Background Plasmodium vivax shows a small prevalence in West and Central Africa due to the high prevalence of Duffy negative people. However, Duffy negative individuals infected with P. vivax have been reported in areas of high prevalence of Duffy positive people who may serve as supply of P. vivax strains able to invade Duffy negative erythrocytes. We investigated the presence of P. vivax in two West African countries, using blood samples and mosquitoes collected during two on-going studies.Methodology/FindingsBlood samples from a total of 995 individuals were collected in seven villages in Angola and Equatorial Guinea, and 820 Anopheles mosquitoes were collected in Equatorial Guinea. Identification of the Plasmodium species was achieved by nested PCR amplification of the small-subunit rRNA genes; P. vivax was further characterized by csp gene analysis. Positive P. vivax-human isolates were genotyped for the Duffy blood group through the analysis of the DARC gene. Fifteen Duffy-negative individuals, 8 from Equatorial Guinea (out of 97) and 7 from Angola (out of 898), were infected with two different strains of P. vivax (VK210 and VK247).ConclusionsIn this study we demonstrated that P. vivax infections were found both in humans and mosquitoes, which means that active transmission is occurring. Given the high prevalence of infection in mosquitoes, we may speculate that this hypnozoite-forming species at liver may not be detected by the peripheral blood samples analysis. Also, this is the first report of Duffy negative individuals infected with two different strains of P. vivax (VK247 and classic strains) in Angola and Equatorial Guinea. This finding reinforces the idea that this parasite is able to use receptors other than Duffy to invade erythrocytes, which may have an enormous impact in P. vivax current distribution.
Pneumocystis pneumonia (PcP) is a major HIV-related illness caused by Pneumocystis jirovecii. Definitive diagnosis of PcP requires microscopic detection of P. jirovecii in pulmonary specimens. The objective of this study was to evaluate the usefulness of two serum markers in the diagnosis of PcP. Serum levels of (1-3)-beta-d-glucan (BG) and lactate dehydrogenase (LDH) were investigated in 100 HIV-positive adult patients and 50 healthy blood donors. PcP cases were confirmed using indirect immunofluorescence with monoclonal anti-Pneumocystis antibodies and nested-PCR to amplify the large subunit mitochondrial rRNA gene of P. jirovecii in pulmonary specimens. BG and LDH levels in serum were measured using quantitative microplate-based assays. BG and LDH positive sera were statistically associated with PcP cases (P ≤ 0.001). Sensitivity, specificity, positive/negative predictive values (PPV/NPV), and positive/negative likelihood ratios (PLR/NLR) were 91.3 %, 61.3 %, 85.1 %, 79.2 %, 2.359, and 0.142, respectively, for the BG kit assay, and 91.3 %, 35.5 %, 75.9 %, 64.7 %, 1.415 and 0.245, respectively, for the LDH test. Serologic markers levels combined with the clinical diagnostic criteria for PcP were evaluated for their usefulness in diagnosis of PcP. The most promising cutoff levels for diagnosis of PcP were determined to be 400 pg/ml of BG and 350 U/l of LDH, which combined with clinical data presented 92.8 % sensitivity, 83.9 % specificity, 92.8 % PPV, 83.9 % NPV, 5.764 PLR and 0.086 NLR (P < 0.001). This study confirmed that BG is a reliable indicator for detecting P. jirovecii infection. The combination between BG/LDH levels and clinical data is a promising alternative approach for PcP diagnosis.
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Europe's men need their own health strategyA recent European report on men's health shows that it lags behind that of women. Alan White and colleagues analyse the problems and call for more policy, practice, and research aimed specifically at men Ten years ago the BMJ published a special issue on men's health.1 It noted how, although men fare better than women in most conventional measures such as top jobs and earnings, this advantage is not reflected in their health. A report we produced this summer, The State of Men's Health in Europe, 2 3 shows that little has changed. At any given age, men are still more likely than women to die from most of the leading causes, and in the European Union men have more than twice as many deaths a year as women throughout the working ages (15-64 years). This high level of premature mortality in men has psychological, social, and economic consequences for relatives, households, communities, and the workplace. Yet, in both national and European health policy, men and "masculinity" are largely taken for granted. This has limited the development of evidence based programmes that meet their health needs.Differences in mortality and morbidity are not simply the result of biological factors; nor are they intractable. In fact, the health gap between men and women varies considerably. It is much greater in eastern Europe than in western Europe, 4 and within countries it is influenced by class, education, employment, and other social determinants. 5 The clustering of material, cultural, and psychosocial factors seems to be particularly detrimental to the health of many men. 6 These factors contribute to gendered lifestyles and behaviours that have traditionally been seen as predominantly "masculine" 7 and that cause many of the premature deaths in men. Traditional masculine attitudes are associated with unhealthy behaviours such as poor diet, 8 smoking, excessive alcohol consumption, 9 non-use or delayed uptake of health services, 10 and higher likelihood of injury. All of these factors are more common among men living in eastern Europe than those in western Europe and in poorer material and social conditions everywhere.11 Men also seem to have adapted less well than women to the changes that have accompanied the political and social upheavals in eastern Europe in recent decades, such as more transient and unstable working conditions, increasing unemployment, and changing family structures (reduction in marriage and increased divorce). 12Yet, paradoxically, men often view themselves as having better health than women. There is some justification for this view: those men who survive into old age report less disability than women of the same age 2 ; but what is overlooked is that fewer live this long.13 Though the average difference in life expectancy between men and women in the European Union is 6.1 years, it ranges from 11.3 years in Latvia to 3.3 years in Iceland and Lichtenstein.2 Thus, men in general, and younger men in particular, tend to minimise the potential consequences of pra...
BackgroundOne of the best ways to control the transmission of malaria is by breaking the vector-human link, either by reducing the effective population size of mosquitoes or avoiding infective bites. Reducing house entry rates in endophagic vectors by obstructing openings is one simple way of achieving this. Mosquito netting has previously been shown to have this effect. More recently different materials that could also be used have come onto the market. Therefore, a pilot study was conducted to investigate the protective effect of three types of material against Anopheles funestus and Anopheles gambiae s.l entry into village houses in Mozambique when applied over the large opening at the gables and both gables and eaves.MethodsA two-step intervention was implemented in which the gable ends of houses (the largest opening) were covered with one of three materials (four year old mosquito bed nets; locally purchased untreated shade cloth or deltamethrin-impregnated shade cloth) followed by covering both gable ends and eaves with material. Four experimental rounds (each of three weeks duration), from four houses randomly assigned to be a control or to receive one of the three intervention materials, were undertaken from March to August 2010 in the village of Furvela in southern Mozambique. Mosquito entry rates were assessed by light-trap collection and the efficacy of the different materials was determined in terms of incidence rate ratio (IRR), obtained through a Generalized Estimating Equations (GEE), of mosquito entry in a treated house compared to the untreated (control) house.ResultsAltogether 9,692 An. funestus and 1,670 An. gambiae s.l. were collected. Houses treated with mosquito netting or the untreated shade cloth had 61.3% [IRR = 0.39 (0.32-0.46); P <0.0001] and 70% [IRR = 0.30 (0.25 – 0.37); P <0.001] fewer An. funestus in relation to untreated houses, but there was no difference in An. funestus in houses treated with the deltamethrin-impregnated shade cloth [IRR = 0.92 (0.76 –1.12); P = 0.4] compared to untreated houses. Houses treated with mosquito netting reduced entry rates of An. gambiae s.l, by 84% [IRR = 0.16 (0.10 – 0.25); P <0.001], whilst untreated shade cloth reduced entry rates by 69% [IRR = 0.31 (0.19 –0.53); P <0.001] and entry rates were reduced by 76% [IRR = 0.24 (0.15 0.38); P <0.001] in houses fitted with deltamethrin-impregnated shade cloth.
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