clove and Parasitemia

We report the results of clinical studies carried out at six sites in Madagascar, between January and October 2006. The aims were (i) to update our knowledge of the burden of Plasmodium malariae infection and (ii) to assess the therapeutic efficacy of chloroquine for uncomplicated quartan malaria. Our findings confirm that P. malariae is the third leading cause of malaria, accounting for 1.1% of all malarial infections. They also demonstrate that chloroquine-currently recommended for the home management of presumed malaria in children under the age of five years and commonly used by adults-remains highly effective in patients with uncomplicated P. malariae infection.

Topics: Adolescent; Adult; Animals; Antimalarials; Child; Child, Preschool; Chloroquine; Female; Humans; Infant; Madagascar; Malaria; Male; Parasitemia; Plasmodium malariae; Prevalence; Time Factors; Treatment Outcome

Madagascar is one of the world's top twelve "megadiversity" hot spots hosting unique and threatened flora and fauna. Parasites are a major component of biodiversity but remain largely uncharacterized in wildlife. In this study we combine microscopic and molecular assessment of hemoparasites in endemic reptile species from Madagascar. We detected three distinct parasites: the apicomplexans Hepatozoon and Sarcocystis, and filarial nematodes. The prevalence and intensity of these apicomplexans were low overall, while microfilarial infections in chameleons were relatively high. We detected mixed infections of two Hepatozoon haplotypes in Madagascarophis colubrinus, and of Hepatozoon and microfilariae in a Furcifer sp. Phylogenetic analyses of Hepatozoon showed evidence of prey-predator transmission, with identical sequences found in the snakes M. colubrinus and Ithycyphus oursi, and their prey Furcifer sp. Based on previous studies regarding the life cycle of Hepatozoon domerguei Landau, Chabaud, Michel, and Brygoo, 1970 in these hosts and due to their morphological similarity, we propose that this Hepatozoon haplotype is Hepatozoon domerguei. Future studies, including the examination of invertebrate hosts, are needed to verify this preliminary taxonomic identification. A distinct hemogregarine haplotype was found in Oplurus sp., which displayed morphologically different gametocytes, some of which were apparently inside leukocytes. The Sarcocystis identified from Tracheloptychus petersi was identical to that reported in a North African snake, indicating that the same lineage is found in geographically distinct regions. By combining morphological and genetic information, Foleyella furcata (Linstow, 1899) filarial nematodes were identified in several Furcifer chameleons. This study provides insights into the distribution, diversity and host-parasite interactions of hemoparasites in wild reptile populations from Madagascar.

Topics: Animals; Base Sequence; Coccidia; Coccidiosis; DNA, Helminth; DNA, Protozoan; DNA, Ribosomal; Electron Transport Complex IV; Filariasis; Filarioidea; Helminth Proteins; Lizards; Madagascar; Molecular Sequence Data; Parasitemia; Phylogeny; Protozoan Proteins; RNA, Ribosomal; Sarcocystis; Sarcocystosis; Snakes; Species Specificity

Madagascar has long been recognized for its unique and diverse biota. In particular, significant effort has been made to establish baseline population data to better conserve the endemic avifauna. During field expeditions between 1993 and 2004, birds were mist-netted at 11 different sites, at elevations from 60 m to 2,050 m above sea level. Data on endemic status, forest type, and habitat preference were recorded. Thin blood films from 947 birds, belonging to 26 families and 64 species, were examined by light microscopy to determine the prevalence of blood parasites. Of these 947 birds, 30.7% were infected by at least one species of blood parasite, 26.8% of which were infected by more than one species. Species of Haemoproteus were the most prevalent (17.4%), followed by microfilariae (11.0%), Leucocytozoon spp. (9.4%), Plasmodium spp. (1.9%), Trypanosoma spp. (0.9%), and Babesia spp. (0.2%). Species level identifications confirmed the presence of 47 species of hemosporidians and trypanosomes, which is notably high and mirrors the diversity of their avian hosts. Eleven (23.4%) of these parasite species were new to science and thought to be endemic to the island. Significant differences in prevalence were observed by sample site, forest type (humid vs. dry), and habitat preference. Birds from all elevational zones sampled were infected, although not all parasite genera were present in each zone. Four of the six endemic avian families or subfamilies (Bernieridae, Brachypteraciidae, Philepittinae [Eurylaimidae], and Vangidae) were sampled and found to be parasitized. Of the families with the largest sample sizes, the Zosteropidae and Ploceidae had the highest prevalence of infection (65.6% and 49.3%, respectively). The vectors of hematozoan parasites in Madagascar are currently unknown. These results add to the current knowledge of avian parasitism in Madagascar and are of particular interest for the conservation of endemic species, as well as threatened or endangered populations.

Topics: Animals; Animals, Wild; Bird Diseases; Birds; Conservation of Natural Resources; Female; Madagascar; Male; Parasitemia; Parasitic Diseases, Animal; Prevalence; Sentinel Surveillance; Species Specificity

The main purpose of this study was to assess the accuracy of various techniques available for diagnosis of malaria. Blood samples were collected from 313 patients with clinical suspicion of uncomplicated malaria in 2 primary health centers in Madagascar. The presence of Plasmodium parasites was assessed by conventional microscopy, 2 rapid diagnostic tests (one HRP2-based test, PALUTOP(+4), and one pLDH-based test, OptiMAL-IT), and real-time polymerase chain reaction (PCR), which is used as the "gold standard" method. The degree of agreement observed was very high for microscopy (0.99) and the HRP2-based test (0.93) and high for the pLDH-based test (0.82). Public-health implications are also discussed in this paper.

Topics: Adolescent; Adult; Aged; Animals; Antigens, Protozoan; Child; Child, Preschool; Endemic Diseases; Female; Fever; Humans; Immunoassay; Infant; Madagascar; Malaria; Male; Microscopy; Middle Aged; Parasitemia; Plasmodium; Predictive Value of Tests; Reproducibility of Results

Topics: Animals; Anopheles; France; Humans; Insect Vectors; Madagascar; Malaria, Vivax; Male; Middle Aged; Parasitemia; Plasmodium vivax; Travel

Intermittent preventive treatment (IPT) of pregnant women with sulfadoxine-pyrimethamine (SP) is being considered as a routine practice in Madagascar, mainly to decrease the risks of malaria-associated severe anaemia in the women, and of low birthweight in their babies. There is, however, relatively little information available on the efficacy of SP when used, in Madagascar, to treat cases of Plasmodium falciparum malaria. In a preliminary study, carried out in 2003 in the village of Saharevo, 36 uncomplicated cases were each treated with a standard dose of SP and with paracetamol and then followed up for 28 days. No case of therapeutic failure occurred and all the asexual parasitaemias cleared by day 3. It therefore appears that SP is effective against P. falciparum in Saharevo (and probably in the whole, rural district of Moramanga in which the village lies). This is an encouraging observation to make before IPT is initiated throughout the country.

Topics: Animals; Antimalarials; Child; Child, Preschool; Drug Combinations; Female; Humans; Madagascar; Malaria, Falciparum; Male; Parasitemia; Plasmodium falciparum; Pyrimethamine; Rural Health; Sulfadoxine; Treatment Outcome

Blood smears from birds in the Philepittidae, endemic to Madagascar, were examined for the presence of hematozoa. All slides were read on a compound microscope at x100, x160, and x1000. To date, no species of avian hematozoa has been reported from asities in Madagascar, although parasites have been observed. Leucocytozoon greineri n. sp. is described from the common sunbird asity (Neodrepanis coruscans) and is also reported from the velvet asity (Philepitta castanea). It is a relatively small species of Leucocytozoon, less than 2 times the size of uninfected erythrocytes. The parasite is capped by the host cell nucleus, covering 38% of the parasite perimeter. This represents the first description of hematozoa from this family.

Topics: Animals; Bird Diseases; Erythrocytes; Haemosporida; Madagascar; Male; Parasitemia; Passeriformes; Protozoan Infections, Animal

To date, limited surveys have been conducted on the endemic avifauna of Madagascar with regard to hematozoa. Wild-caught birds from the Vangidae, endemic to Madagascar and the Comoros Islands, were mist-netted, and blood smears were made. Slides were examined for the presence of hematozoa at x100, x160, and x1000 using a light microscope. Parasites were measured using established techniques, and morphometrics were compared. On the basis of their distinctive morphologies and morphometrics, 4 new species of avian hematozoa are described in this study. Haemoproteus vangii n. sp. and Leucocytozoon lairdi n. sp. occur in the blue vanga (Cyanolanius madagascarinus), whereas Haemoproteus madagascariensis n. sp. and Leucocytozoon bennetti n. sp. are described from the hook-billed vanga (Vanga curvirostris). These represent the first hematozoa described from this family.

Topics: Animals; Bird Diseases; Erythrocytes; Haemosporida; Madagascar; Male; Parasitemia; Passeriformes; Protozoan Infections, Animal

Malaria transmission in the central highlands of Madagascar was interrupted in the 1960s by a national control program that used DDT indoor spraying and mass treatment with chloroquine. At the end of the 1980s in this region, epidemic malaria reappeared. Italian health authorities provided technical assistance to the National Malaria Control Program since the beginning of the resurgence of malaria in the central highlands. Yearly residual house spraying performed for 5 years (1993-1998) and the availability of antimalarial drugs reduced malaria transmission to very low levels, with improvement in parasitologic and entomologic indexes. A significant reduction of malaria prevalence was observed in the villages located at altitudes of 1,000-1,500 m, corresponding to the stratum of unstable malaria that was the main target of the antivector interventions. A significant reduction of malaria prevalence was also observed in the villages located at altitudes of 900-1,000 m, where malaria transmission is stable. The main vector Anopheles funestus was dramatically reduced in abundance and distribution in the sprayed areas.

Topics: Adolescent; Altitude; Animals; Anopheles; Child; Child, Preschool; Cohort Studies; DDT; Humans; Insect Vectors; Madagascar; Malaria, Falciparum; Mosquito Control; Parasitemia; Plasmodium falciparum; Prospective Studies; Rural Population

Chloroquine has been used in Madagascar since 1945 and remains the first-line treatment for uncomplicated cases of malaria. Low-grades of resistance type R1 and R2 have been reported. Thus, in vitro tests were performed in order to monitor the drug sensitivity of Plasmodium falciparum from different study sites, with the aim of identifying alternatives to chloroquine. Chloroquine IC50 values ranged from 0.2 nM to 283.4 nM (n = 190, mean IC50 = 52.6 nM; 95% CI = 46.1-59.1 nM). Fifteen isolates (7.9%) were chloroquine-resistant. One mefloquine-resistant isolate was detected (1/139). The test isolates were sensitive to amodiaquine (n = 118), quinine (n = 212), pyrimethamine (n = 86) and cycloguanil (n = 79). The median IC50 for amodiaquine was 12.3 nM (mean IC50 = 15.3 nM, 95% CI = 13.3-17.3 nM). Amodiaquine was 3.4 times as active as chloroquine in vitro and 7 times as active as quinine against P. falciparum. These results indicate that amodiaquine may be a potent alternative to chloroquine in Madagascar. There was positive correlation between tested quinoline-containing drugs activities, which suggests in vitro cross-susceptibility.

Topics: Amodiaquine; Animals; Antimalarials; Chloroquine; Drug Resistance; Drug Resistance, Multiple; Humans; Inhibitory Concentration 50; Madagascar; Malaria, Falciparum; Mefloquine; Parasitemia; Plasmodium falciparum; Proguanil; Pyrimethamine; Quinine; Triazines

An epidemiologic survey on malaria endemicity levels, including entomologic, parasitologic, and immunologic indicators, was carried out in a village of the Madagascar highlands (Analaroa) at the end of the 1990-1991 rainy season. The results indicate that malaria is hyperendemic and Anopheles funestus is the main vector in the area. The prevalence of parasitemia decreased with age from a maximum level of about 60% in children less than five years of age to a minimum of about 16% among those more than 29 years of age. The prevalence of Plasmodium falciparum circumsporozoite antibodies (Ab-Cs) increased with age from a minimum level of about 10% in children less than five years of age to a maximum of 71.7% among those more than 29 years of age. An inverse correlation was observed between P. falciparum prevalence and levels of Ab-Cs and parasite prevalence. The study confirmed that prevalence and Ab-Cs levels are reliable indicators of malaria endemicity in hyperendemic areas. Schoolchildren between five and 14 years of age are considered the most practical and susceptible group for this kind of epidemiologic study.

Topics: Adolescent; Adult; Age Factors; Aged; Animals; Antibodies, Protozoan; Child; Child, Preschool; Humans; Madagascar; Middle Aged; Parasitemia; Plasmodium falciparum; Prevalence; Protozoan Proteins

To evaluate the ability of antibodies to Plasmodium falciparum ring-infected erythrocyte surface antigen (Pf155/RESA) epitopes to discriminate between individuals well protected or poorly protected against malaria, a receiver operating characteristic analysis was performed in two populations living in Madagascar and Malawi. The definition of protection was based on longitudinal measurements of clinical malarial attacks during the season of high malaria transmission in the Madagascar study, and on a cross-sectional measurement of parasitemia in the Malawi study. Antibodies to peptides reproducing the 4-mer, 8-mer, and 11-mer of the Pf155/RESA were tested for their reactivities using the Falcon assay screening test-enzyme-linked immunosorbent assay. Maximal detection of poorly protected individuals (specificity = 100%) corresponded to high cutoff antibody titers (range = 1.65-3.0 optical density [OD] units in the Madagascar study and 0.67-1.42 OD units in the Malawi study) and a sensitivity less than 50%. For a given sensitivity of 50%, specificity ranged from 55% to 62% in the Madagascar study, and from 67% to 94% in the Malawi study. The antibody cutoff titers corresponding to minimal misclassification rates ranged from 0.24 to 1.73 OD units in the Madagascar study and from 0.15 to 0.55 OD units in the Malawi study. For each antibody, the highest detectability value as measured by the area under the curve was obtained for anti-R11 in the Malawi study (0.838). In demonstrating such qualities, antibodies to Pf155/RESA epitopes could be used for screening poorly protected populations in which malaria control programs have to be implemented.

Topics: Amino Acid Sequence; Animals; Antibodies, Protozoan; Antigens, Protozoan; Cohort Studies; Enzyme-Linked Immunosorbent Assay; Epitopes; Female; Humans; Madagascar; Malaria, Falciparum; Malawi; Male; Molecular Sequence Data; Parasitemia; Plasmodium falciparum; Protozoan Proteins; ROC Curve; Sensitivity and Specificity