Distinguishing malaria and influenza: Early clinical features in controlled human experimental infection studies

Lillie, Patrick; Duncan, Christopher; Sheehy, Suzanne; Meyer, Joel N.; O’Hara, Geraldine; Gilbert, Sarah C.; Hill, Adrian V. S.

doi:10.1016/j.tmaid.2012.03.008

Cited by 10 publications

(10 citation statements)

References 19 publications

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“…Parasite density is associated with disease severity [ 26 ] and it is also important in the setting of clinical trials with defined cut-offs for outcome definitions [ 27 ]. In endemic areas, distinguishing malaria from other diseases even when parasites are present is not straightforward because of the non-specific symptoms of the disease [ 28 ]. Therefore, a reliable parasite cut-off must be determined and standardization between readers and study sites must be achieved.…”

Section: Discussionmentioning

confidence: 99%

Limit of blank and limit of detection of Plasmodium falciparum thick blood smear microscopy in a routine setting in Central Africa

Joanny

Löhr

Engleitner

et al. 2014

Malar J

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BackgroundProper malaria diagnosis depends on the detection of asexual forms of Plasmodium spp. in the blood. Thick blood smear microscopy is the accepted gold standard of malaria diagnosis and is widely implemented. Surprisingly, diagnostic performance of this method is not well investigated and many clinicians in African routine settings base treatment decisions independent of microscopy results. This leads to overtreatment and poor management of other febrile diseases. Implementation of quality control programmes is recommended, but requires sustained funding, external logistic support and constant training and supervision of the staff. This study describes an easily applicable method to assess the performance of thick blood smear microscopy by determining the limit of blank and limit of detection. These two values are representative of the diagnostic quality and allow the correct discrimination between positive and negative samples.MethodsStandard-conform methodology was applied and adapted to determine the limit of blank and the limit of detection of two thick blood smear microscopy methods (WHO and Lambaréné method) in a research centre in Lambaréné, Gabon. Duplicates of negative and low parasitaemia thick blood smears were read by several microscopists. The mean and standard deviation of the results were used to calculate the limit of blank and subsequently the limit of detection.ResultsThe limit of blank was 0 parasites/μL for both methods. The limit of detection was 62 and 88 parasites/μL for the Lambaréné and WHO method, respectively.ConclusionWith a simple, back-of-the-envelope calculation, the performance of two malaria microscopy methods can be measured. These results are specific for each diagnostic unit and cannot be generalized but implementation of a system to control microscopy performance can improve confidence in parasitological results and thereby strengthen malaria control.

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Section: Discussionmentioning

confidence: 99%

Limit of blank and limit of detection of Plasmodium falciparum thick blood smear microscopy in a routine setting in Central Africa

Joanny

Löhr

Engleitner

et al. 2014

Malar J

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“…Early diagnosis facilitates early management and is recognized as one way to combat ARIs [8] . In fact, lack of sensitivity and specificity of symptoms prevents differentiation between influenza or any other viral infection and malaria [9] , [10] . The recommended early and easy use of antibiotics is not effective in viral ARIs, and can only prevent occurrence of bacterial super infection.…”

Section: Introductionmentioning

confidence: 99%

Viral Etiology of Respiratory Tract Infections in Children at the Pediatric Hospital in Ouagadougou (Burkina Faso)

Ouédraogo¹,

Traoré²,

Bi³

et al. 2014

PLoS ONE

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BackgroundAcute respiratory infections (ARIs) are a major cause of morbidity and mortality in children in Africa. The circulation of viruses classically implicated in ARIs is poorly known in Burkina Faso. The aim of this study was to identify the respiratory viruses present in children admitted to or consulting at the pediatric hospital in Ouagadougou.MethodsFrom July 2010 to July 2011, we tested nasal aspirates of 209 children with upper or lower respiratory infection for main respiratory viruses (respiratory syncytial virus (RSV), metapneumovirus, adenovirus, parainfluenza viruses 1, 2 and 3, influenza A, B and C, rhinovirus/enterovirus), by immunofluorescence locally in Ouagadougou, and by PCR in France. Bacteria have also been investigated in 97 samples.Results153 children (73.2%) carried at least one virus and 175 viruses were detected. Rhinoviruses/enteroviruses were most frequently detected (rhinovirus n = 88; enterovirus n = 38) and were found to circulate throughout the year. An epidemic of RSV infections (n = 25) was identified in September/October, followed by an epidemic of influenza virus (n = 13), mostly H1N1pdm09. This epidemic occurred during the period of the year in which nighttime temperatures and humidity were at their lowest. Other viruses tested were detected only sporadically. Twenty-two viral co-infections were observed. Bacteria were detected in 29/97 samples with 22 viral/bacterial co-infections.ConclusionsThis study, the first of its type in Burkina Faso, warrants further investigation to confirm the seasonality of RSV infection and to improve local diagnosis of influenza. The long-term objective is to optimize therapeutic management of infected children.

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“…However, it is difficult to distinguish between malaria flu-like symptoms and influenza. Experimental malaria studies have shown that flu-like symptoms in malaria can be easily classified as flu itself ( Lillie et al, 2012 ). Thus, it must be underscored that flu-like symptoms can be observed in cases of malaria, and in areas where malaria transmission is present, testing for malaria is important in patients presenting with flu-like symptoms at health-centres.…”

Section: Discussionmentioning

confidence: 99%

Clustering symptoms of non-severe malaria in semi-immune Amazonian patients

Martins

Araújo

Braga

et al. 2015

PeerJ

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Malaria is a disease that generates a broad spectrum of clinical features. The purpose of this study was to evaluate the clinical spectrum of malaria in semi-immune populations. Patients were recruited in Mâncio Lima, a city situated in the Brazilian Amazon region. The study included 171 malaria cases, which were diagnosed via the use of a thick blood smear and confirmed by molecular methods. A questionnaire addressing 19 common symptoms was administered to all patients. Multiple correspondence analysis and hierarchical cluster analysis were performed to identify clusters of symptoms, and logistic regression was used to identify factors associated with the occurrence of symptoms. The cluster analysis revealed five groups of symptoms: the first cluster, which included algic- and fever-related symptoms, occurred in up to 95.3% of the cases. The second cluster, which comprised gastric symptoms (nausea, abdominal pain, inappetence, and bitter mouth), occurred in frequencies that ranged between 35.1% and 42.7%, and at least one of these symptoms was observed in 71.9% of the subjects. All respiratory symptoms were clustered and occurred in 42.7% of the malaria cases, and diarrhea occurred in 9.9% of the cases. Symptoms constituting the fifth cluster were vomiting and pallor, with a 14.6% and 11.7% of prevalence, respectively. A higher parasitemia count (more than 300 parasites/mm3) was associated with the presence of fever, vomiting, dizziness, and weakness (P < 0.05). Arthralgia and myalgia were associated with patients over the age of 14 years (P < 0.001). Having experienced at least eight malaria episodes prior to the study was associated with a decreased risk of chills and fever and an increased risk of sore throat (P < 0.05). None of the symptoms showed an association with gender or with species of Plasmodium. The clinical spectrum of malaria in semi-immune individuals can have a broad range of symptoms, the frequency and intensity of which are associated with age, past exposure to malaria, and parasitemia. Understanding the full spectrum of nonsevere malaria is important in endemic areas to guide both passive and active case detection, for the diagnosis of malaria in travelers returning to non-endemic areas, and for the development of vaccines aimed to decrease symptom severity.

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Distinguishing malaria and influenza: Early clinical features in controlled human experimental infection studies

Cited by 10 publications

References 19 publications

Limit of blank and limit of detection of Plasmodium falciparum thick blood smear microscopy in a routine setting in Central Africa

Limit of blank and limit of detection of Plasmodium falciparum thick blood smear microscopy in a routine setting in Central Africa

Viral Etiology of Respiratory Tract Infections in Children at the Pediatric Hospital in Ouagadougou (Burkina Faso)

Clustering symptoms of non-severe malaria in semi-immune Amazonian patients

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