Transfusion-Transmitted Malaria of Plasmodium malariae in Palermo, Sicily

Transfusion-transmitted malaria (TTM) is a rare occurrence with serious consequences for the recipient. In non-endemic areas, the incidence of transmission of malaria by transfusion is very low. We report a clinical case of transfusion-transmitted malaria due to Plasmodium malariae, which happened in a patient with acute hemorrhagic gastropathy. Case presentation: In April 2019, a 70-year-old Italian man with recurrent spiking fever for four days was diagnosed with a P. malariae infection, as confirmed using microscopy and real-time PCR. The patient had never been abroad, but about two months before, he had received a red blood cell transfusion for anemia. Regarding the donor, we revealed that they were a missionary priest who often went to tropical regions. Plasmodium spp PCR was also used on donor blood to confirm the causal link. Discussion and Conclusions: The donations of asymptomatic blood donors who are predominantly “semi-immune” with very low parasitic loads are an issue. The main problem is related to transfusion-transmitted malaria. Our case suggests that P. malariae infections in semi-immune asymptomatic donors are a threat to transfusion safety. Currently, microscopy is considered the gold standard for the diagnosis of malaria but has limited sensitivity to detect low levels of parasitemia. Screening using serological tests and molecular tests, combined with the donor’s questionnaire, should be used to reduce the cases of TTM.

Download Full-text

Systematic Review into Diagnostics for Post-Kala-Azar Dermal Leishmaniasis (PKDL)

Journal of Tropical Medicine ◽

10.1155/2013/150746 ◽

2013 ◽

Vol 2013 ◽

pp. 1-8 ◽

Cited By ~ 16

Author(s):

Emily R. Adams ◽

Inge Versteeg ◽

Mariska M. G. Leeflang

Keyword(s):

Diagnostic Accuracy ◽

Clinical Symptoms ◽

Statistical Modelling ◽

Study Quality ◽

Serological Tests ◽

Molecular Tests ◽

Kala Azar ◽

Valid Estimate ◽

Low Sensitivity ◽

Control Designs

Identification of post-kala-azar dermal leishmaniasis (PKDL) is important due to the long and toxic treatment and the fact that PKDL patients may serve as a reservoir for visceral leishmaniasis (VL). We summarized the published literature about the accuracy of diagnostic tests for PKDL. We searched Medline for eligible studies investigating the diagnostic accuracy of any test for PKDL. Study quality was assessed using QUADAS-2. Data were extracted from 21 articles including 43 separate studies. Twenty-seven studies evaluated serological tests (rK39 dipstick, ELISA, DAT, and leishmanin tests), six studies molecular tests, eight microscopy, and two cultures. Only a few of these studies reported a valid estimate of diagnostic accuracy, as most were case-control designs or used a reference standard with low sensitivity. The included studies were very heterogeneous, for example, due to a large variety of reference standards used. Hence, no summary estimates of sensitivity or specificity could be made. We recommend well-designed diagnostic accuracy trials that evaluate, side-by-side, all currently available diagnostics, including clinical symptoms, serological, antigen, molecular, and parasitological tests and possible use of statistical modelling to evaluate diagnostics when there is no suitable gold standard.

Download Full-text

Asymptomatic Plasmodium Parasites among Adults in Eastern Uganda: A Case of Donor Blood Screening at Mbale Regional Blood Bank

Journal of Tropical Medicine ◽

10.1155/2018/6359079 ◽

2018 ◽

Vol 2018 ◽

pp. 1-6 ◽

Cited By ~ 1

Author(s):

Simon Peter Inyimai ◽

Mosses Ocan ◽

Benjamin Wabwire ◽

Peter Olupot-Olupot

Keyword(s):

Blood Transfusion ◽

Adult Population ◽

Sampling Technique ◽

Plasmodium Malariae ◽

Blood Bank ◽

Donor Blood ◽

Transmitted Infection ◽

Cross Sectional ◽

Blood Transfusion Service ◽

Eastern Uganda

Background. There is a paucity of data on asymptomatic carriage of Plasmodium parasite among adult population in Eastern Uganda, an area of perennial high transmission of malaria. In this study, we estimated the prevalence of Plasmodium parasites in donor blood units at Mbale Regional Blood Bank (Mbale RBB), a satellite centre of the Uganda Blood Transfusion Service (UBTS). Method. This was a cross-sectional descriptive study in which 380 screened donor blood units were examined for the presence of Plasmodium parasites. A systematic random sampling technique using the interval of 7 was used in selecting the screened blood units for testing. Two experienced malaria slide microscopists (MC1 and MC2) independently examined each thick and thin blood slide under high power magnification of X400 and then X1000 as stated on the study standard operation procedure (SOP). Each slide was examined for 100 oil immersion fields before the examiner declared them negative for Plasmodium parasites. The results by each microscopist’s examination were tallied separately, and finally, the two tallies were compared. The third independent microscopist (MC3) was blinded to the results from MC1 and MC2, but whose role was to perform quality control on the slides randomly sampled and read 38 (10%) of all the slides and was available to examine any slides with inconsistent findings by MC1 or MC2. Results. All the microscopists were unanimous in all the slide readings. Five of the thick smears (1.3%) confirmed the presence of Plasmodium parasites among donor blood units. Of these, 4/5 were from male donors. Plasmodium falciparum was identified in 4 positive samples, while Plasmodium malariae was identified in one of the donor units. Conclusion. The 1.3% prevalence of Plasmodium malaria parasites in screened donor blood units represents risk of malaria blood transfusion transmitted infection and a pool of community transmittable malaria infections, respectively.

Download Full-text

Sensitivity, Specificity and Predictive Values of Molecular and Serological Tests for COVID-19: A Longitudinal Study in Emergency Room

Diagnostics ◽

10.3390/diagnostics10090669 ◽

2020 ◽

Vol 10 (9) ◽

pp. 669 ◽

Cited By ~ 4

Author(s):

Zeno Bisoffi ◽

Elena Pomari ◽

Michela Deiana ◽

Chiara Piubelli ◽

Niccolò Ronzoni ◽

...

Keyword(s):

Emergency Room ◽

Latent Class ◽

Single Gene ◽

Molecular Test ◽

Clinical Context ◽

Serological Tests ◽

Predictive Values ◽

Molecular Tests ◽

Sensitivity Specificity

Background: We assessed the sensitivity, specificity and positive and negative predictive value (PPV and NPV) of molecular and serological tests for the diagnosis of SARS-CoV-2 infection. Methods: A total of 346 patients were enrolled in the emergency room. We evaluated three Reverse Transcriptase-real time PCRs (RT-PCRs) including six different gene targets, five serologic rapid diagnostic tests (RDT) and one ELISA. The final classification of infected/non-infected patients was performed using Latent Class Analysis combined with clinical re-assessment of incongruous cases. Results: Out of these, 24.6% of patients were classified as infected. The molecular test RQ-SARS-nCoV-2 showed the highest performance with 91.8% sensitivity, 100% specificity, 100.0% PPV and 97.4% NPV respectively. Considering the single gene targets, S and RdRp of RQ-SARS-nCoV-2 had the highest sensitivity (94.1%). The in-house RdRp presented the lowest sensitivity (62.4%). The specificity ranged from 99.2% for in-house RdRp and N2 to 95.0% for E. The PPV ranged from 97.1% of N2 to 85.4% of E and the NPV from 98.1% of S to 89.0% of in-house RdRp. All serological tests had < 50% sensitivity and low PPV and NPV. VivaDiag IgM (RDT) had 98.5% specificity, with 84.0% PPV, but 24.7% sensitivity. Conclusion: Molecular tests for SARS-CoV-2 infection showed excellent specificity, but significant differences in sensitivity. Serological tests have limited utility in a clinical context.

Download Full-text

Successful Peripheral Blood Stem Cell (PBSC) Mobilisation with G-CSF in Patients with Chronic Myeloid Leukaemia Achieving Complete Cytogenetic Remission with Imatinib.

Blood ◽

10.1182/blood.v104.11.4652.4652 ◽

2004 ◽

Vol 104 (11) ◽

pp. 4652-4652

Author(s):

A.M. Carella ◽

Maria T. Corsetti ◽

Carlo Bodenizza ◽

Francesco Iuliano ◽

Giulia Pucci ◽

...

Keyword(s):

Stem Cell ◽

Peripheral Blood Stem Cell ◽

The Other ◽

Cell Yield ◽

Molecular Tests ◽

Cytogenetic Remission ◽

Low Levels ◽

Term Management ◽

Hematological Remission

Abstract The clinical studies have demonstrated the efficacy of Imatinib in the induction of hematological remission, cytogenetic remission (CCR) and molecular reduction of the bcl-abl transcript as shown by RT-qPCR. Unfortunately, the optimal long-term management of patients who achieve CCR after Imatinib is unknown. It is unclear that Imatinib alone will prove to be curative and initial responders may eventually lose Imatinib responsiveness. Therefore it may be prudent to collect autologous PBSC in CCR patients treated with Imatinib with low levels of detectable leukemia analyzed by molecular tests. We evaluated G-CSF mobilisation of PBSC in 18 patients who have achieved CCR with Imatinib. Our data demonstrated that the target CD34+ cell yields of ≥ 2.0x106/kg was attained with G-CSF at the dose of 10 mg/kg/day in 4/8 (50%) patients during uninterrupted Imatinib therapy and in 8/10 (80%) when Imatinib was temporarily interrupted. Three patients (37%) in the first group and 7 patients (70%) in the second group achieved >1x106/kg CD34+ cell yield per apheresis. Twelve patients were evaluated on PBSC for bcr-abl by RT-qPCR. Three patients were negative and in the other 9 patients, a median of 0.20 (range, 0.02–8.6) remained detectable. These data compared favourably with a median of 0.04 (range, 0.02 – 0.86) of all measurements taken before mobilisation. There was no impact of G-CSF mobilisation on the CML as measured by cytogenetic and serial blood bcr-abl levels. In conclusion, PBSC mobilisation with Imatinib and G-CSF in CCR patients is feasible, CD34+ cell yield is significantly better with temporary withheld of Imatinib, G-CSF did not preferentially mobilize leukemic progenitors and leukemic burden did not show significant change in the months following G-CSF mobilisation.

Download Full-text

Otogenic tetanus: Case presentation

The Journal of Laryngology & Otology ◽

10.1017/s0022215100088356 ◽

1979 ◽

Vol 93 (12) ◽

pp. 1235-1236 ◽

Cited By ~ 4

Author(s):

R. L. Blair ◽

D. Hussarau

Keyword(s):

North America ◽

Rare Disease ◽

Operative Treatment ◽

Early Years ◽

Primary Immunization ◽

Radical Mastoidectomy ◽

Case Presentation ◽

Tropical Regions ◽

Ear Injury ◽

Immunization Programmes

AbstractTetanus resulting from ear injury is extremely rare. However, the otologist should be aware that it does occur. A case of otogenic tetanus recently treated by the authors is presented.In Western countries tetanus in now a rare disease because of extensive immunization programmes. Otogenic tetanus is extremely uncommon in North America, but occurs more frequently in tropical regions (De and De, 1970).Less than forty new cases of tetanus are seen in the Province of Ontario (population, 8·4 million) each year (Department of Statistics, Government of Ontario).It has been stated that the operative treatment of otogenic tetanus should include radical mastoidectomy (Black and Atkins, 1972). This is probably true in severe cases but milder cases do not require this form of therapy.Most children in Canada receive primary immunization with Diphtheria, Tetanus and Pertussis vaccine (DTP) in the early years of life. However, especially in large urban centres, there is a large non-immunized or partially immunized immigrant population.Tetanus occurring in such an immigrant is described.

Download Full-text

SARS-CoV-2 and COVID-19: A Brief Review for Family Physicians

Osteopathic Family Physician ◽

10.33181/12042 ◽

2020 ◽

pp. 20-27

Author(s):

Bindu Mayi ◽

Aarti Raja ◽

Gina Foster-Moumoutjis ◽

Pamela Moran-Walcutt ◽

Mayur Parmar ◽

...

Keyword(s):

Immune Response ◽

Severe Disease ◽

Collective Responsibility ◽

The Elderly ◽

Host Factors ◽

Prevention Measures ◽

Prophylactic Regimen ◽

Serological Tests ◽

Molecular Tests ◽

Inflammatory Syndrome

SARS-CoV-2, the newest coronavirus, causes COVID-19, a disease that runs the gamut of symptoms from none too mild to severe to death. The severe cases are most often due to acute respiratory distress. In addition to pulmonary symptoms, the virus causes a wide variety of pathological manifestations involving multiple other systems, including eliciting an exaggerated immune response that contributes to fatalities. The elderly are at the highest risk of severe disease. Higher mortality is seen among males, along with individuals with pre-existing comorbidities such as cardiovascular disease and diabetes, among others. Although pregnancy has not been identified as a risk factor yet, more research is needed to assess vertical transmission and strict perinatal precautions are recommended to minimize infecting newborns. Although COVID-19 in children is less likely to be severe, recent cases, albeit rare, have emerged of a multiorgan inflammatory syndrome, similar to Kawasaki disease. Early diagnosis can be done using molecular tests that detect viral genome, while cases manifesting late symptoms can be detected using serological tests looking for antibodies. Although there are no FDA-approved vaccines or therapeutics for prophylaxis, there are many viable vaccine candidates either in clinical trials or awaiting study in humans. Of the several drugs being considered for treatment, some target the virus, while others address the host factors that facilitate virus infection, from proteases that enable virus entry, to cytokines that elicit a harmful and out-of-control immune response. While we await a standardized prophylactic regimen, it is our collective responsibility to continue engaging in prevention measures.

Download Full-text

Comparative Analysis of the Serological Reactivity of Individuals with Clinical History of Malaria using Two Different ELISA Tests

Diagnostics ◽

10.3390/diagnostics9040168 ◽

2019 ◽

Vol 9 (4) ◽

pp. 168

Author(s):

Yorleydy Ruiz Moreno ◽

Silvia Tavares Donato ◽

Fátima Nogueira ◽

Marcelo Sousa Silva

Keyword(s):

Clinical History ◽

Negative Control ◽

Enzyme Linked Immunosorbent Assay ◽

Serological Response ◽

Serum Samples ◽

Serological Tests ◽

Serological Reactivity ◽

History Of ◽

Low Levels ◽

Antigenic Reactivity

Early diagnosis of malaria reduces disease, prevents deaths, and contributes to decreased malaria transmission. The use of specific and sensitive antigens in the execution of serological diagnostics may have an impact on the transmission of the disease. However, many individuals cannot be easily diagnosed by serological tests due to low levels of antibodies in the serum. Using two different Enzyme-Linked Immunosorbent Assay (ELISA) tests (a commercial and an in-house ELISA), a total of 365 serum samples from individuals with a clinical history of malaria were analyzed. From the serum samples analyzed, 192 (53%) samples from the commercial ELISA and 219 (60%) samples from the in-house ELISA presented positive serological reactivity to malaria. The concordance of the samples tested (n = 365) between both ELISAs was of 67% (n = 242), and with the negative control was 100% (n = 17). We demonstrated that the in-house ELISA showed high antigenic reactivity to Plasmodium falciparum antigens when compared with the commercial ELISA. The degree of concordance of both ELISAs suggested the possibility of existence of other P. falciparum antigens present in the crude extract of P. falciparum that are important in the serological response during malaria infection.

Download Full-text

Methemoglobinaemia in Diabetic Ketoacidosis Patient

New Emirates Medical Journal ◽

10.2174/03666211227181618 ◽

2021 ◽

Vol 03 ◽

Author(s):

Magdy Mohamed ◽

Nadem Javed

Keyword(s):

Ascorbic Acid ◽

Family History ◽

Diabetic Ketoacidosis ◽

G6pd Deficiency ◽

Genetic Disorder ◽

Red Blood Cell Transfusion ◽

Case Presentation ◽

History Of ◽

Insulin Dependent ◽

Glucose 6 Phosphate Dehydrogenase

Background: Glucose-6-phosphate dehydrogenase (G6PD) deficiency is a common X-linked genetic disorder. Case Presentation: In this paper, we report a case of a 41-years-old male patient with non-insulin-dependent diabetes and a family history of G6PD deficiency never known to have any previous hemolytic episodes, presented as a case of diabetic ketoacidosis with features of hemolytic anemia due to G6PD deficiency manifesting as methemoglobinemia and anemia. Conclusion: Our patient successfully managed with ascorbic acid and red blood cell transfusion. Clinicians should, therefore, be aware of the possibility of this uncommon association between diabetic ketoacidosis, G6PD deficiency, and methemoglobinemia which may be present in patients with G6PD deficiency and severe hemolysis.

Download Full-text

Neurosyphilis presenting as psychiatric symptoms: an unusual case report

Acta Neuropsychiatrica ◽

10.1111/j.1601-5215.2007.00209.x ◽

2007 ◽

Vol 19 (4) ◽

pp. 251-253 ◽

Cited By ~ 4

Author(s):

Hasan Mirsal ◽

Ayhan Kalyoncu ◽

Özkan Pektaş ◽

Mansur Beyazyürek

Keyword(s):

Psychiatric Symptoms ◽

Treponema Pallidum ◽

Antibody Test ◽

Risk Groups ◽

Serological Tests ◽

Case Presentation ◽

Antibody Absorption ◽

Gradual Loss ◽

Neuropsychiatric Diseases ◽

Organic Brain

Objective:Neurosyphilis remains a differential diagnosis for a wide variety of psychiatric syndromes, including dementia, mood disorders and psychosis. However, the incidence of neurosyphilis presenting initially with psychiatric symptomalogy is unclear. In this article, a clinical case is reported so as to illustrate some of the issues involved.Case presentation:A 33-year-old married man was admitted because of a depressive episode associated with somatic preoccupations and a gradual loss of ability to function a year prior to his admission. The symptoms described above raised the question of an organic brain syndrome associated with the psychotic depression. Some laboratory and additional examinations were performed. Serological tests for syphilis were positive for both the hemagglutination test, Treponema pallidum hemaglutination (TPHA), and the immunofluorescent antibody test, fluorescent treponemal antibody-absorption (FTA-ABS). Based on these findings, the diagnosis of neurosyphilis was made. The patient was treated with benzathine penicillin (2 400 000 units i.m. once a week) for 3 weeks and venlafaxine (150 mg daily) and olanzapine (5 mg daily). His depression disappeared gradually, and he was discharged in partial remission.Conclusion:High-risk groups such as patients with neuropsychiatric diseases should be screened with serological tests so as to prevent morbidity and help eliminate syphilis.

Download Full-text

Oral sodium phenylbutyrate for hyperammonemia associated with congenital portosystemic shunt: a case report

Journal of Pediatric Endocrinology and Metabolism ◽

10.1515/jpem-2020-0603 ◽

2020 ◽

Vol 0 (0) ◽

Author(s):

Takeshi Sato ◽

Tomohiro Ishii ◽

Mototoshi Kato ◽

Takayuki Oyanagi ◽

Seishi Nakatsuka ◽

...

Keyword(s):

Portosystemic Shunt ◽

Psychomotor Development ◽

Case Presentation ◽

The Third ◽

Congenital Portosystemic Shunt ◽

Low Levels ◽

Portal Veins ◽

Branched Chain ◽

Oral Sodium ◽

Sodium Phenylbutyrate

AbstractObjectivesThe efficacy of sodium phenylbutyrate (SPB) for hyperammonemia associated with congenital portosystemic shunt (CPSS) remains unknown. We show the effectiveness of oral SPB.Case presentationOur patient had CPSS with severe hypoplasia of extrahepatic portal veins. At 9 months of age, to assess the efficacy of oral SPB, we evaluated the 24 h fluctuations of venous ammonia levels. In the first two days without SPB, ammonia levels were above 80 μmol/L for half a day. On the third and fourth days, administration of oral SPB three times a day decreased ammonia to acceptable levels, except at midnight. On the fifth day, another oral SPB administration at 8 pm decreased ammonia at midnight. Low levels of branched-chain amino acids, as well as coagulation disturbances, were observed without apparent symptoms. At 12 months of age, he showed normal psychomotor development.ConclusionsOral SPB may be effective for hyperammonemia associated with CPSS.

Download Full-text