Post-malaria neurological syndrome manifesting as new onset psychosis with generalized encephalopathy: an analysis of two cases in children

Post-malaria neurological syndrome(PMNS) is a rare heterogenous syndrome heralded by the appearance of new neurological or psychiatric manifestations emerging in the post-infectious phase after clearance of malaria parasitaemia. Most cases of PMNS have been described in adults. Only seven cases have been reported in children. We describe two further cases of possible PMNS who presented with prominent psychiatric manifestations evolving into generalized encephalopathy after complete recovery from malaria. Both patients were treated with antivirals and antibiotics without clinical improvement. One patient received pulse corticosteroids and had a remarkable and rapid clinical improvement. The other recovered without specific treatment.

Determination of Dengue Virus IGM Seroprevalence, Malaria Parasitaemia and Some Haematological Parameters of HIV Infected Individuals in Awka, Nigeria

Dengue fever is regarded as an important neglected Arboviral disease worldwide. This study aimed at investigating the prevalence of dengue IgM seroprevalence, malaria parasitaemia and some haematological parameters of HIV infected individuals attending Chukwuemeka Odumegwu Ojukwu Teaching Hospital Amaku, Awka, Nigeria. A cross sectional study consisting of 188 participants was performed. The demographic data and possible risks factors of the subjects were obtained using well-structured questionnaire. Dengue virus IgM was analysed using Enzyme-linked immunosorbent assay (ELISA) techniques, Malaria parasitaemia was determined using microscopy technique while some haematological parameters were evaluated using heamatology auto analyser (PE-6800 fully auto heamatology analyser procan). Statistical analysis was performed using the statistical package for social (spss) version 25. The results of this study showed that the prevalence of Dengue virus was 20.2% while that of Malaria was 37.2%. The co-infection of Dengue virus IgM antibodies and Malaria parasitemia was 8.51%. Plasmodium falciparium was seen as the only specie of malaria parasite present in the study. The results of some haematogical parameters of the Dengue virus seropositive participants as compared with the Dengue virus seronegative participants were statistically significant with neutrophils (p = 0.035), mean cell hemoglobin concentration (MCHC = p<0.013), eosinophils (EOS = p<0.001) and mean corpuscular volume (MCV = p<0.001). This study suggests that Dengue maybe the emerging cause of fever of unknown origin among populations. This calls for urgent attention, adoption of immediate control measures and public health preventive actions against the disease so as to curb or mitigate the emergence as well as reduce the morbidity and mortality resulting from dengue burden especially in the immunocompromised individuals.

Evaluation of pilot implementation of seasonal malaria chemoprevention on morbidity in young children in Northern Sahelian Ghana

Background In Sahelian Africa, the risk of malaria increases with the arrival of the rains, particularly in young children. Following successful trials, the World Health Organization (WHO) recommended the use of seasonal malaria chemoprevention (SMC) in areas with seasonal peak in malaria cases. This study evaluated the pilot implementation of SMC in Northern Ghana. Methods Fourteen communities each serving as clusters were selected randomly from Lawra District of Upper West Region as intervention area and West Mamprusi District in the Northern Region as the non-intervention area. The intervention was undertaken by the National Malaria Control Programme in collaboration with regional health directorates using sulfadoxine-pyrimethamine plus amodiaquine and standard WHO protocols. Before and after surveys for malaria parasitaemia and haemoglobin levels as well as monitoring for malaria morbidity and mortality were undertaken. Results At the end of the intervention, participant retention was 92.9% (697/731) and 89.5% (634/708) in the intervention and the non-intervention areas, respectively. The proportion of children with asexual parasites reduced by 19% (p = 0.000) in the intervention and increased by 12% (p = 0.000) in the non-intervention area. Incidence rates of severe malaria were 10 and 20 per 1000 person-years follow up in the intervention and comparison areas, respectively with P.E of 45% (p = 0.62). For mild malaria, it was 220 and 170 per 1000 person-years in intervention and comparison area, respectively with PE of - 25% (p = 0.31). The proportion of children with anaemia defined as Hb< 11.0 g/dl reduced from 14.2% (52.8–38.6%) in the intervention area as compared to an increase of 8.1% (54.5% to 62.6) the non-intervention arm, Mean Hb reduced by 0. 24 g/dl (p = 0.000) in the non-intervention area and increased of 0.39 g/dl (p = 000) in the intervention area. Conclusions The feasibility and effectiveness of SMC introduction in Northern Ghana was demonstrated as evidenced by high study retention, reduction in malaria parasitaemia and anaemia during the wet season.

Assessment of Malaria Parasitaemia among the Residents of Abuja Municipal Area Council (AMAC), FCT, Abuja, Nigeria

Malaria intensity in both Urban and Rural areas of Nigeria is of Public Health importance. This study was conducted to assess the malaria parasitaemia among the residence of Abuja Municipal Area Council, FCT, in order to provide epidemiological data on malaria in the council for effective management program. A total of 200 residence within the range of 2-50 years were sampled for malaria parasitaemia using thick and thin film smears. A capillary blood sample was collected from each of the residence using finger prick technique, thick and thin blood films were prepared, stained, dried and examined for malaria parasites. The data was analyzed using simple percentages and chi-square analytical methods. The result from the study revealed an overall prevalence of 54.0% while the proportion of the residence infected were highest within the 2-10 years age-group (76.9%, P = 0.003, X2 = 8.42) followed by those in 11-20 years (65.0%) and 21-30 years (50.0%). Those in 31-40 years and 41-50 years (29-7% and 21.4%) had lowest. The highest density recorded was >10,000 parasites/ul across the positives as 2-10 years (P = 0.003, X2 = 2.22) has the highest. Malaria parasitaemia was highest among the vulnerable group 2-10 years (P = 0.003, X2 = 2.22) in the council and remain endemic. There is an urgent need to identify innovative and integrated control measures to reduce the scurge among them. Public Health education campaign against malaria infection and its agent (mosquito) should be intensified in the Council.

Asymptomatic and sub-microscopic Plasmodium falciparum infection in children in the Mount Cameroon area: a cross-sectional study on altitudinal influence, haematological parameters and risk factors

Background The Mount Cameroon area has experienced a 57.2% decline in confirmed malaria cases between 2006 and 2013 with the implementation of different control measures but, the disease is still of public health concern. The objective of the study was to assess the burden of asymptomatic and sub-microscopic Plasmodium infection, altitudinal influence on it, their effect on haematological parameters as well as identify the risk factors of infection. Methodology A cross-sectional community-based survey involving 1319 children of both sexes aged 6 months to 14 years was conducted between July 2017 and May 2018. Malaria parasitaemia was confirmed by Giemsa-stained microscopy, sub-microscopic Plasmodium infection by 18S mRNA using nested PCR and full blood count analysis was done using an auto haematology analyser. Results Malaria parasite, asymptomatic malaria parasitaemia and sub-microscopic Plasmodium infection and anaemia were prevalent in 36.4%, 34.0%, 43.8% and 62.3% of the children, respectively. The risk of having sub-microscopic Plasmodium infection was highest in children 5‒9 (OR = 3.13, P < 0.001) and 10‒14 years of age (OR = 8.18, P < 0.001), non-insecticide treated net users (OR = 1.69, P < 0.04) and those anaemic (OR = 9.01, P < 0.001). Children with sub-microscopic infection had a significantly lower mean haemoglobin (9.86 ± 1.7 g/dL, P < 0.001), red blood cell counts (4.48 ± 1.1 × 1012/L, P < 0.001), haematocrit (31.92%, P < 0.001), mean corpuscular haemoglobin concentration (313.25 ± 47.36, P = 0.035) and platelet counts (280.83 ± 112.62, P < 0.001) than their negative counterparts. Children < 5 years old (73.8%), having asymptomatic (69.8%) and sub-microscopic Plasmodium infection (78.3%) as well as resident in the middle belt (72.7%) had a higher prevalence of anaemia than their peers. Conclusion The meaningful individual-level heterogeneity in the burden of asymptomatic and sub-microscopic Plasmodium infection in addition to its corollary on haematological variables among children in the different attitudinal sites of the Mount Cameroon Region accentuate the need for strategic context specific planning of malaria control and preventative measures.

Effect of a single dose of oral azithromycin on malaria parasitaemia in children: a randomized controlled trial

Background Azithromycin has recently been shown to reduce all-cause childhood mortality in sub-Saharan Africa. One potential mechanism of this effect is via the anti-malarial effect of azithromycin, which may help treat or prevent malaria infection. This study evaluated short- and longer-term effects of azithromycin on malaria outcomes in children. Methods Children aged 8 days to 59 months were randomized in a 1:1 fashion to a single oral dose of azithromycin (20 mg/kg) or matching placebo. Children were evaluated for malaria via thin and thick smear and rapid diagnostic test (for those with tympanic temperature ≥ 37.5 °C) at baseline and 14 days and 6 months after treatment. Malaria outcomes in children receiving azithromycin versus placebo were compared at each follow-up timepoint separately. Results Of 450 children enrolled, 230 were randomized to azithromycin and 220 to placebo. Children were a median of 26 months and 51% were female, and 17% were positive for malaria parasitaemia at baseline. There was no evidence of a difference in malaria parasitaemia at 14 days or 6 months after treatment. In the azithromycin arm, 20% of children were positive for parasitaemia at 14 days compared to 17% in the placebo arm (P = 0.43) and 7.6% vs. 5.6% in the azithromycin compared to placebo arms at 6 months (P = 0.47). Conclusions Azithromycin did not affect malaria outcomes in this study, possibly due to the individually randomized nature of the trial. Trial registration This study is registered at clinicaltrials.gov (NCT03676751; registered 19 September 2018).

Prevalence and density of malaria parasitaemia amongst HIV Individuals in Warri, Nigeria

Background: Malaria parasite has been observed to be a common infection in Human Immunodeficiency virus (HIV), an increase malaria infection in adults. Objective: This experimental study is sets to determine the prevalence and density of malaria parasitaemia in Warri com- munity, South-Southern Nigeria. Methods and Results: A total of 600 participants were screened for Human immunodeficiency virus and malaria parasite using WHO systems two and Geimsa staining technique for thick and thin blood films and absolute parasite counts done respectively. The prevalence rate of 38% and 39% were obtained for malaria parasite infection among HIVSP and HIV/ span>SN respectively. The difference in malaria parasite infection was not statistically significant (P>0.05) between HIVSP and HIVSN. However, the mean parasite density in HIVSP was significant (P<0.05) when compared with HIVSN. The mean parasite densities of 2384 ± 747 and 1883 ± 645 were recorded for HIVSP and HIVSN respectively. The mean par- asite densities of 2385 ± 782 and 2383 ± 717 observed for males and females respectively showed no statistical significant difference (P<0.05). Conclusion: This study has shown a high prevalence of malaria parasite among the HIV infected subjects. Keywords: Density; Malaria; HIV; prevalence; Nigeria.

Clinical features of bacterial meningitis among hospitalised children in Kenya

Background Diagnosing bacterial meningitis is essential to optimise the type and duration of antimicrobial therapy to limit mortality and sequelae. In sub-Saharan Africa, many public hospitals lack laboratory capacity, relying on clinical features to empirically treat or not treat meningitis. We investigated whether clinical features of bacterial meningitis identified prior to the introduction of conjugate vaccines still discriminate meningitis in children aged ≥60 days. Methods We conducted a retrospective cohort study to validate seven clinical features identified in 2002 (KCH-2002): bulging fontanel, neck stiffness, cyanosis, seizures outside the febrile convulsion age range, focal seizures, impaired consciousness, or fever without malaria parasitaemia and Integrated Management of Childhood Illness (IMCI) signs: neck stiffness, lethargy, impaired consciousness or seizures, and assessed at admission in discriminating bacterial meningitis after the introduction of conjugate vaccines. Children aged ≥60 days hospitalised between 2012 and 2016 at Kilifi County Hospital were included in this analysis. Meningitis was defined as positive cerebrospinal fluid (CSF) culture, organism observed on CSF microscopy, positive CSF antigen test, leukocytes ≥50/μL, or CSF to blood glucose ratio <0.1. Results Among 12,837 admissions, 98 (0.8%) had meningitis. The presence of KCH-2002 signs had a sensitivity of 86% (95% CI 77–92) and specificity of 38% (95% CI 37–38). Exclusion of ‘fever without malaria parasitaemia’ reduced sensitivity to 58% (95% CI 48–68) and increased specificity to 80% (95% CI 79–80). IMCI signs had a sensitivity of 80% (95% CI 70–87) and specificity of 62% (95% CI 61–63). Conclusions A lower prevalence of bacterial meningitis and less typical signs than in 2002 meant the lower performance of KCH-2002 signs. Clinicians and policymakers should be aware of the number of lumbar punctures (LPs) or empirical treatments needed for each case of meningitis. Establishing basic capacity for CSF analysis is essential to exclude bacterial meningitis in children with potential signs.

Prevalence of Concomitant Infection of Intestinal Helminthiasis with Malaria Parasitaemia in a typical Nigeria Suburban Areas.

Helminthic infestation and malaria parasitaemia, separately or co- joined, can be present, in a host and still be asymptomatic. It is, therefore, crucial to assess the extent of co-infestation among individuals, particularly children who are most prone to parasitic infestations. Blood and Stool samples were collected from 557 pupils who were examined for intestinal helminths, malaria parasitaemia and anaemia. Formal acetate concentration method was used to analyse the stool specimens after which positive ones were further processed using Stolls method of counting helminths egg to determine the number of parasite per gram of stool. Thick film was used for malaria parasite test and malaria parasite density was calculated for the positive samples while anaemia was screened using cyanmethaemoglobin method. There were 235(42.2%) pupils co-infested with intestinal helminths and malaria parasitaemia Co-infestation of Ascaris lumbricoides and malaria parasitaemia 91(16.3%), and co-infection with hookworm and malaria parasitaemia 72(13.0%) had the highest prevalence. The percentage of pupils co-infested and anaemic were 130(23.3%) and is statistically significant (p > 0.05) across the communities. There was a negative correlation between haemoglobin concentrations (the indicator of anaemia), helminthic count with malaria parasite density count. This study revealed that intestinal helminths and malaria parasitaemia have a resurgence and concomitant infestation which constitutes a public menace. Co-infection increased the risk associated with anaemia and intensify the burden in Nigerian children. Keywords: Co-infestation, malaria parasitaemia, intestinal helminthiasis, anaemia, pupils