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Diaz P.B.,Institute of Tropical Medicine | Lozano P.M.,Institute of Tropical Medicine | Rincon J.M.R.,Hospital General Universitario Of Alicante | Garcia L.,Institute of Tropical Medicine | And 2 more authors.
Malaria Journal | Year: 2015

Background: Approximately 50 million people (60 %) live in malaria risk areas in Ethiopia, at altitudes below 2000 m. According to official data, 60-70 % of malaria cases are due to Plasmodium falciparum, and 40-30 % by Plasmodium vivax. The species Plasmodium ovale was detected in 2013 in the northwest of the country, being the first report of the presence of this species in Ethiopia since the 60 s. The aim of this study was to assess the diagnosis by microscopy and PCR, and demonstrate the presence of other Plasmodium species in the country. Methods: The survey was conducted in Bulbula, situated in the Rift Valley (West Arsi Province, Oromia Region). From December 2010 to October 2011, 3060 samples were collected from patients with symptoms of malaria; the diagnosis of malaria was done by microscopy and confirmation by PCR. Results: 736 samples were positive for malaria by microscopy. After removing the 260 samples (109 positives and 151 negatives) for which it was not possible to do PCR, there were a total of 2800 samples, 1209 are used for its confirmation by PCR and quality control (627 are positives and 582 negatives by microscopy). From the 627 positive samples, 604 were confirmed as positive by PCR, 23 false positives were detected, and the group of 582 negative samples, 184 were positive by PCR (false negatives), which added to the previous positive samples is a total of 788, positive samples for some species of Plasmodium sp. 13.3 % more positives were detected with the PCR than the microscopy. Importantly, 23 samples were detected by PCR as P. ovale, after the sequencing of these samples was determined as P. ovale curtisi. Conclusions: The PCR detected more positive samples than the microscopy; in addition, P. ovale and P. ovale/P. vivax were detected that had not been detected by microscopy, which can affect in the infection control. © 2015 Díaz et al. Source

Ramos J.M.,Hospital General Universitario Of Elche | Toro C.,Service of Microbiology | Reyes F.,Gambo General Rural Hospital | Amor A.,Service of Microbiology | Gutierrez F.,Hospital General Universitario Of Elche
Journal of Clinical Virology | Year: 2011

Background: Human immunodeficiency virus type 1 (HIV-1), hepatitis B virus (HBV), human T-cell lymphotropic virus type 1 (HTLV-1) and Treponema pallidum represent major public health problems in sub-Saharan countries. These infections can be transmitted from mother to children and may cause severe morbidities in their offspring. Ethiopia is among the countries where HIV-1, HBV and T. pallidum infections are highly prevalent. However, information on seroprevalence of these infections among antenatal care attendees is very scarce and the majority of studies have been conducted in pregnant women from urban areas. Objectives: To determine the seroprevalence of HIV-1, HBV, HTLV-1 and T. pallidum infections among pregnant women in a rural hospital in Southern Ethiopia. Study design: A cross-sectional study was conducted among consecutive pregnant women attending a mother and child clinic in August 2008. Results: A total of 165 pregnant women were included. The seroprevalence of HIV-1 was 1.8% (95% confidence intervals [CI]: 0.6-5.2%), and for HBV (HBsAg seropositivity) was 6.1% (95% CI: 3.3-10.8%). Co-infection with HIV-1 and HBV was detected in one patient (prevalence: 0.6%; 95% CI: 0.1-3.4%). No cases of HTLV-1 infection and syphilis were found (95% CI: 0-2.3%). Conclusions: A far from negligible percentage of pregnant women from rural areas harbour HBV, and to a lesser extent, HIV-1 infections. Continuing efforts to strengthen the existing health education program and comprehensive screening for all pregnant women are necessary to prevent mother-to-child transmission of HBV and HIV-1. © 2011 Elsevier B.V. Source

Mula P.,Institute of Tropical Medicine | Fernandez-Martinez A.,Institute of Tropical Medicine | De Lucio A.,Institute of Tropical Medicine | Ramos J.,Gambo General Rural Hospital | And 5 more authors.
Malaria Journal | Year: 2011

Background: In Ethiopia, malaria is caused by Plasmodium falciparum and Plasmodium vivax, and anti-malarial drug resistance is the most pressing problem confronting control of the disease. Since co-infection by both species of parasite is common and sulphadoxine-pyrimethamine (SP) has been intensively used, resistance to these drugs has appeared in both P. falciparum and P. vivax populations. This study was conducted to assess the prevalence of anti-malarial drug resistance in P. falciparum and P. vivax isolates collected at a rural hospital in southern Ethiopia. Methods. A total of 1,147 patients with suspected malaria were studied in different months across the period 2007-2009. Plasmodium falciparum dhfr and dhps mutations and P. vivax dhfr polymorphisms associated with resistance to SP, as well as P. falciparum pfcrt and pfmdr1 mutations conferring chloroquine resistance, were assessed. Results: PCR-based diagnosis showed that 125 of the 1147 patients had malaria. Of these, 52.8% and 37.6% of cases were due to P. falciparum and P. vivax respectively. A total of 10 cases (8%) showed co-infection by both species and two cases (1.6%) were infected by Plasmodium ovale. Pfdhfr triple mutation and pfdhfr/pfdhps quintuple mutation occurred in 90.8% (95% confidence interval [CI]: 82.2%-95.5%) and 82.9% (95% CI: 72.9%-89.7%) of P. falciparum isolates, respectively. Pfcrt T76 was observed in all cases and pfmdr1 Y86 and pfmdr1 Y1246 in 32.9% (95% CI: 23.4%-44.15%) and 17.1% (95% CI: 10.3-27.1%), respectively. The P. vivax dhfr core mutations, N117 and R58, were present in 98.2% (95% CI: 89.4-99.9%) and 91.2% (95% CI: 80.0-96.7%), respectively. Conclusion: Current molecular data show an extraordinarily high frequency of drug-resistance mutations in both P. falciparum and P. vivax in southern Ethiopia. Urgent surveillance of the emergence and spread of resistance is thus called for. The level of resistance indicates the need for implementation of entire population access to the new first-line treatment with artemether-lumefantrine, accompanied by government monitoring to prevent the emergence of resistance to this treatment. © 2011 Mula et al; licensee BioMed Central Ltd. Source

Santana-Morales M.A.,University of La Laguna | Quispe-Ricalde M.A.,University of La Laguna | Afonso-Lehmann R.N.,University of La Laguna | Berzosa P.,Institute of Tropical Medicine | And 6 more authors.
Malaria Journal | Year: 2013

Background: Knowledge of appropriate reference intervals is critical not only to provide optimal clinical care, but also to enrol populations in medical research. The aim of this study was to generate normal ranges of laboratory values for haemoglobin among healthy Ethiopian adults and children and to determine if anaemia is a possible indicator of malaria in women and children in this area of Ethiopia. Methods. This study was carried out from January 2008 to May 2010. The reference sample population with malaria-negative consisted of 454 individuals, divided women, men and children. The malaria-infected sample population consisted of 117 individuals. The reference ranges were based on the guidelines from the Clinical and Laboratory Standards Institute. Haemoglobin concentration was determined by Hemo-Control EKF Diagnostic Analyser on whole blood. Testing for malaria-positive and negative infection was done by microscopy and by PCR. Results: The lower limits for adult haemoglobin range obtained from this population were slightly higher than those derived from other African populations, but were equal to those established by other studies in Ethiopia and the World Health Organization (WHO). Regarding children, the minimum values were lower than those obtained from different African populations and those established by WHO. The malaria-negative group had anaemia in 35.6% of cases and in the malaria-positive group in 70.9%. There was a stronger, statistically significant association between anaemia and malaria-positive samples than between anaemia and malaria-negative samples in women and both groups of children. Conclusions: The results from this study are a contribution in the definition of the haemoglobin parameters in African populations, which could be taken as standards for interpretation of laboratory results. The haemoglobin indices in adults from Gambo tended to be higher than other African populations and in children were lower than other studies in Africa. The results also suggest that anaemia is not useful as a supportive diagnostic criterion to monitor and evaluate malaria in women and children from Ethiopia, because a 29.1% of malaria cases will be not detected, because of not having anaemia. © 2013 Santana-Morales et al.; licensee BioMed Central Ltd. Source

Santana-Morales M.A.,University of La Laguna | Afonso-Lehmann R.N.,University of La Laguna | Quispe M.A.,University of La Laguna | Reyes F.,Gambo General Rural Hospital | And 4 more authors.
Malaria Journal | Year: 2012

Background: Malaria is a leading public health problem in Ethiopia. Accurate diagnosis of Plasmodium infections is crucial for the reduction of malaria in tropical areas and for epidemiological studies. The role of light microscopy (LM) as gold standard has been questioned and, therefore, new molecular methods have been developed for the detection of Plasmodium species. The aim of the present work was to compare different malaria diagnostic methods in order to detect the most common species of Plasmodium and to broaden the knowledge of malaria prevalence in a hospital in a rural area in Ethiopia. Methods. A cross-sectional survey of 471 individuals was carried out in a hospital in the rural area of Gambo (Ethiopia). Blood samples were prepared for microscopic observation and collected in filter paper for Seminested-Multiplex PCR (SnM-PCR) and real time PCR (qPCR) testing. The SnM-PCR was considered as the gold standard technique and compared with the rest. Thus, agreement between SnM-PCR and LM was determined by calculating Kappa Statistics and correlation between LM and qPCR quantification was calculated by pair-wise correlation co-efficient. Results: Samples analysed by LM and SnM-PCR were positive for Plasmodium sp. 5.5% and 10.5%, respectively. Sensitivity was 52.2% by LM and 70% by qPCR. Correlation co-efficient between microscopy counts and qPCR densities for Plasmodium vivax was R2=0.586. Prevalence was estimated at 7% (95% CI: 4.7-9.3). Plasmodium vivax was the dominant species detected and the difference was statistically significant ( 2=5.121 p<0.05). The highest prevalence of the parasite (10.9%) was observed in age groups under 15years old. Conclusion: Accurate malaria diagnostic methods have a great effect in the reduction of the number of malaria-infected individuals. SnM-PCR detection of malaria parasites may be a very useful complement to microscopic examination in order to obtain the real prevalence of each Plasmodium species. Although SnM-PCR shows that it is a good tool for the determination of Plasmodium species, today light microscopy remains the only viabletool for malaria diagnosis in developing countries. Therefore, re-inforcement in the training of microscopists is essential for making the correct diagnosis of malaria. Plasmodium vivax was the predominant species in Gambo, a meso-endemic area for this species. © 2012 Santana-Morales et al.; licensee BioMed Central Ltd. Source

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