Clinical Features of Children Hospitalized with Malaria- A study from Bikaner, Northwest India

Kochar DK, Tanwar GS, Khatri PC, Kochar SK, Sengar GS, Gupta A, Kochar A, Middha S, Acharya J, Saxena V, Pakalapati D, Garg S, Das A.

                A clinical prospective study was done on 303 admitted children with Malaria. Malaria is endemic in the tropics and subtropics, causing 247 million infections worldwide.  Peripheral blood smears (PBS), rapid diagnostic test (RDT), and polymerase chain reaction (PCR) test were done on admitted children to further analyze pathology. The proportions of patients infected with Plasmodium vivax were 33.99% or 102 patients out of the 303 being analyzed. The study was conducted at the Department of Pediatrics, Sadar Patel Medical College and Associated Group of Hospitals, Bikaner, Rajasthan, India from August 2007 to November 2008. The categorization criteria for children with severe Malaria were done according to the 2000 World Health Organization (WHO). Only patients with severe indices and evidence of the asexual phase of Malaria, or a positive RDT were used in this study (Kochar et. Al 2010).

            Thick and thin peripheral blood smears were used and stained with a Giesma stain and examined under oil immersion. The Rapid blood tests were based on the detection of the specific P. vivax antigen, Lactate dehydrogenase. Other tests such as complete blood count, palate count, bleeding count, clotting time, blood glucose, blood urea, serum creatine, serum bilirubin , serum aspartate aminotransferase, serum alanine aminotransferase, serum alkaline phosphate, complete urine analysis, and electrocardiogram to rule out co-infections such as typhoid fever, leptospirosis, infectious mononucleosis, and dengue fever. The PCR studies were ran against 18S ribosomal RNA gene template, a minimum of four rounds of PCR was done on each genome to eliminate overlooking co-infections (Kochar et al. 2010).

Cerebral Malaria was present in 13.9% of patients infected with severe P. vivax infections. Respiratory distress was present in 10 % of the patients infected with servere P. vivax infections. 26.2% of the patients severely infected with P. vivax suffered from Hepatic dysfunction, while 15.4% suffered from renal dysfunction. Abnormal bleeding was found in 10.8% of the patients infected with severe P.vivax. Hemoglobinuria was present in 3.1% of the patients infected with severe P.vivax. Multi-organ dysfunction was present in 47.7% of the patients infected with the severe P.vivax strain.  A total of 10 children died during the suration of the study, 60% of them died within 72 hours of the start of the study. The major causes of death for this study due to severe P. vivax infections were cerebral malaria and multi organ dysfunction (Kocher et al. 2010).

Kochar, DK, Tanwar, GS, Khatri, PC, Kochar , SK, Sengar, GS, Gupta, A, , et al. (2010). Clinical Features of Children Hospitalized with Malaria- A study from Bikaner, Northwest India. The American Journal of Tropical Medicine and Hygine , 83(5), 981-989.

A Mouse Model of Leishmania braziliensis braziliensis Infection Produced by Coinjection with Sand Fly Saliva

Leishmania braziliensis is found in Central and South America and is transmitted through the bite of a sand fly. This parasite is dangerous because L. braziliensis causes mucocutaneous leishmaniasis that cause disfiguring lesions of the nose, mouth, and other areas of the body with mucous membranes (Samuelson et al. 1991). Sand flies are carriers of multiple species of Leishmania parasites; one being L. braziliensis. When a sand fly bites a mammal for a blood meal, the sand fly salivates into the skin and transmits L. braziliensis by injecting epimastigotes. The saliva of a sand fly is thought to enhance the transmission of Leishmania species due to the saliva of the sand fly containing several substances that include a vasodilator, which is a substance that widens the blood vessels increasing blood flow (Samuelson et al. 1991).  Samuelson et al (1991) sought to confirm if sand fly saliva does effect Leishmania transmission by looking at L. braziliensis infection in mice.

In order to test if sand fly saliva does effect Leishmania transmission, a strain of L. braziliensis was isolated from a human patient and was cultured on blood agar plates. The test animals for this study were BALB/c mice, which are laboratory-bred albino house mice. Groups of five mice were injected in the hind footpad with the cultured L. braziliensis and other groups of mice were injected with L. braziliensis that was mixed with one salivary gland of a sand fly. When lesions developed, the thickness of the lesion was measured as well as an uninfected hind footpad (Samuelson et al. 1991). After several months, the mice were killed and the number of parasites found within the lesions was measured.

The results of this study showed L. braziliensis caused faster progressive cutaneous lesions in mice when injected with the contents of sand fly saliva. Parasites that had been injected with sand fly saliva produced large and rapidly growing cutaneous nodules (Samuelson et al. 1991). Lesions in the mice caused by L. braziliensis injected with sand fly saliva were also found to have 5,000-fold more parasites than the hosts injected with parasites without sand fly saliva.

 

This article relates to the study by Gabriel et al. (1992) “Description of Leishmania equatorensis sp. n. (Kinetoplastida: Trypanosomatidae), A New Parasite Infecting Arboreal Mammals in Ecuador” because Gabrial et al. (1992) found Leishmania braziliensis and Leishmania equatorensis are indistinguishable in behavior and appearance and are almost identical in their enzymatic profile. However, L. braziliensis can infect humans unlike L. equatorensis. Due to the lack of studies performed on L. equatorensis, L. braziliensis was chosen for my future articles because of their structural similarities.

Citation

J. Samuelson, E. Lerner, R. Tesh, R. Titus, 1991, A Mouse Model of Leishmania braziliensis braziliensis Infection Produced by Coinjection with Sand Fly Saliva, J. Exp. Med. Sci. 173(1): 49-54

-Kaitlin Smith (Revised 11/29/12)