Predictive Factors of Malaria in Travelers to Areas Where Malaria Is Endemic

Casalino, Enrique; Bras, J. Le; Chaussin, Florence; Fichelle, A.; Bouvet, E.

doi:10.1001/archinte.162.14.1625

Cited by 73 publications

(40 citation statements)

References 25 publications

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“…In our patients, 185 (95.4%) malaria patients had thrombocytopenia, with severe cases (Ͻ50,000 platelets/l) accounting for 21.6% of patients. The presence of thrombocytopenia is more common in malaria than in other febrile disease, but it has only a limited role in the prediction of malaria due to its low sensitivity and specificity (1). Our findings show that the presence of thrombocytopenia can have a role in the rapid diagnosis of vivax malaria in that all patients with a positive SD Bioline Malaria Antigen test when thrombocytopenia was present had a positive microscopic examination.…”

Section: Discussionmentioning

confidence: 70%

“…Although the symptoms of malaria are very nonspecific and overlap those of other febrile illness, thrombocytopenia has been reported to be associated with vivax malaria as well as with falciparum malaria (14,20,22) and is more common with malaria than with other febrile diseases (7,15,17). Recent studies have also demonstrated the high predictive value of thrombocytopenia in the diagnosis of malaria (1)(2)(3). However, as a substantial proportion of cases falciparum malaria was included in those studies, the predictive value of thrombocytopenia in the diagnosis of vivax malaria would have been limited.…”

mentioning

confidence: 99%

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Rapid Diagnosis of Vivax Malaria by the SD Bioline Malaria Antigen Test When Thrombocytopenia Is Present

Lee

Jeon

2008

J Clin Microbiol

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An easy and reliable diagnostic method for malaria is highly desirable. We examined the recently introduced SD Bioline Malaria Antigen test, which detects Plasmodium lactate dehydrogenase, with the additional aid of the presence or absence of thrombocytopenia to diagnose vivax malaria. We enrolled 732 patients with clinically suspected malaria in an area where vivax malaria is endemic. We performed microscopic examination of thin film, applied the SD Bioline Malaria Antigen test, and checked platelet counts. One hundred ninety-five patients were smear positive for vivax malaria. The sensitivity of the SD Bioline Malaria Antigen test was 96.4%, and its specificity was 98.9%. We found that 95.4% of malaria patients had thrombocytopenia, and the proportion with malaria increased as platelet counts decreased. A positive SD Bioline Malaria Antigen test when thrombocytopenia was present showed a 100% positive predictive value for vivax malaria. In conclusion, the SD Bioline Malaria Antigen test is a rapid and accurate diagnostic method for vivax malaria, and a platelet count can facilitate a rapid diagnosis of malaria.

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Section: Discussionmentioning

confidence: 70%

mentioning

confidence: 99%

Rapid Diagnosis of Vivax Malaria by the SD Bioline Malaria Antigen Test When Thrombocytopenia Is Present

Lee

Jeon

2008

J Clin Microbiol

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“…For example, several studies indicate that men tend to have higher parasitemia than women (23,32,52). In a recent prospective study of imported malaria cases in France, men reported more severe symptoms of malaria infection (e.g., chills, fever, and low platelet counts) than did women (7). Among Ghanaian school children, although the prevalence of P. falciparum infection does not differ between the sexes, the parasite density is significantly higher for boys than girls around puberty (i.e., from ages 8 to 16), suggesting that circulating sex steroids may influence this outcome (23).…”

Section: Vol 74 2006 Sex Difference In Malaria Infection 3197mentioning

confidence: 97%

Involvement of Gonadal Steroids and Gamma Interferon in Sex Differences in Response to Blood-Stage Malaria Infection

et al. 2006

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To examine the hormonal and immunological mechanisms that mediate sex differences in susceptibility to malaria infection, intact and gonadectomized (gdx) C57BL/6 mice were inoculated with Plasmodium chabaudi AS-infected erythrocytes, and the responses to infection were monitored. In addition to reduced mortality, intact females recovered from infection-induced weigh loss and anemia faster than intact males. Expression microarrays and real-time reverse transcription-PCR revealed that gonadally intact females exhibited higher expression of interleukin-10 (IL-10), IL-15R␣, IL-12R␤, Gadd45␥, gamma interferon (IFN-␥), CCL3, CXCL10, CCR5, and several IFN-inducible genes in white blood cells and produced more IFN-␥ than did intact males and gdx females, with these differences being most pronounced during peak parasitemia. Intact females also had higher anti-P. chabaudi immunoglobulin G (IgG) and IgG1 responses than either intact males or gdx females. To further examine the effector mechanisms mediating sex differences in response to P. chabaudi infection, responses to infection were compared among male and female wild-type (WT), T-cell-deficient (TCR␤␦ ؊/؊ ), B-cell-deficient (MT), combined T-and B-cell-deficient (RAG1), and IFN-␥ knockout (IFN-␥ ؊/؊ ) mice. Males were 3.5 times more likely to die from malaria infection than females, with these differences being most pronounced among TCR␤␦ ؊/؊ , MT, and RAG1 mice. Male mice also exhibited more severe weight loss, anemia, and hypothermia, and higher peak parasitemia than females during infection, with WT, RAG1, TCR␤␦ ؊/؊ , and MT mice exhibiting the most pronounced sexual dimorphism. The absence of IFN-␥ reduced the sex difference in mortality and was more detrimental to females than males. These data suggest that differential transcription and translation of IFN-␥, that is influenced by estrogens, may mediate sex differences in response to malaria.Males are more susceptible to many protozoan infections than females and field and laboratory studies link increased susceptibility to infection with circulating steroid hormones (17,18,39). One genus of protozoan parasites that causes a pronounced sexual dimorphism in vertebrate hosts is Plasmodium. Among humans, although the incidence of infection is often similar between the sexes (see references 51 and 52), sex differences in the intensity of infection are reported in which men have higher parasitemia than women (23, 32, 52). The observation that P. falciparum (i.e., a human malaria parasite) density increases at puberty in men, but not in women, suggests that circulating sex steroids may influence this outcome (23).Studies of rodent malarias have confirmed that males are more likely to die after blood-stage malaria infection than are females (2,3,(54)(55)(56)

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“…23 Even when pretravel advice is sought, adherence to travel recommendations, suboptimal in standard travelers, [24][25][26][27] may be worse among VFRs. 28,29 Of 307 Canadians of Asian origin traveling to India, only 31% intended to use malaria chemoprophylaxis and fewer than 10% intended to use mosquito prevention. The majority sought pretravel advice from family practitioners of whom 76% prescribed inappropriate malaria chemoprophylaxis.…”

Section: Barriers To Pretravel Health Advicementioning

confidence: 99%

Travel Medicine Considerations for North American Immigrants Visiting Friends and Relatives

Bacaner¹

2004

JAMA

213

119

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RAVEL MEDICINE TRADITIONally focuses on assisting tourist and business travelers avoid travel-related illnesses. It is now clear that immigrants returning to their home countries, termed visiting friends and relatives (VFRs), are at particularly high risk and that traditional travel services are inadequate for protecting this population. This article will review existing data concerning the increased risk and discuss practical recommendations that may assist the primary care and travel clinicians.International migration has risen from 120 million in 1990 to 175 million in 2002. 1,2 In 2002 more than 1 million persons legally immigrated to the United States from more than 220 countries. 3 Twenty percent of the US population are first-generation immigrants or their children are. 4 In spite of being a minority of the population, VFRs comprised approximately 40% of US international air travelers in 2002. 5 Similarly, in the United Kingdom, VFRs made 40% of the 2 million visitors to Africa in 2000. 6,7 Although no VFR demographics exist, it is assumed that national statistics pertaining to immigration patterns reflect subsequent travel patterns for immigrants. There have been major shifts in

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Predictive Factors of Malaria in Travelers to Areas Where Malaria Is Endemic

Abstract: Malaria should be suspected in all patients presenting with complaints after travel to an area where malaria is endemic, and these patients should undergo blood microscopy.

Cited by 73 publications

References 25 publications

Rapid Diagnosis of Vivax Malaria by the SD Bioline Malaria Antigen Test When Thrombocytopenia Is Present

Rapid Diagnosis of Vivax Malaria by the SD Bioline Malaria Antigen Test When Thrombocytopenia Is Present

Involvement of Gonadal Steroids and Gamma Interferon in Sex Differences in Response to Blood-Stage Malaria Infection

Travel Medicine Considerations for North American Immigrants Visiting Friends and Relatives

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