Background: The development of modern information telecommunication (ITC) technology and its use in telemedicine plays an increasingly important role in facilitating access to some diagnostic services even to people living in the most remote areas. However, physical and economical constraints in the access to broad band data-transmission network, still represent a considerable obstacle to the transmission of images for the purpose of tele-pathology.

BackgroundThe literature data on malaria in Western Kasai, DRC, are limited and inadequate. A recent molecular survey there has detected Plasmodium ovale and Plasmodium malariae as mixed infections with Plasmodium falciparum. In Tshimbulu, Western Kasai, during a humanitarian initiative designed to provide children with free preventive screening and to reduce the local high malaria death rate, accurate species identification was performed, in order to collect unambiguous epidemiological data and to evaluate the reliability of locally applied diagnostics.MethodsFinger pricks provided fresh blood for microscopic analysis (MA), for rapid diagnostic test (RDT) and for molecular diagnostics (MD). MA and RDT were first performed by the local team and then a re-interpretation of the results (on the same slides and on RDT’s taken pictures) was conducted in Italy, where MD were performed.ResultsThe analysis was conducted on 306 children; RDT found 80.9 % as P. falciparum-positive (37.4 % as two-band positive, P. falciparum single infection). MA identified a further four children as positive to P. falciparum and six co-infections with P. ovale. The second RDT evaluation confirmed a similar infection rate (78.2 %) but interpreted as two-band positive a significantly higher share of tests (56.8 %). MA confirmed 80.0 % of the children as malaria positive and, in addition to P. falciparum, identified P. malariae (13.8 %), P. vivax (3.4 %) and P. ovale (2.4 %), and detected Babesia microti in 19 smears. MD confirmed all of the species found (Babesia microti included), classified as mono-infection with P. falciparum a rate of spots comparable to MA revision, and identified all P. ovale as Plasmodium ovale wallikeri. The RDT used locally proved 93.1 % sensitive and 92.1 % specific for P. falciparum.ConclusionsThe malaria prevalence among the children and the presence of four Plasmodium species, highlighted in this study, identified a sanitary issue which proved to be more alarming than expected, as it was worsened by the unpredictable presence of P. vivax and Babesia microti (never before reported in DRC). Each diagnostic tool showed its point of weakness. Therefore, the most correct approach is by the combined use of different, locally available, diagnostic tools.

As previously demonstrated, m-phones can be easily used, without any adapter, to photograph and send images from a microscope. The objective of the current study was to test the appropriateness and educational potential of this mobile diagnosis approach with health workers in limited-resource settings, such as health units in Uganda, Bangladesh and Afghanistan. A total of 61 lab technicians were trained in basic lab skills and in using the m-phone to capture microscopic images and send them to distant Reference Centers for a second opinion. Structured pre-test interviews were used to define parameters such as health workers' sex and age, duty station, schooling, experience in the laboratory, access to internet and availability to and use of m-phones. Images from the microscope were also uploaded on the available computers and shared on the screen to facilitate group discussions and comparisons with reference images. Standard instructions were then elaborated and tested with totally inexperienced people. Results showed that use of integrated camera mphones was widespread. Mobile Messaging Service (MMS) was commonly accessible, however, not used. Neither mmicroscopy, nor clinical use of m-phones was previously known among local health workers. A standard written procedure, without any additional verbal instruction, was enough to easily learn to take pictures of the microscope samples, even for the most inexperienced person. The possibility to share images on the m-phone and/or a computer screen, and the group discussions proved to be phenomenal educational tools.

Chickens can easily be induced to develop delayed-type skin reactions to oxazolone when animals are sensitized 7 days before the challenge. The reaction is quantitated by assessing the increase in wattle thickness: maximum reactions occur 24 h after challenge. The reaction is inhibited by neonatal thymectomy or bursectomy; these findings therefore suggest also an important B-derived component in delayed hypersensitivity to oxazolone.

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