Malaria in infants aged less than six months - is it an area of unmet medical need?

D’Alessandro, Umberto; Ubben, David; Hamed, Kamal; Ceesay, Serign J.; Okebe, Joseph; Taal, Makie; Lama, Eugène Kaman; Keïta, Moussa; Koivogui, Lamine; Nahum, Alain; Bojang, Kalifa; Sonko, Aja Adam Jagne; Lalya, Honorat Francis; Brabin, Bernard

doi:10.1186/1475-2875-11-400

Cited by 61 publications

(62 citation statements)

References 58 publications

(71 reference statements)

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“…A review of age pattern of malaria revealed that as transmission increased, there was a shift of malaria towards younger age groups, regardless of seasonality [16], [17]. Overall, the most prevalent parasite was P. falciparum (80%) followed by P. vivax .…”

Section: Discussionmentioning

confidence: 99%

Dynamics of Forest Malaria Transmission in Balaghat District, Madhya Pradesh, India

et al. 2013

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BackgroundAn epidemiological and entomological study was carried out in Balaghat district, Madhya Pradesh, India to understand the dynamics of forest malaria transmission in a difficult and hard to reach area where indoor residual spray and insecticide treated nets were used for vector control.MethodsThis community based cross-sectional study was undertaken from January 2010 to December 2012 in Baihar and Birsa Community Health Centres of district Balaghat for screening malaria cases. Entomological surveillance included indoor resting collections, pyrethrum spray catches and light trap catches. Anophelines were assayed by ELISA for detection of Plasmodium circumsporozoite protein.Findings Plasmodium falciparum infection accounted for >80% of all infections. P. vivax 16.5%, P. malariae 0.75% and remaining were mixed infections of P. falciparum, P. vivax and P. malariae. More than, 30% infections were found in infants under 6 months of age. Overall, an increasing trend in malaria positivity was observed from 2010 to 2012 (chi-square for trend = 663.55; P<0.0001). Twenty five Anopheles culicifacies (sibling species C, D and E) were positive for circumsporozoite protein of P. falciparum (44%) and P. vivax (56%). Additionally, 2 An. fluviatilis, were found positive for P. falciparum and 1 for P. vivax (sibling species S and T). An. fluviatilis sibling species T was found as vector in forest villages for the first time in India.ConclusionThese results showed that the study villages are experiencing almost perennial malaria transmission inspite of indoor residual spray and insecticide treated nets. Therefore, there is a need for new indoor residual insecticides which has longer residual life or complete coverage of population with long lasting insecticide treated nets or both indoor residual spray and long lasting bed nets for effective vector control. There is a need to undertake a well designed case control study to evaluate the efficacy of these interventions.

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Section: Discussionmentioning

confidence: 99%

Dynamics of Forest Malaria Transmission in Balaghat District, Madhya Pradesh, India

et al. 2013

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“…The former is assumed to be acquired from the mother, the latter by mosquito inoculation, although it is never possible for the clinician to distinguish between these routes of infection with confidence (D'Alessandro et al . ), and transplacental infection can present up to 2 months after delivery.…”

Section: Section 6: Severe Malaria In the Newbornmentioning

confidence: 99%

Severe Malaria

2014

Tropical Med Int Health

458

354

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Fever and diarrhea developed in a 34-year-old Swiss man two weeks after his return from Madagascar. Before his visit he had not taken any prophylactic antimalarial drugs. Despite self-treatment with ciprofloxacin and metronidazole, he remained febrile. He also reported hematuria and dark urine. On admission, his temperature was 39.2°C and his vital signs and mental status were normal. The abdomen was tender, and the spleen was palpable 15 cm below the costal margin. The hemoglobin level was 12.4 g per deciliter, the hematocrit was 35 percent, the white-cell count was 8500 per cubic millimeter, and the platelet count was 15,000 per cubic millimeter. The creatinine level was 2.6 mg per deciliter (234 µmol per liter), the lactate dehydrogenase level was 1920 U per liter (normal, 187 to 443), and the bilirubin level was 11.5 mg per deciliter (197 µmol per liter); the results of other liver-function tests were in the normal range. Examination of blood smears showed severe infestation with Plasmodium falciparum, with 70 to 80 percent of red cells containing up to five parasites (small ring forms) per cell (long arrow in Panel A). Other features of P. falciparum that were present included chromatin dots (arrowheads in Panel A) and appliqué forms (short arrow in Panels A and B; Wright's stain, ¬1000). About 70 percent of the neutrophils contained hemozoin (shown in a band form [long arrows] in Panel B). The patient was treated with intravenous quinine sulfate and exchange transfusions, with dramatic improvement. The degree of parasitemia fell to 65 percent after the first exchange transfusion and to 8 percent after the second. The patient's course was complicated by acute renal failure, the acute respiratory distress syndrome, and spontaneous rupture of the spleen, necessitating continuous hemofiltration, mechanical ventilation, and laparotomy with splenectomy. Despite these complications , the patient was able to return home within three months and was well at the last follow-up visit.

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“…Asymptomatic malaria is not uncommon in newborns, and symptomatic disease occurs as well. Under highly endemic conditions, the prevalence of parasites and splenomegaly is high in the first months of life, and young infants are frequently susceptible to malaria . In malarious areas, cord hemoglobin values below 14 g/dL, which are indicative of fetal anemia, are commonly reported and are associated with maternal iron deficiency, placental malaria, and development of subsequent infant anemia …”

Section: Iron Status and Risk Of Infection In Neonatesmentioning

confidence: 99%

Influence of iron status on risk of maternal or neonatal infection and on neonatal mortality with an emphasis on developing countries

Brabin

Gies

2013

Nutr Rev

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Infection is a major cause of neonatal death in developing countries. We address the question whether host iron status affects maternal and/or neonatal infection risk, potentially contributing to neonatal death. We summarize the iron acquisition mechanisms described for pathogens causing stillbirth, preterm birth, and congenital infection. There is in vitro evidence that iron availability influences severity and chronicity of infections that cause these outcomes. The risk in vivo is unknown as relevant studies of maternal iron supplementation have not assessed infection risk. Reducing iron deficiency anemia among women is beneficial and should improve the iron stores of babies, but there is evidence that iron status in young children predicts malaria risk and possibly invasive bacterial diseases. Caution with maternal iron supplementation is indicated in iron-replete women who have high infection exposure, although distinguishing iron-replete and iron-deficient women is currently difficult. Further research is indicated to investigate infection risk in relation to iron status in mothers and babies in order to avoid iron intervention strategies that result in detrimental birth outcomes for some groups of women.

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Malaria in infants aged less than six months - is it an area of unmet medical need?

Cited by 61 publications

References 58 publications

Dynamics of Forest Malaria Transmission in Balaghat District, Madhya Pradesh, India

Dynamics of Forest Malaria Transmission in Balaghat District, Madhya Pradesh, India

Severe Malaria

Influence of iron status on risk of maternal or neonatal infection and on neonatal mortality with an emphasis on developing countries

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