (IDIRMS) and the Parasitic Diseases Information Reporting Management System (PDIRMS). The incidence and distribution of malaria were described in Jiangsu Province from 2015 to 2019. The distribution of three dimension, diagnostic institutions and diagnostic timeliness of imported malaria cases were described and analyzed. Results From 2015 to 2019, a total of 1 439 cases were reported in Jiangsu Province, of which 1 436 were imported cases, and 3 cases were blood transfusion infection cases. The reported cases were comprised of Plasmodium falciparum (1 075, 74.7%), Plasmodium vivax (63, 4.4%), Plasmodium ovale (233, 16.2%), Plasmodium malariae (65, 4.5%), and mixed infections (3, 0.2%). Imported malaria cases mainly came from Africa(97.5%, 1 400/1 436), Asia (1.9%, 28/1 436), South America and Oceania (0.6%, 8/1 436). The cases were reported from 13 cities in Jiangsu Province. The main imported malaria cases were young men aged 35-<50 years. In January, June and October, more cases were reported than other months. And 83.2% of the cases were diagnosed by medical institutions. The percentage of cases diagnosed by disease control agencies has decreased year by year (P<0.05). The percentage of patients with more than 9 days time interval between onset and diagnosis in 2019 was significantly lower than that in the previous four years (P<0.01). Conclusion Malaria epidemic situation in Jiangsu Province has been stable in recent five years. Most malaria cases are imported from abroad, a small part of malaria cases are infected by blood transfusion. The interval between onset and diagnosis is shorter. Prevention of the retransmisson of imported malaria, improving the efficiency of diagnosis and treatment, and strengthen health education are very important for malaria prevention in Jiangsu Province. [ABSTRACT FROM AUTHOR]

Objective To understand the malaria epidemic characteristics in Hubei Province from 2015 to 2019, so as to provide the evidence for adjusting the strategies in the post-elimination stage. Methods The data from the Disease Reporting Information System of Chinese Center for Disease Control and Prevention were analyzed, with the descriptive epidemiological method for the epidemiological characteristics of malaria in Hubei Province from 2015 to 2019. Results During 2015 to 2019, a total of 645 malaria cases were reported in Hubei Province, all reported cases were imported from overseas, 456 were infected with falciparum malaria (70.7%), 78 with vivax malaria (12.1%), 88 with ovale malaria (13.6%), 20 with quartan malaria (3.1%) and 3 with mixed infection (0.5%). The top 5 cities with highest number of imported malaria cases were Wuhan (222, 34.4%), Yichang (85, 13.2%), Huangshi (60, 9.3%), Huanggang (46, 7.1%), Xiangyang (45, 7.0%). The peak of disease onset mainly occurred in January to February, in July and in November. 84.3% (544/645) of the whole cases were concentrated in 20-<50 age groups. There were 621 male cases and 24 female cases, with a sex ratio of 25.9. 1. The patients first selected diagnosis units were mainly concentrated in medical institutions, 452 (70.1%) cases were diagnosed with malaria at initial doctor visited. 43.9% of the cases were diagnosed as malaria within 24 hours after seeing a doctor. The proportion of cases with a time interval of ≥4 d from initial diagnosis to confirmed showed a decreasing trend. Imported malaria cases were mainly confirmed by prefecture-level medical institutions, accounting for 33.6%. During 2015-2019, all imported malaria cases of Hubei province were came from 39 countries distributed Africa, Asia, Oceania and South America. The imported cases came mainly from Congo-Kinshasa (118), Nigeria (73), Angola (53), Ethiopia (48) and Republic of Congo (39). Conclusions During 2015-2019, the imported malaria cases were reported in Hubei Province every year, therefore the surveillance system of malaria must be continue to work for strengthen the achievement of malaria elimination in Hubei Province. [ABSTRACT FROM AUTHOR]

Objective This paper analyzed 11 cases of severe malaria in Jiangsu Province, summarized the causes of severe malaria, evaluated the effect of diagnosis and treatment, and provided scientific basis for formulating feasible treatment measures of severe malaria. Methods The case information, epidemiological investigation reports and inpatient medical records of 11 severe malaria cases in Jiangsu Province in 2019 were collected from the Infectious Disease Report Information Management System and Parasitic Disease Prevention and Control Information Management System. The onset time, clinical manifestations, diagnosis process and treatment of severe malaria cases were summarized and analyzed. Results Totally 11 cases of severe malaria, including 10 cases of falciparum malaria, and 1 case of ovale malaria, were all imported cases from abroad. The shortest time of living abroad was 22 days, and the longest was 1 070 days. Four cases had malaria while abroad. All of the 10 severe cases of falciparum malaria developed within one month after they returned to China, and three of them became ill on the day they returned home. One severe case of Plasmodium ovale began onset 134 days after returning home. The average time from onset to treatment was 2.5 days, and the average interval time from visit to diagnosis was 1.81 days. There were 3 cases of coma or shock, 3 cases of severe anemia, 4 cases of acute renal failure, and 1 case of acute respiratory distress syndrome. 1 case of Plasmodium ovale had severe anemia due to spontaneous rupture of spleen. Except one case of ovale malaria was treated with dihydroartemisinin piperaquine tablets plus primaquine tablets, the other 10 severe falciparum malaria cases were treated with artesunate injection for antimalarial treatment, and all of them were cured and discharged from hospital after receiving antimalarial treatment. 11 cases of severe cases, the shortest length of stay was 9 days, the longest was 40 days, with an average of 22.64 days; the minimum hospitalization cost was 9 270 yuan, the maximum was 177 174 yuan, with an average of 81 520.76 yuan. Conclusion It is necessary to strengthen multi department cooperation to improve patients' awareness of timely treatment, strengthen the professional knowledge and professional training of medical staff, find and treat imported malaria cases as soon as possible, so as to prevent severe malaria caused by delayed diagnosis. [ABSTRACT FROM AUTHOR]

Abstract Background In acute falciparum malaria, asexual parasite reduction ratio two days post-treatment initiation (PRRD2) ≥ 10 000 per cycle has been used as a measure of the rapid clearance of parasitaemia and efficacy of artemisinin derivatives. However, there is little evaluation of alternative measures; for example, parasite reduction ratio one day after treatment initiation (PRRD1) and its relationship with parasite clearance time (PCT) or PRRD2. This study evaluated the use of PRRD1 as a measure of responsiveness to antimalarial drugs. Methods In acutely malarious children treated with artesunate-amodiaquine (AA), artemether-lumefantrine (AL) or dihydroartemisinin-piperaquine (DHP), the relationships between PRRD1 or PRRD2 and PCT, and between PRRD1 and PRRD2 were evaluated using linear regression. Agreement between estimates of PCT using PRRD1 and PRRD2 linear regression equations was evaluated using the Bland-Altman analysis. Predictors of PRRD1 > 5000 per half cycle and PRRD2 ≥ 10 000 per cycle were evaluated using stepwise multiple logistic regression models. Using the linear regression equation of the relationship between PRRD1 and PCT previously generated in half of the DHP-treated children during the early study phase, PCT estimates were compared in a prospective blinded manner with PCTs determined by microscopy during the later study phase in the remaining half. Results In 919 malarious children, PRRD1 was significantly higher in DHP- and AA-treated compared with AL-treated children (P 15 months, parasitaemia > 10 000/μl and DHP treatment independently predicted PRRD1 > 5000 per half cycle, while age > 30 months, haematocrit ≥31%, body temperature > 37.4 °C, parasitaemia > 100 000/μl, PRRD1 value > 1000 and no gametocytaemia independently predicted PRRD2 ≥ 10 000 per cycle. Using the linear regression equation generated during the early phase in 166 DHP-treated children, PCT estimates and PCTs determined by microscopy in the 155 children in the later phase were similar in the same patients. Conclusions PRRD1 and estimates of PCT using PRRD1 linear regression equation of PRRD1 and PCT can be used in therapeutic efficacy studies. Trial registration Pan African Clinical Trial Registration PACTR201709002064150, 1 March 2017, http://www.pactr.org

Severe malaria is a concerning problem in developing country and is mostly due to Plasmodium Falciparum. Common organs involved are liver, central nervous system, lungs, kidneys, and vasculature. Cardiac involvement is very rare and is mostly underestimated. Cardiac involvement occurs in the form of myocardial dysfunction, arrhythmia, and ventricular systolic dysfunction. This is the rare case of acute pericarditis due to plasmodium falciparum mimicking as inferolateral ST elevation myocardial infarction (STEMI) due to suggestive electrocardiography (ECG) findings.

Background: Anti-malarial drugs play a critical role in reducing malaria morbidity and mortality, but their role is mediated by their effectiveness. Effectiveness is defined as the probability that an anti-malarial drug will successfully treat an individual infected with malaria parasites under routine health care delivery system. Anti-malarial drug effectiveness (AmE) is influenced by drug resistance, drug quality, health system quality, and patient adherence to drug use; its influence on malaria burden varies through space and time. Methods: This study uses data from 232 efficacy trials comprised of 86,776 infected individuals to estimate the artemisinin-based and non-artemisinin-based AmE for treating falciparum malaria between 1991 and 2019. Bayesian spatiotemporal models were fitted and used to predict effectiveness at the pixel-level (5 km × 5 km). The median and interquartile ranges (IQR) of AmE are presented for all malaria-endemic countries. Results: The global effectiveness of artemisinin-based drugs was 67.4% (IQR: 33.3–75.8), 70.1% (43.6–76.0) and 71.8% (46.9–76.4) for the 1991–2000, 2006–2010, and 2016–2019 periods, respectively. Countries in central Africa, a few in South America, and in the Asian region faced the challenge of lower effectiveness of artemisinin-based anti-malarials. However, improvements were seen after 2016, leaving only a few hotspots in Southeast Asia where resistance to artemisinin and partner drugs is currently problematic and in the central Africa where socio-demographic challenges limit effectiveness. The use of artemisinin-based combination therapy (ACT) with a competent partner drug and having multiple ACT as first-line treatment choice sustained high levels of effectiveness. High levels of access to healthcare, human resource capacity, education, and proximity to cities were associated with increased effectiveness. Effectiveness of non-artemisinin-based drugs was much lower than that of artemisinin-based with no improvement over time: 52.3% (17.9–74.9) for 1991–2000 and 55.5% (27.1–73.4) for 2011–2015. Overall, AmE for artemisinin-based and non-artemisinin-based drugs were, respectively, 29.6 and 36% below clinical efficacy as measured in anti-malarial drug trials. Conclusions: This study provides evidence that health system performance, drug quality and patient adherence influence the effectiveness of anti-malarials used in treating uncomplicated falciparum malaria. These results provide guidance to countries' treatment practises and are critical inputs for malaria prevalence and incidence models used to estimate national level malaria burden. [ABSTRACT FROM AUTHOR]

Background: Malaria in pregnancy, including asymptomatic infection, has a detrimental impact on foetal development. Individual patient data (IPD) meta-analysis was conducted to compare the association between antimalarial treatments and adverse pregnancy outcomes, including placental malaria, accompanied with the gestational age at diagnosis of uncomplicated falciparum malaria infection.Methods: A systematic review and one-stage IPD meta-analysis of studies assessing the efficacy of artemisinin-based and quinine-based treatments for patent microscopic uncomplicated falciparum malaria infection (hereinafter uncomplicated falciparum malaria) in pregnancy was conducted. The risks of stillbirth (pregnancy loss at ≥ 28.0 weeks of gestation), moderate to late preterm birth (PTB, live birth between 32.0 and < 37.0 weeks), small for gestational age (SGA, birthweight of < 10th percentile), and placental malaria (defined as deposition of malaria pigment in the placenta with or without parasites) after different treatments of uncomplicated falciparum malaria were assessed by mixed-effects logistic regression, using artemether-lumefantrine, the most used antimalarial, as the reference standard. Registration PROSPERO: CRD42018104013.Results: Of the 22 eligible studies (n = 5015), IPD from16 studies were shared, representing 95.0% (n = 4765) of the women enrolled in literature. Malaria treatment in this pooled analysis mostly occurred in the second (68.4%, 3064/4501) or third trimester (31.6%, 1421/4501), with gestational age confirmed by ultrasound in 91.5% (4120/4503). Quinine (n = 184) and five commonly used artemisinin-based combination therapies (ACTs) were included: artemether-lumefantrine (n = 1087), artesunate-amodiaquine (n = 775), artesunate-mefloquine (n = 965), and dihydroartemisinin-piperaquine (n = 837). The overall pooled proportion of stillbirth was 1.1% (84/4361), PTB 10.0% (619/4131), SGA 32.3% (1007/3707), and placental malaria 80.1% (2543/3035), and there were no significant differences of considered outcomes by ACT. Higher parasitaemia before treatment was associated with a higher risk of SGA (adjusted odds ratio [aOR] 1.14 per 10-fold increase, 95% confidence interval [CI] 1.03 to 1.26, p = 0.009) and deposition of malaria pigment in the placenta (aOR 1.67 per 10-fold increase, 95% CI 1.42 to 1.96, p < 0.001).Conclusions: The risks of stillbirth, PTB, SGA, and placental malaria were not different between the commonly used ACTs. The risk of SGA was high among pregnant women infected with falciparum malaria despite treatment with highly effective drugs. Reduction of malaria-associated adverse birth outcomes requires effective prevention in pregnant women. [ABSTRACT FROM AUTHOR]

Purpose: When considering malaria disease severity, estimation of parasitemia in erythrocytes is important, but sometimes misleading, since the infected erythrocytes may be sequestered in peripheral capillaries. In African children and Asian adults with falciparum malaria, parasitemia as assessed by quantitative PCR (qPCR) in plasma seems to be a valuable indicator of disease severity, but data on African adults as well as the impact of co-infection with HIV is lacking. Methods: In 131 patients with falciparum malaria in a public tertiary teaching hospital in Mozambique, plasma malaria parasitemia as assessed by qPCR, compared to qualitative malaria PCR in blood cell fraction, was related to malaria disease severity and HIV co-infection. Results: Of the 131 patients with falciparum malaria, based on positive qualitative PCR in the blood cell fraction, 93 patients (72%) had positive malaria qPCR in plasma. Patients with severe malaria as defined by the WHO criteria had higher malaria quantitative plasma parasitemia (median 143 genomes/µL) compared to those with uncomplicated malaria (median 55 genomes/µL, p = 0.037) in univariate analysis, but this difference was attenuated after adjusting for age, sex and HIV co-infection (p = 0.055). A quarter of the patients with severe malaria had negative qPCR in plasma. Conclusions: This study of adult African in-patients with falciparum malaria with and without HIV co-infection, neither confirms nor rejects previous studies of malaria qPCR in plasma as an indicator of disease severity in patients with falciparum malaria. There is a need for further and larger studies to clarify if parasitemia as assessed malaria qPCR in plasma could be a surrogate marker of disease severity in falciparum malaria. [ABSTRACT FROM AUTHOR]

Background: The immune response during falciparum malaria mediates both harmful and protective effects on the host; however the participating molecules have not been fully defined. Interleukin (IL)-27 is a pleiotropic cytokine exerting both inflammatory and anti-inflammatory effects, but data on IL-27 in malaria patients are scarce.Methods: Clinical data and blood samples were collected from adults in Mozambique with P. falciparum infection, with (n = 70) and without (n = 61) HIV-1 co-infection, from HIV-infected patients with similar symptoms without malaria (n = 58) and from healthy controls (n = 52). In vitro studies were performed in endothelial cells and PBMC using hemozoin crystals. Samples were analyzed using enzyme immunoassays and quantitative PCR.Results: (i) IL-27 was markedly up-regulated in malaria patients compared with controls and HIV-infected patients without malaria, showing no relation to HIV co-infection. (ii) IL-27 was correlated with P. falciparum parasitemia and von Willebrand factor as a marker of endothelial activation, but not with disease severity. (iii) In vitro, IL-27 modulated the hemozoin-mediated cytokine response in endothelial cells and PBMC with enhancing effects on IL-6 and attenuating effects on IL-8.Conclusion: Our findings show that IL-27 is regulated during falciparum malaria, mediating both inflammatory and anti-inflammatory effects, potentially playing an immune-regulatory role during falciparum malaria. [ABSTRACT FROM AUTHOR]

Objective To analyze the characteristics and causes of 4 malaria death cases. Methods Retrospective analysis was performed for the data of epidemiological survey, laboratory indicators and clinical characteristics in 4 malaria death cases. Results Four malaria patients dead from P. falcipanum were male adults, imported from Africa. The average time from onset to diagnosis as malaria was 8.3 d. The initial clinical symptoms were varied, including atypical toothache, abdominal pain, diarrhea and fatigue. The main abnormal results of laboratory examination were decreased of PLT, RBC, HGB, and eosinophil percentage; increased of TB, IBIL, ALT, AST; decreased of TP, ALB; increased of UN, Cr; increased of blood coagulation index Fib and myocardial enzyme index HBDH, LDH; The density of P. falciparum ring form was high in venous blood, and falciparum gametophytes were present in 2 cases. All 4 patients were misdiagnosed due to initial diagnosis. Two patients did not receive antimalarial treatment before death, one patient received intravenous infusion of artesunate and symptomatic treatment on the day before death and one patient received the day before death. All the 4 patients died of multiple organ failure due to misdiagnosis, missing the best treatment time. Conclusions Early clinical manifestations of P. falcipanum may not be typical, easy to be misdiagnosed and mistreated. When the density of plasmodium in blood is high, timely anti-malarial treatment is given to reduce the density of plasmodium, and symptomatic treatment is used to control complications. It is of significance for preventing deaths from P. falcipanum to improve the awareness of migrant workers on malaria prevention and the awareness and ability of diagnosis and treatment of clinicians. [ABSTRACT FROM AUTHOR]

Abstract Background Pakistan has an estimated annual burden of 1.5 million malaria cases. The current situation calls for an effective malaria control and eradication programme in this country. Currently, primaquine is an attractive option for eliminating reservoirs of Plasmodium vivax hypnozoites and killing gametocytes of Plasmodium falciparum. However, this drug causes haemolysis in individuals who are glucose-6-phosphate (G6PD) deficient. It is important to map G6PD deficiency and malaria distribution in Pakistan to design an effective malaria eradication regimen. Frequency of G6PD deficiency (G6PDd) in malaria patients has not been reported from Pakistan in any meaningful way. The purpose of this study was to evaluate the frequency of G6PD c.563C>T (G6PD Mediterranean) in male individuals with and without falciparum malaria. Methods Two hundred and ten archived DNA samples from males (110 from falciparum malaria patients and 100 from healthy individuals) were utilized in this study. Healthy blood donors were selected based on stringent pre-defined criteria. Patients were confirmed for malaria parasites on microscopy and or immune chromatographic assay detecting P. falciparum histidine-rich protein 2. Parasitaemia was also computed. DNA samples were tested for G6PD c.563C>T mutation through PCR–RFLP according to the previously defined protocol and its allelic frequency was computed. Results G6PD c.563C>T was observed in four of 110 patients with falciparum malaria and in two of 100 healthy donors. Mean (± SD) haemoglobin, median (IQR) platelet and median (IQR) parasite count in G6PD-deficient malaria-patients were 8.9 ± 0.9 g/dL, 124 × 109/L (IQR 32, 171) and 57,920/μL of blood (IQR 12,920, 540,000) respectively. Conclusions Cumulative allelic frequency for G6PD 563c.C>T was 0.0285 detected in 6 of 210 X-chromosomes in Southern Pakistan. Frequency for this G6PD allele was 0.0364 in malaria-patients and 0.0200 in healthy individuals. Large studies including females are needed to elucidate the true burden of G6PDd in malaria-endemic areas. The information will enable local health policy makers to design effective strategies for eliminating malaria form this region.

Purpose: analysis of epidemiological, clinical and laboratory features of imported malaria in the North-Western Federal district (NWFD) in 2012–2016. Research materials: the study included 84 patients treated for malaria in the hospitals of the NWFD. Results: 84 cases of malaria were registered in the NWFD from 2012 to 2016, which constituted 18,9% of all cases registered inRussian Federation(n=445):St. Petersburg(n=60),Arkhangelsk(n=10),Murmansk(n=5),Leningradregion (n=4),Vologdaregion (n=2) and 1 case in Komi,NovgorodandKaliningradregion. Patients with malaria had a history of a recent visit to: Asian countries (37%, n=31), West Africa (35%, n=30), North Africa (11%, n=7),South Africa(8%, n=7), East and Central Africa (3% correspondingly),Dominican Republic,CubaandSouth America(1% correspondingly). Pl. vivax was most common cause of malaria in patients visited Asia (87%), while recent travel to West Africa predispose patients to malaria caused by Pl. vivax in 37%, Pl. falciparum in 57% and Pl. оvale in 6% of all cases. All patients arrived from the North, South, Central Africa andDominican Republichad malaria caused by Pl. falciparum. Conclusion: in NWFD in 2012-2016 in the process of providing care to patients with malaria the following trends were marked: late referral of patients for medical care, careless collection of epidemiological data and travel history, late diagnosis of the disease, insufficient supply of antimalarial drugs and severe malaria in patients with comorbidity. Lack of adequate therapy with modern drugs has led to the lethal cases in patients with tropical malaria and the occurrence of late relapses of tertian malaria.

Abstract Background The spleen plays a pivotal role in the rapid clearance of parasitized red blood cells in patients with falciparum malaria after artemisinin treatment. Prolonged parasite clearance can be found in patients who have had a splenectomy, or those with hemoglobin abnormalities and/or reduced immunity, which are all distinguishable from artemisinin resistance. This paper reports on a case of prolonged parasite clearance in a Chinese splenectomized patient with falciparum malaria imported from Nigeria. Case presentation A 35-year-old Chinese male suffered 2 days of febrile illness after returning to Zhumadian city of Henan province from Nigeria on October 1, 2014. The main symptoms were febrile, including the highest axillary temperature of 40 °C, headache, and chills. A peripheral blood smear showed parasitemia (53 913 asexual parasites/μl) of Plasmodium falciparum. The patient had not used any chemoprophylaxis against malaria in Nigeria when he worked there as a construction worker between 2009 and 2014. The patient had three episodes of malaria in Nigeria and had a splenectomy due to a traffic accident 8 years ago from the time he was admitted to hospital. The patient was orally administrated a total of 320 mg/2.56 g dihydroartemisinin-piperaquine for 2 days and intravenously administrated a total of 3 000 mg artesunate for 18 days. The axillary temperature of the patient ranged between 37.0 and 37.7 °C from Day 0 to Day 3, and blood microscopy revealed falciparum malaria parasitemia (26 674 asexual parasites/μl) on Day 3. The patient was afebrile on Day 4, falciparum malaria parasitemia was continuously present and then gradually decreased on the next days, and was negative on Day 21. The patient was cured and left hospital on Day 24 after no plasmodium falciparum was found in the blood on Day 21 to Day 23. No mutation was found in the K13 propeller gene when compared with the PF3D7_1343700 K13 propeller gene reference sequence. Conclusions This is the first reported case in China of prolonged parasite clearance in a splenectomized patient with imported falciparum malaria. Artemisinin resistance should be distinguished when prolonged parasite clearance is found in a malaria patient who has had splenectomy.

Abstract Background Intravascular hemolysis is an intrinsic feature of severe malaria pathophysiology but the pathogenic role of cell-free hemoglobin-mediated oxidative stress in severe malaria associated acute kidney injury (AKI) is unknown. Methods As part of a prospective observational study, enrolment plasma cell-free hemoglobin (CFH), lipid peroxidation markers (F2-isoprostanes (F2-IsoPs) and isofurans (IsoFs)), red cell deformability, and serum creatinine were quantified in Bangladeshi patients with severe falciparum malaria (n = 107), uncomplicated malaria (n = 80) and sepsis (n = 28). The relationships between these indices and kidney function and clinical outcomes were examined. Results AKI was diagnosed at enrolment in 58% (62/107) of consecutive patients with severe malaria, defined by an increase in creatinine ≥1.5 times expected baseline. Severe malaria patients with AKI had significantly higher plasma cell-free hemoglobin (geometric mean CFH: 8.8 μM; 95% CI, 6.2–12.3 μM), F2-isoprostane (56.7 pg/ml; 95% CI, 45.3–71.0 pg/ml) and isofuran (109.2 pg/ml; 95% CI, 85.1–140.1 pg/ml) concentrations on enrolment compared to those without AKI (CFH: 5.1 μM; 95% CI, 4.0–6.6 μM; P = 0.018; F2-IsoPs: 27.8 pg/ml; 95% CI, 23.7–32.7 pg/ml; P

Abstract Background Control of malaria increasingly involves administration of 8-aminoquinolines, with accompanying risk of haemolysis in individuals with glucose-6-phosphate dehydrogenase (G6PD) deficiency. Few data on the prevalence and genotypic basis of G6PD deficiency are available from Bangladesh, where malaria remains a major problem in the South (Chittagong Division). The aim of this study was to determine the prevalence of G6PD deficiency, and associated G6PD genotypes, in adults with falciparum malaria in southern Bangladesh. Methods G6PD status was assessed via a combination of fluorescent spot testing (FST) and genotyping in 141 Bengali patients admitted with falciparum malaria to two centres in Chittagong Division from 2012 to 2014. In addition, an analysis of genomic data from 1000 Genomes Project was carried out among five healthy Indian subcontinent populations. Results One male patient with uncomplicated malaria was found to have G6PD deficiency on FST and a genotype associated with deficiency (hemizygous Orissa variant). In addition, there were two female patients heterozygous for deficiency variants (Orissa and Kerala-Kalyan). These three patients had a relatively long duration of symptoms prior to admission compared to G6PD normal cases, possibly suggesting an interaction with parasite multiplication rate. In addition, one of 27 healthy local controls was deficient on FST and hemizygous for the Mahidol variant of G6PD deficiency. Examination of 1000 Genomes Project sequencing data across the Indian subcontinent showed that 19/723 chromosomes (2.63%) carried a variant associated with deficiency. In the Bengali from Bangladesh 1000 Genomes population, three of 130 chromosomes (2.31%) carried deficient alleles; this included single chromosomes carrying the Kerala-Kalyan and Orissa variants. Conclusions In line with other recent work, G6PD deficiency is uncommon in Bengalis in Bangladesh. Further studies of particular ethnic groups are needed to evaluate the potential risk of wide deployment of primaquine in malaria control efforts in Bangladesh.

Background & objectives: Malaria is considered as the most important parasitic disease of humans, causing seri- ous illness that can be fatal, if not diagnosed and treated immediately. It is a multisystem disorder affecting nearly every system of the body. The aim of the present study was to evaluate the involvement of cardiovascular system in severe malaria using non-invasive methods. Methods: This prospective study was conducted on patients of severe malaria who were admitted between June and November 2015 in the Department of Medicine, Rajendra Institute of Medical Sciences and Hospital, Ranchi, Jharkhand, India. A total of 27 cases (18 males and 9 females; age ranging between 15 and 70 yr) of severe malaria (P. falciparum 24; P. vivax 1; mixed 2) were diagnosed by microscopic examination of peripheral blood smear and bivalent rapid diagnostic test (RDT) kit. The assessment of cardiovascular system was done by clinical examination, chest X-ray, ECG and transthoracic echocardiography. Results: In all, 7 (26%) patients were found to be suffering from circulatory failure, out of which one was P. vivax case and rest were cases of P. falciparum infection with high parasite density. One patient died due to cardiovascular collapse. ECG revealed sinus bradycardia [Heart rate (HR): 40-60] in 7% of the cases, extreme tachycardia (HR: 120-150) in 3.7% of cases and premature arterial ectopic with tachycardia in 3.7% of patients (p

Background: Following news of deaths in two districts of Jharkhand (West Singhbum and Garhwa) in November 2016, epidemiological investigations were contemplated to investigate any current outbreak of falciparum malaria and deaths attributed to it. Methodology: The epidemiological investigations, verbal autopsy of suspected deaths attributed to malaria and keys interviews were conducted in the 2nd and 4th week of November 2016 in Khuntpani and Dhurki block of West Singhbum and Garhwa districts, respectively, following a strict protocol. Results: The affected villages were Argundi and Korba-Pahariya and their adjacent tolas in Khuntpani and Dhurki block. Undoubtedly, there was the continuous transmission of falciparum malaria in both the regions in October and November 2016. The total cases (according to case definitions) were 1002, of them, 338 and 12 patients were positive for Plasmodium falciparum positive (Pf +ve) and Plasmodium vivax positive (Pv +ve), respectively, in the affected areas of Khuntpani block. In Dhurki block, out of the total of 631 patients fulfilling the case definition, 65 patients were PF +ve and 23 Pv +ve. Comparing to the last year, there is remarkably high number of falciparum cases. Verbal autopsy of deceased individuals showed that malaria might be one of the strongly probable diagnoses, but not conclusively. Conclusion: According to epidemiological investigation, verbal autopsy and key interviews conducted, it may be concluded that there is a definite outbreak of falciparum malaria in the area and environment is congenial for malaria and other tropical diseases.

Introduction: It is well known that hyponatremia is common in severe malaria. However, there is scanty and conflicting literature regarding hyponatremia as a predictor of mortality in severe malaria. Aim: To determine the prevalence of hyponatremia in severe malaria and its association with mortality. Materials and Methods: It was a hospital based cross-sectional study conducted in a tertiary care referral hospital in the state of Odisha in India. Sample size was calculated to be 99 by using the prevalence of hyponatremia in severe malaria 55% with absolute precision of 10%. Taking into account of 10% drop out rates, the final sample size was determined to 109. Considering the prevalence of mixed plasmodium infection to be 13% and the proportion of falciparum to vivax infection to be 49:51, samples ≥45 in each group was adequate for comparison. Consecutive sampling was done over a period of two years. Severe malaria included either infection with Plasmodium falciparum alone or both Plasmodium falciparum and Plasmodium vivax along with any one feature of WHO criteria for severity. Patients aged more than 15 years with both smear positive and rapid card test positive were included. Vital parameters and electrolyte levels were measured for each patient. The data was analysed using SPSS and significance level was set at 95%. Results: Out of the total number of 110 cases of severe malaria, isolated falciparum malaria was 57.3% (n=63) vs. mixed falciparum-vivax infection of 42.7% (n=47); overall mortality was 6.3% (n=4) vs. 14.8% (n=7) respectively. Hyponatremia was observed in 63.6% (n=70) of the total cases. The difference in incidence of hyponatremia in both the groups was 133±6 mEq/L vs. 127±6.3 mEq/L respectively and was statistically significant. Among the hyponatremic group of patients, the difference in level of sodium in both the group was (128±3.5 vs. 124±3.2) mEq/L and was statistically significant. Overall mortality rate was 10% (n=11/110), however mortality rate among the hyponatremic patients was 15.7% (n=11/70; 12.1% vs. 18.9% in both the groups respectively). Hyponatremia at a cut-off of 126 mEq/L predicted mortality with a sensitivity of 81.8%, specificity of 78.8%, and negative predictive value of 97.5%. Conclusion: Hyponatremia was highly prevalent among the severe malarial patients. Higher degree of hyponatremia was observed in mixed plasmodium infection. Severe hyponatremia predicted mortality with high sensitivity and specificity.