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Problems Associated with the Diagnosis of Imported Malaria in Anhui Province, China.

ABSTRACT: Imported malaria in Anhui Province, China, remains a significant public health issue with frequent reporting of severe and fatal cases, partly because of globalization and increased international communication. A retrospective evaluation using surveillance data from 2012 to 2018 was conducted to draw lessons on diagnosis of imported malaria. Epidemiological characteristics, together with diagnostic information, were analyzed using descriptive and comparative statistics. Simultaneously, blinded rechecking of malaria blood slides was performed at general hospitals in Anhui Province in 2018. The results showed that, in their first medical visits, 238 (28.2%) of 844 imported cases were not correctly diagnosed. Notably, the proportion of patients who were misdiagnosed at the first clinic visit was 104/120 (86.7%) at private and village clinics, and 41/81 (50.6%) at primary hospitals. The species identification rates for Plasmodium falciparum, Plasmodium vivax, Plasmodium ovale, and Plasmodium malariae were 85.2%, 66.7%, 23.2%, and 32.3% (?² = 224, P < 0.001), respectively. Nearly 7% of cases lacked laboratory evidence and were classified as presumed cases. Our findings suggest that physicians and health care providers, especially those at the primary level, lacked the awareness of diagnosing imported malaria. The training of physicians in malaria diagnosis needs to be enhanced. In addition, polymerase chain reactions (previously only carried out at the provincial level) should be performed at municipal CDC for rapid species identification, thereby guiding clinical treatment.

SUBMITTER: Li W

PROVIDER: S-EPMC6947788 | biostudies-literature | 2020 Jan

REPOSITORIES: biostudies-literature

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Problems Associated with the Diagnosis of Imported Malaria in Anhui Province, China.

Li Weidong W Zhang Tao T Xu Xian X Jiang Jingjing J Yu Chen C Tian Cuicui C Wang Shuqi S Lyu Xiaofeng X Liu Zhirong Z

The American journal of tropical medicine and hygiene 20200101 1

Imported malaria in Anhui Province, China, remains a significant public health issue with frequent reporting of severe and fatal cases, partly because of globalization and increased international communication. A retrospective evaluation using surveillance data from 2012 to 2018 was conducted to draw lessons on diagnosis of imported malaria. Epidemiological characteristics, together with diagnostic information, were analyzed using descriptive and comparative statistics. Simultaneously, blinded r ...[more]

PMID: 31701862

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Project description:BackgroundAnhui Province in China is facing a severe HIV epidemic with an increasing number of newly diagnosed cases.MethodsIn this study, HIV genetic characteristics in the province were investigated. Newly reported HIV-positive individuals from 15 districts of Anhui Province were enrolled and interviewed. Total viral RNA was extracted from plasma isolated from blood samples. We amplified and sequenced an HIV pol fragment of the 1062 bp. The sequences were used for determination of HIV subtypes and the presence of drug resistance mutations. Transmission networks were constructed to explore possible relationships. And all of assembled partial pol genes were submitted to the Stanford HIV Drug Resistance Database website to find the transmitted drug resistance.ResultsPartial pol gene sequences were obtained from 486 cases. The results showed that MSM was the most dominant transmission route (253, 52.06%), followed by heterosexual transmission (210, 43.21%) and blood-borne transmission (1, 0.21%). Many subtypes were identified, including CRF01_AE (226, 46.50%), CRF07_BC (151, 31.07%), subtype B (28, 5.76%), CRF08_BC (20, 4.12%), CRF55_01B (15, 3.09%), CRF68_01B (7, 1.44%), CRF67_01B (3, 0.62%), CRF57_BC (2, 0.41%), CRF59_01B (2, 0.41%), CRF79_0107 (2, 0.41%), subtype C (2, 0.41%), CRF64_BC (1, 0.21%), and circulating recombinant forms (URFs) (27, 5.55%). Four transmission subnetworks containing high transmission risk individuals (with degree ≥4) were identified based on CRF01_AE and CRF07_BC sequences, including two CRF01_AE transmission subnetworks constituted by elderly people with average ages of 67.9 and 61.5 years. Infection occurred most likely through heterosexual transmission, while the other two CRF07_BC transmission subnetworks consist mainly of MSMs with average ages of 31.73 and 34.15. The level of HIV-transmitted drug resistance is 3.09%.ConclusionsThe simultaneous spread of multiple HIV subtypes in Anhui province underscores that close surveillance of the local HIV epidemic is necessary. Furthermore, the elderly people were frequently involved, arguing for behaviour intervention in this specific population besides the MSM risk group.

Project description:BACKGROUND:Imported falciparum malaria from Africa has become a key public health challenge in Guizhou Province since 2012. Understanding the polymorphisms of molecular markers of drug resistance can guide selection of antimalarial drugs for the treatment of malaria. This study was aimed to analyze the polymorphisms of pfcrt, pfmdr1, and K13-propeller among imported falciparum malaria cases in Guizhou Province, China. METHOD:Fifty-five imported falciparum malaria cases in Guizhou Province during 2012-2016 were included in this study. Their demographic information and filter paper blood samples were collected. Genomic DNA of Plasmodium falciparum was extracted from the blood samples, and polymorphisms of pfcrt, pfmdr1, and K13-propeller were analyzed with nested PCR amplification followed by sequencing. Data were analyzed with the SPSS17.0 software. RESULTS:The prevalence of pfcrt K76T, pfmdr1 N86Y, and pfmdr1 Y184F mutation was 56.6, 22.2, and 72.2%, respectively, in imported falciparum malaria cases in Guizhou Province. We detected two mutant haplotypes of pfcrt, IET and MNT, with IET being more commonly found (54.7%), and five mutant haplotypes of pfmdr1, of which NFD was the most frequent (53.7%). There were totally 10 combined haplotypes of pfcrt and pfmdr1, of which the haplotype IETNFD possessed a predominance of 28.8%. In addition, three nonsynonymous mutations (S459T, C469F, and V692L) and two synonymous mutations (R471R and V589V) were detected in K13-propeller, all having prevalence less than 6.0%. In particular, a candidate K13 resistance mutation, C469F, was identified for the first time from Democratic Republic of the Congo with the prevalence of 2.0%. CONCLUSIONS:The high prevalence of IET haplotype of pfcrt and NFD haplotype of pfmdr1 suggests the presence of chloroquine, artemether/lumefantrine, and dihydroartemisinin/piperaquine resistance in these cases. Therefore cautions should be made to artemisinin therapy for P. falciparum in Africa. Continuous monitoring of anti-malarial drug efficacy in imported malaria cases is helpful for optimizing antimalarial drug therapy in Guizhou Province, China.

Dataset Information

Problems Associated with the Diagnosis of Imported Malaria in Anhui Province, China.

Publications

Problems Associated with the Diagnosis of Imported Malaria in Anhui Province, China.

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