Asymptomatic<i>Plasmodium</i>Infections in Children in Low Malaria Transmission Setting, Southwestern Uganda1

Roh, Michelle E.; Oyet, Caesar; Orikiriza, Patrick; Wade, Martina; Kiwanuka, Gertrude N.; Mwanga-Amumpaire, Juliet; Parikh, Sunil; Boum, Yap

doi:10.3201/eid2208.160619

Cited by 27 publications

(29 citation statements)

References 12 publications

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“…Malaria prevalence by microscopy was 3.5% (95% confidence interval [CI]: 1.9 to 5.1) across all three districts. 10 Prevalence of G6PD deficiency by quantitative assay. G6PD enzyme activity values ranged from 1.2 to 12.2 U/g hemoglobin (Hb).…”

Section: Resultsmentioning

confidence: 99%

“…A stratified, two-stage cluster sampling design was used to select a total of 631 children between 6 and 59 months of age as previously described. 10 Briefly, 60 villages were randomly selected (20 per district) using probability proportionate to population size sampling and stratified by their urban and rural status. The number of households sampled per village was determined by the total number of participants required from each district, which was weighted by population size.…”

Section: Methodsmentioning

confidence: 99%

“…4,9 The prevalence of this variant in southwestern Uganda, an area where all four major malaria species circulate, has not been established. 10 More importantly, the comparative performance of varied G6PD deficiency diagnostic modalities in field-based settings requires further investigation to determine the most viable method to exclude at-risk G6PD-deficient persons before a 14-day course of primaquine.…”

Section: Introductionmentioning

confidence: 99%

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Screening for Glucose-6-Phosphate Dehydrogenase Deficiency Using Three Detection Methods: A Cross-Sectional Survey in Southwestern Uganda

Roh

Oyet

Orikiriza

et al. 2016

The American Society of Tropical Medicine and Hygiene

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Despite the potential benefit of primaquine in reducing Plasmodium falciparum transmission and radical cure of Plasmodium vivax and Plasmodium ovale infections, concerns over risk of hemolytic toxicity in individuals with glucose-6-phosphate dehydrogenase deficiency (G6PDd) have hampered its deployment. A cross-sectional survey was conducted in 2014 to assess the G6PDd prevalence among 631 children between 6 and 59 months of age in southwestern Uganda, an area where primaquine may be a promising control measure. G6PDd prevalence was determined using three detection methods: a quantitative G6PD enzyme activity assay (Trinity Biotech G-6-PDH kit), a qualitative point-of-care test (CareStart G6PD rapid diagnostic test [RDT]), and molecular detection of the G6PD A- G202A allele. Qualitative tests were compared with the gold standard quantitative assay. G6PDd prevalence was higher by RDT (8.6%) than by quantitative assay (6.8%), using a < 60% activity threshold. The RDT performed optimally at a < 60% threshold and demonstrated high sensitivity (≥ 90%) and negative predictive values (100%) across three activity thresholds (below 60%, 30%, and 40%). G202A allele frequency was 6.4%, 7.9%, and 6.8% among females, males, and overall, respectively. Notably, over half of the G202A homo-/hemizygous children expressed ≥ 60% enzyme activity. Overall, the CareStart G6PD RDT appears to be a viable screening test to accurately identify individuals with enzyme activities below 60%. The low prevalence of G6PDd across all three diagnostic modalities and absence of severe deficiency in our study suggests that there is little barrier to the use of single-dose primaquine in this region.

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Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Screening for Glucose-6-Phosphate Dehydrogenase Deficiency Using Three Detection Methods: A Cross-Sectional Survey in Southwestern Uganda

Roh

Oyet

Orikiriza

et al. 2016

The American Society of Tropical Medicine and Hygiene

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“…Consistent with this possibility, a recent report studying areas of relatively low transmission intensity in southwestern Uganda noted a surprisingly high prevalence of 45% for P. malariae in samples from asymptomatic parasitemic children. 27 Continued surveillance for the species causing malaria in regions undergoing interventions that decrease transmission intensity will be warranted.…”

Section: Discussionmentioning

confidence: 99%

Plasmodium Species Infecting Children Presenting with Malaria in Uganda

Asua

Tukwasibwe

Conrad

et al. 2017

The American Journal of Tropical Medicine and Hygiene

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Contributions of species other than to human malaria in sub-Saharan Africa are uncertain. We collected blood from children aged 6 months to 10 years diagnosed with malaria by Giemsa-stained blood smears (176 subjects) or histidine rich protein-2-based rapid diagnostic tests (323 subjects) in 2016; 50 samples from each of 10 sites across Uganda were studied to identify infecting species. Of 499 available samples, 474 demonstrated plasmodial infection by polymerase chain reaction amplification of 18S ribosomal RNA genes, including in 472, in 22, in 15, and in four; 435 were pure, two did not contain , and the remainder were mixed infections including. The prevalence of nonfalciparum species varied geographically. Stratifying based on recent history of indoor residual spraying (IRS) of insecticides, nonfalciparum infections were seen in 27/189 (14.8%) samples from sites that received and 13/285 (4.6%) samples from sites that did not receive IRS since 2010 ( = 0.0013). Overall, 39/474 (8.2%) samples from individuals diagnosed with malaria included nonfalciparum infections. Thus, a substantial proportion of episodes of malaria in Uganda include infections with plasmodial species other than .

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“…13 The recent use of sensitive molecular diagnosis suggested that the prevalence of P. malariae in many early studies may have been significantly underestimated because of the limited sensitivity of light microscopy (LM). [14][15][16] By quantitative PCR (qPCR), 15% P. malariae prevalence was observed in 5-to 9-year-old children from PNG. 17 In this study, we report P. malariae infection in a hypoendemic area of Thailand near the Thailand-Myanmar border.…”

Section: Introductionmentioning

confidence: 99%

Indigenous Plasmodium malariae Infection in an Endemic Population at the Thai–Myanmar Border

Yorsaeng

Saeseu

Chotivanich

et al. 2019

The American Journal of Tropical Medicine and Hygiene

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Plasmodium malariae is a neglected malaria parasite. It has wide geographic distribution and, although often associated with mild malaria, is linked to a high burden of anemia and nephrotic syndromes. Here, we report a cohort study conducted in the Kanchanaburi Province of Thailand during May 2013-June 2014 in which P. malariae infection was detected. Of the 812 study participants, two were found to be infected with P. malariae. One had an infection that led to acute malaria, but the other was positive for P. malariae at multiple visits during the study and apparently had chronic asymptomatic infection. Such persistent infection may explain how P. malariae has been able to thrive at very low prevalence and represents a challenge for malaria elimination.

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AsymptomaticPlasmodiumInfections in Children in Low Malaria Transmission Setting, Southwestern Uganda1

Cited by 27 publications

References 12 publications

Screening for Glucose-6-Phosphate Dehydrogenase Deficiency Using Three Detection Methods: A Cross-Sectional Survey in Southwestern Uganda

Screening for Glucose-6-Phosphate Dehydrogenase Deficiency Using Three Detection Methods: A Cross-Sectional Survey in Southwestern Uganda

Plasmodium Species Infecting Children Presenting with Malaria in Uganda

Indigenous Plasmodium malariae Infection in an Endemic Population at the Thai–Myanmar Border

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