bluuebunny/crossref_metadata_2025 huggingface dataset:
FREQUENCIES OF PERIPHERAL BLOOD MYELOID CELLS IN HEALTHY KENYAN CHILDREN WITH α+ THALASSEMIA AND THE SICKLE CELL TRAIT
Authors: URBAN BRITTA C. , SHAFI MOHAMMED J. , CORDERY DAMIEN V. , MACHARIA ALEX , LOWE BRETT , MARSH KEVIN , WILLIAMS THOMAS N.
Published: September 2018

The high frequencies of both α+ thalassemia and the sickle cell trait (hemoglobin AS [HbAS]) found in many tropical populations are thought to reflect selection pressure from Plasmodium falciparum malaria. For HbAS, but not for α+ thalassemia, protection appears to be mediated by the enhanced phagocytic clearance of ring-infected erythrocytes. We have investigated the genotype-specific distributions of peripheral blood leukocyte populations in two groups of children living on the coast of Kenya: a group of healthy P. falciparum parasite-negative children sampled at cross-sectional survey during a period of low malaria transmission, and a group of children attending the hospital with acute malaria. We report distinctive distributions of peripheral blood myeloid dendritic cells and monocytes in children with α+ thalassemia and HbAS during healthy periods and disease, and suggest ways in which these might relate to the mechanisms of protection afforded by these conditions.
WOUND BOTULISM ACQUIRED IN THE AMAZONIAN RAIN FOREST OF ECUADOR
Authors: RELLER MEGAN E. , DOUCE RICHARD W. , MASLANKA SUSAN E. , TORRES DARWIN S. , MANOCK STEPHEN R. , SOBEL JEREMY
Published: September 2018

Wound botulism results from colonization of a contaminated wound by Clostridium botulinum and the anaerobic in situ production of a potent neurotoxin. Between 1943, when wound botulism was first recognized, and 1990, 47 laboratory-confirmed cases, mostly trauma-associated, were reported in the United States. Since 1990, wound botulism associated with injection drug use emerged as the leading cause of wound botulism in the United States; 210 of 217 cases reported to the Centers for Disease Control and Prevention between 1990 and 2002 were associated with drug injection. Despite the worldwide distribution of Clostridium botulinum spores, wound botulism has been reported only twice outside the United States, Europe, and Australia. However, wound botulism may go undiagnosed and untreated in many countries. We report two cases, both with type A toxin, from the Ecuadorian rain forest. Prompt clinical recognition, supportive care, and administration of trivalent equine botulinum antitoxin were life-saving.
HUMAN AND MOSQUITO INFECTIONS BY DENGUE VIRUSES DURING AND AFTER EPIDEMICS IN A DENGUE–ENDEMIC REGION OF COLOMBIA
Authors: MÉNDEZ FABIÁN , BARRETO MAURICIO , ARIAS JUAN F. , RENGIFO GRACIELA , MUÑOZ JAIME , BURBANO MARÍA E. , PARRA BEATRIZ
Published: September 2018

We conducted a study in a dengue-endemic area of Colombia to evaluate the dynamics of transmission of dengue viruses during and after epidemics. Information was simultaneously gathered about occurrence of infection in humans and mosquitoes every three months in four cities with endemic transmission. Viral isolation was confirmed in 6.7% of the persons and most were asymptomatic. Adult mosquito and larvae house indexes were not found associated with increased burden of disease. The only entomologic indicator related to dengue infection in humans was the pooled infection rate of mosquitoes. Aedes aegypti infection rates showed significant differences between the epidemic (10.68, 95% confidence interval [CI] = 7.04–15.62) and after epidemic periods of the study (6.15, 95% CI = 3.46–10.19). In addition, Ae. albopictus were also infected with dengue viruses. Increases in mosquito infection rates were associated with increases in human infection rates in the following trimester.
VOLUME REPLACEMENT IN INFANTS WITH DENGUE HEMORRHAGIC FEVER/DENGUE SHOCK SYNDROME
Authors: HUNG NGUYEN THANH , LAN NGUYEN TRONG , LEI HUAN-YAO , LIN YEE-SHIN , LIEN LE BICH , HUANG KAO-JEAN , LIN CHIOU-FENG , HA DO QUANG , HUONG VU THI QUE , MY LAM THI , YEH TRAI-MING , HUANG JYH-HSIUNG , LIU CHING-CHUAN , HALSTEAD SCOTT B.
Published: September 2018

Volume replacement was studied prospectively in 208 infants with dengue hemorrhagic fever/dengue shock syndrome (DHF/DSS). The mean volume of intravenous fluid used was 110.4 mL/kg administered over a mean period of 25.8 hours. The mean volumes of intravenous fluid replacement in infants with DSS was significantly higher than in those with non-shock DHF (129.8 mL/kg versus 102.1 mL/kg; P = 0.001). Patients with DSS had significantly higher proportional requirements for dextran and blood transfusions than non-shock infants. Recurrent shock, prolonged shock, and acute respiratory failure were recorded in 8, 6, and 13 patients, respectively. Four patients with DSS died of severe complications. Intravenous fluid replacement with special care to avoid fluid overload requires careful attention to established indications for use of colloidal solutions and blood transfusions. To improve case fatality rates, special efforts need to be directed to infants with DHF/DSS accompanied by severe complications.
MALARIA IN WANOKAKA AND LOLI SUB-DISTRICTS, WEST SUMBA DISTRICT, EAST NUSA TENGGARA PROVINCE, INDONESIA
Authors: SYAFRUDDIN DIN , ASIH PUJI B. S. , COUTRIER FARAH N. , TRIANTY LEILY , NOVIYANTI RINTIS , LUASE YAVETH , SUMARTO WAJIYO , CALEY MARTEN , VAN DER VEN ANDRE J.A.M. , SAUERWEIN ROBERT W.
Published: September 2018

Malaria has long been known as one of the major public health problems in West Sumba District, East Nusa Tenggara Province, Indonesia. To obtain baseline data for establishment of a suitable malaria control program in the area, malariometric surveys were conducted in two sub-districts, Wanokaka and Loli, during the periods of January, May, and August 2005. The survey included three selected villages in each sub-district, and blood smear analyses of 701, 921, and 894 randomly selected subjects in January, May, and August revealed 30.5%, 25.3%, and 28.2% malaria positives, respectively, consisting mainly of Plasmodium falciparum and P. vivax, and in a few cases, P. malariae. Analysis of malaria prevalence at different age groups clearly reflected the common phenomenon that younger individuals are more vulnerable by infection of either P. falciparum or P. vivax. In falciparum malaria, the frequency of cases carrying gametocytes was also relatively high involving all age groups. The findings indicate that the malaria incidence and transmission in the area are relatively high and that further exploration is warranted to establish a precise malaria control program.
DYNAMICS OF PLASMODIUM FALCIPARUM MALARIA AFTER SUB-OPTIMAL THERAPY IN UGANDA
Authors: MYRICK ALISSA , LEEMANN ERIKA , DOKOMAJILAR CHRIS , HOPKINS HEIDI , DORSEY GRANT , KAMYA MOSES R. , ROSENTHAL PHILIP J.
Published: September 2018

We followed parasite genotypes of 75 patients for 42 days after treatment of uncomplicated malaria with chloroquine + sulfadoxine-pyrimethamine in Kampala, Uganda. Infections were complex (mean, 2.88 strains) and followed three patterns: 27% of patients eliminated all strains and remained parasite-free, 48% had a long aparasitemic interval followed by reappearance of original strains after 3–33 days (mean, 9.2 days), and 25% failed to clear original strains and required therapy after 3–35 days (mean, 17 days). These results highlight the complexity of malaria in Africa and have implications for efficacy trials, because missing late reappearances of strains could lead to misclassification of outcomes.
EVALUATION OF A NEW RECOMBINANT K39 RAPID DIAGNOSTIC TEST FOR SUDANESE VISCERAL LEISHMANIASIS
Authors: RITMEIJER KOERT , MELAKU YOSEPH , MUELLER MARIUS , KIPNGETICH SAMMY , O’KEEFFE CAROLINE , DAVIDSON ROBERT N.
Published: September 2018

A new rK39 rapid diagnostic dipstick test (DiaMed-IT-Leish®) was compared with aspiration and a direct agglutination test (DAT) for diagnosis of visceral leishmaniasis (VL) in 201 parasitologically confirmed cases, 133 endemic controls, and in 356 clinical suspects in disease-endemic and -epidemic areas in Sudan. The sensitivity of the rK39 test in parasitologically confirmed VL cases was 90%, whereas the specificity in disease-endemic controls was 99%. The sensitivity of the DAT was 98%. In clinically suspected cases, the sensitivity of the rK39 test was 81% and the specificity was 97%. When compared with the diagnostic protocol based on the DAT and aspiration used by Médecins sans Frontières in epidemic situations, the positive predictive value was 98%, and the negative predictive value was 71%. This rK39 rapid diagnostic test is suitable for screening as well as diagnosis of VL. Further diagnostic work-up of dipstick-negative patients with clinically suspected VL is important. The ease and convenience of the dipstick test will allow decentralization and improved access to care in disease-endemic areas in Sudan.
EXTINCTION OF EXPERIMENTAL TRIATOMA INFESTANS POPULATIONS FOLLOWING CONTINUOUS EXPOSURE TO DOGS WEARING DELTAMETHRIN-TREATED COLLARS
Authors: REITHINGER RICHARD , CEBALLOS LEONARDO , STARIOLO RAÚL , DAVIES CLIVE R. , GÜRTLER RICARDO E.
Published: September 2018

Dogs are domestic reservoir hosts of Trypanosoma cruzi, the etiological agent of Chagas disease. We evaluated the effect of deltamethrin-treated dog collars (DTDCs) over time on the population dynamics of Triatoma infestans, a main T. cruzi vector. Forty founder bugs of mixed life stages were allowed to colonize mud-thatched experimental huts and exposed continuously to either uncollared control dogs (N = 3) or dogs wearing DTDCs (N = 7) for a period of up to 196 days. When compared with bugs exposed to control dogs, bugs exposed to collared dogs were shown to have reduced feeding success (odds ratio [OR] = 0.40; 95% confidence interval [CI], 0.26–0.63; P < 0.001) and lower survival (OR = 0.15; 95% CI, 0.08–0.29; P < 0.001); in fact, all of the bug populations exposed to collared dogs became extinct 77–196 days after study initiation. Bugs exposed to DTDC-wearing dogs were also shown to have a lower fecundity (i.e., number of eggs produced per live female bug: OR = 0.64; 95% CI, 0.51–0.81; P < 0.001) and molting rate to first-instar nymphs (OR = 0.32; 95% CI, 0.13–0.75; P < 0.01) than those bugs exposed to control dogs. DTDCs could represent a novel tool to prevent and control canine and (hence) human Chagas disease.
EFFECTS OF MICROCLIMATIC CHANGES CAUSED BY DEFORESTATION ON THE SURVIVORSHIP AND REPRODUCTIVE FITNESS OF ANOPHELES GAMBIAE IN WESTERN KENYA HIGHLANDS
Authors: AFRANE YAW A. , ZHOU GOUFA , LAWSON BERNARD W. , GITHEKO ANDREW K. , YAN GUIYUN
Published: September 2018

Land use changes have been suggested as one of the causes for malaria epidemics in the African highlands. This study investigated the effects of deforestation-induced changes in indoor temperature on the survivorship and reproductive fitness of Anopheles gambiae in an epidemic prone area in the western Kenya highlands. We found that the mean indoor temperatures of houses located in the deforested area were 1.2°C higher than in houses located in the forested area during the dry season and 0.7°C higher during the rainy season. The mosquito mortality rate was highly age-dependent regardless of study site or season. Mosquitoes that were placed in houses in the deforested area showed a 64.8–79.5% higher fecundity than those in houses located in the forested area, but the median survival time was reduced by 5–7 days. Female mosquitoes in the deforested area showed a 38.5–40.6% increase in net reproductive rate and an 11.6–42.9% increase in intrinsic growth rate than those in the forested area. Significant increases in net reproductive rate and intrinsic growth rate for mosquitoes in the deforested area suggest that deforestation enhances mosquito reproductive fitness, increasing mosquito population growth potential in the western Kenya highlands. The vectorial capacity of An. gambiae under study was estimated at least 106% and 29% higher in the deforested area than in the forested area in dry and rainy seasons, respectively.
FIELD EVALUATION OF THE CHESSBOARD MODIFICATION FOR SEROTYPING OF STREPTOCOCCUS PNEUMONIAE IN A SMALL LABORATORY IN BANGLADESH
Authors: HERVA ELJA , GRANAT SIMO , MIA ZAKARIA , OLLGREN JUKKA , PIIRAINEN LIISA , MÄKELÄ P. HELENA
Published: September 2018

The chessboard modification of the quellung method for serotyping Streptococcus pneumoniae (Pneumococcus) was introduced in the Gonoshasthaya Vaccine Research Laboratory, a small laboratory in Bangladesh. We applied initial bench-side training and subsequent continuous surveillance and quality assurance as approaches for good laboratory practice. Results obtained a this laboratory on 1,101 consecutive isolates had satisfactory sensitivity (85.1–100%) and specificity (97.9–99.9%) for serotyping the 10 most common serogroups/types of pneumococci when compared with the results obtained in the Finnish reference laboratory for pneumococcal serotyping at the National Public Health Institute. We conclude that serotyping of pneumococci by the chessboard method can be introduced into a small laboratory by providing basic bacteriologic skills, adequate initial training, and continuous external support.
CLINICAL COURSE OF ERYTHEMA NODOSUM LEPROSUM: AN 11-YEAR COHORT STUDY IN HYDERABAD, INDIA
Authors: POCATERRA LEONOR , JAIN SUMAN , REDDY RAJGOPAL , MUZAFFARULLAH SYED , TORRES OBDULITA , SUNEETHA SUJAI , LOCKWOOD DIANA N. J.
Published: September 2018

Erythema nodosum leprosum (ENL) or type 2 lepra reactions complicate lepromatous leprosy and borderline lepromatous leprosy. We report an 11-year retrospective case record analysis of 481 outpatients with borderline lepromatous and lepromatous leprosy at the Dhoolpet Leprosy Research Center in Hyderabad, India. The overall prevalence of ENL was 24%, 49.4% among cases of lepromatous leprosy (LL) and 9% among cases of borderline lepromatous (BL) leprosy. Logistic regression analysis identified LL (odds ratio [OR] = 8.4, 95% confidence interval [CI] = 4.6–15.4, P < 0.001) and BL with a bacterial index ≥ 4+ (OR = 5.2, 95% CI = 2.1–12.9, P = 0.001) as major risk factors. The average patient with ENL was male, 34.7 years of age, and had multiple episodes of ENL (mean = 3.1) over an 18.5-month period. Three types of ENL were identified: single acute ENL, multiple acute ENL (repeated discrete episodes), and chronic ENL (continuous episodes). Acute single ENL is rare, accounting for only 8% of cases. Chronic ENL accounted for 62.5% of the cohort. Chronic ENL was of longer duration and more severe. An age ≥ 35 years was a risk factor for developing chronic ENL. Patients with chronic ENL were more compliant with multi-drug therapy, especially during the first six doses of multi-drug therapy. Distinguishing these different types of ENL would be useful for patient management and developing improved treatment of these debilitating reactions. Improved strategies for treatment and management of these reactions need to be developed.
DENGUE HEMORRHAGIC FEVER PATIENTS WITH ACUTE ABDOMEN: CLINICAL EXPERIENCE OF 14 CASES
Authors: KHOR BOON-SIANG , LIU JIEN-WEI , LEE ING-KIT , YANG KUENDER D.
Published: September 2018

Among 328 patients with dengue hemorrhagic fever/dengue shock syndrome (DHF/DSS), 14 (4 men and 10 women, median age 44 years) had acute abdomen. DHF/DSS was initially suspected in only 2 of these 14 patients. Presumptive diagnoses of acute cholecystitis (6 acalculus and 4 calculus cholecystitis) were made in 10 patients, non-specific peritonitis in three patients, and acute appendicitis in one patients. Cholecystectomy, percutaneous transhepatic gallbladder drainage, and appendectomy were performed in three patients. Transfused blood in the three patients who underwent invasive procedures and the 11 patients who received supportive treatment included packed red blood cells (24 versus 0 units; P = 0.048), fresh frozen plasma (84 versus 0 units; P = 0.048), and platelets (192 versus 180 units; P = 0.003). Patients who underwent invasive procedures also had prolonged time in the hospital (median = 11 versus 7 days; P = 0.015). To avoid unnecessary invasive procedure–related morbidity and mortality, this report underscores the importance of a careful differential diagnosis in patients with acute abdomen in a dengue-endemic setting.
SEROLOGIC EVIDENCE FOR HEPATITIS E VIRUS INFECTION IN MONGOOSE
Authors: LI TIAN-CHENG , SAITO MIKA , OGURA GO , ISHIBASHI OSAMU , MIYAMURA TATSUO , TAKEDA NAOKAZU
Published: September 2018

Although pig and wild boar are considered to be the reservoirs of hepatitis E virus (HEV) in Japan, the spread of HEV to other animals is unknown. Serum samples from 84 mongooses (Small Asian mongoose; Herpestes javanicus) collected in Okinawa, Japan were examined for antibodies to HEV by enzyme-linked immunosorbent assay and RNA was analyzed by reverse transcription–polymerase chain reaction. Seven (8.3%) of 84 mongooses were positive for IgG antibodies to HEV, and the antibody-positive rate increased with body weight and size, whereas HEV RNA was not detected in these samples. These results are consistent with the possibility that mongooses in Okinawa are occasionally infected with HEV; however, they are not considered the major zoonotic reservoir of HEV.
ANTIBODY RESPONSES TO SEVERAL MALARIA PRE-ERYTHROCYTIC ANTIGENS AS A MARKER OF MALARIA EXPOSURE AMONG TRAVELERS
Authors: ORLANDI-PRADINES EVE , PENHOAT KRISTELL , DURAND CLAUDE , PONS CHRISTOPHE , BAY CHRISTIAN , PRADINES BRUNO , FUSAI THIERRY , JOSSE RICHARD , DUBROUS PHILIPPE , MEYNARD JEAN-BAPTISTE , DURAND JEAN-PAUL , MIGLIANI RENE , BOUTIN JEAN-PAUL , DRUILHE PIERRE , ROGIER CHRISTOPHE
Published: September 2018

Protective devices against vectors are used by travelers in malaria-endemic areas but their efficacy for protection against mosquitoes has rarely been evaluated. The level of exposure to malaria transmission of 205 soldiers deployed in Africa and the efficacy of their anti-vector prophylaxis was evaluated by comparison of their IgM and IgG responses against five pre-erythrocytic Plasmodium falciparum antigens (circumsporozoite protein, sporozoite threonine- and asparagine-rich protein, sporozoite- and liver-stage antigen, liver stage antigen 1, and SR11.1) before and at the end of their deployment, and three months after returning to France for 106 of these soldiers. The immune responses increased significantly during the mission in 35% (95% confidence interval = 28–42%) of the individuals. The permanent use of insecticide-treated bed nets and long-sleeve battle dress at night were associated with protective efficacy. The analysis of these antibody responses was sensitive enough to evaluate exposure to malaria transmission and the efficacy of anti-vector devices in travelers using antimalarial chemoprophylaxis.
FOLIC ACID TREATMENT OF ZAMBIAN CHILDREN WITH MODERATE TO SEVERE MALARIA ANEMIA
Authors: MULENGA MODEST , MALUNGA PHIDELIS , BENNETT STEVE , THUMA PHILIP , SHULMAN CAROLINE , FIELDING KATHERINE , GREENWOOD BRIAN
Published: September 2018

Whether administration of folic acid to children with malaria anemia is helpful is controversial. Therefore, we conducted a randomised, placebo-controlled trial of 14 days of treatment with folic acid (1 mg/d) in Zambian children with malaria anemia treated with either sulfadoxine/pyrimethamine (SP) or atovaquone/proguanil (AP). Among children who received SP, the prevalence of parasitemia was higher in children treated with folic acid than among those given placebo at days 3, 7, and 14 after the start of treatment, and the difference at day 3 was statistically significant (P = 0.013). Folic acid treatment had no effect on parasitemia in children treated with AP. Administration of folic acid led to a small increase in packed cell volume over that seen in the placebo group at days 14 and 28 after the start of treatment.
IN VITRO AND IN VIVO STUDIES OF RIBAVIRIN ACTION ON BRAZILIAN ORTHOBUNYAVIRUS
Authors: LIVONESI MÁRCIA C. , DE SOUSA RICARDO L. MORO , BADRA SORAYA J. , FIGUEIREDO LUIZ T.M.
Published: September 2018

Oropouche, Caraparu, Guama, Guaroa, and Tacaiuma are viruses (genus Orthobunyavirus) that cause human febrile illnesses and encephalitis. The goal of this study was to evaluate the antiviral action of ribavirin on these orthobunyaviruses to achieve a therapeutical agent to treat the diseases caused by these viruses. In vitro results showed that ribavirin (50 μg/mL) had antiviral activity only on the Tacaiuma virus. Addition of guanosine in the culture reversed the antiviral effect of ribavirin on Tacaiuma virus, suggesting that ribavirin inhibited this virus by reducing the intra-cellular guanosine pool. Moreover, ribavirin was not an effective drug in vivo because it was unable to inhibit the death of the mice or virus replication in the brain. The results suggest that ribavirin has no antiviral activity on the Oropouche, Caraparu, Guama, Guaroa, or Tacaiuma viruses; consequently, ribavirin would not be a good therapeutical agent to treat these arboviruses.
THE RELIABILITY OF ANTERIOR SEGMENT LESIONS AS INDICATORS OF ONCHOCERCAL EYE DISEASE IN GUATEMALA
Authors: WINTHROP KEVIN L. , PROAÑO ROBERTO , OLIVA ORLANDO , ARANA BYRON , MENDOZA CARLOS , DOMINGUEZ ALFREDO , AMANN JOSEF , PUNKOSDY GEORGE , BLANCO CARLOS , KLEIN ROBERT , SAUERBREY MAURICIO , RICHARDS FRANK
Published: September 2018

World Health Organization certification criteria for onchocerciasis elimination use anterior segment eye lesion prevalence as an indicator of mass ivermectin treatment program success. Lesions either contain visible microfilaria (noninflammatory punctate keratitis [PK] or microfilariae in anterior chamber [MFAC]), or microfilaria obscured by inflammation (inflammatory PK). To assess the utility of these disease indicators, two experienced ophthalmologists independently examined persons from endemic (N = 325) and nonendemic (N = 348) Guatemalan communities. Thirty-six (11.1%) and nine (2.6%) persons from endemic and nonendemic areas respectively had lesions found by either ophthalmologist (prevalence ratio = 4.3, 95% CI 2.1–8.8, P < 0.001). All lesions in nonendemic areas were inflammatory PK in whom no persons were seropositive for onchocerciasis. Overall, observer agreement was moderate (Kappa = 0.49), and most (61%) discordance occurred with inflammatory PK lesions. Our findings suggest that inflammatory punctate keratitis is neither a specific nor a reliable indicator of onchocercal eye disease. Future prevalence surveys should rely upon noninflammatory lesions as disease indicators.
RETROSPECTIVE SEROSURVEY OF LEPTOSPIROSIS AMONG PATIENTS WITH ACUTE FEBRILE ILLNESS AND HEPATITIS IN EGYPT
Authors: ISMAIL THARWAT F. , WASFY MOMTAZ O. , ABDUL-RAHMAN BASSEM , MURRAY CLINTON K. , HOSPENTHAL DUANE R. , ABDEL-FADEEL MOUSTAFA , ABDEL-MAKSOUD MOHAMED , SAMIR AHMED , HATEM MAHMOUD E. , KLENA JOHN , PIMENTEL GUILLERMO , EL-SAYED NASR , HAJJEH RANA
Published: September 2018

The epidemiologic status of leptospirosis in Egypt has not been well defined because of difficulties in disease diagnosis. A retrospective study was conducted to detect leptospiral antibodies among undiagnosed acute febrile illness (AFI) and hepatitis cases. Approximately 16% of both AFI (141/886) and acute hepatitis (63/392) cases showed seroreactivity to Leptospira IgM by ELISA and microscopic agglutination test (MAT). Canicola, Djasiman, Grippotyphosa, Pyrogenes, Icterohemorrhagiae, and Pomona were the most commonly reactive serovars among patients with AFI. Djasiman, Grippotyphosa and Icterohemorrhagiae were the most reactive among patients with acute hepatitis. This study represents the first systematic report of Leptospira associated with patients with AFI and hepatitis in Egypt. Physicians need to have increased awareness about the importance of leptospirosis in the differential diagnosis of AFI and acute hepatitis in Egypt. In addition, laboratory capacity should be developed at fever hospitals to diagnose leptospirosis.
CRYPTOSPORIDIOSIS AND OTHER INTESTINAL PROTOZOAN INFECTIONS IN CHILDREN LESS THAN ONE YEAR OF AGE IN MEXICO CITY
Authors: SÁNCHEZ-VEGA JOSÉ T. , TAY-ZAVALA JORGE , AGUILAR-CHIU ARTEMISA , RUIZ-SÁNCHEZ DORA , MALAGÓN FILIBERTO , RODRÍGUEZ-COVARRUBIAS JOSÉ A. , ORDÓÑEZ-MARTÍNEZ JAVIER , CALDERÓN-ROMERO LETICIA
Published: September 2018

Parasitic diseases are very important in Mexico because of their economic impact and adverse effects on normal growth in children. Cryptosporidiosis has been associated with acute diarrhea in immune competent and incompetent human hosts, fecal contamination of drinking water sources, and handling of animals. Due to the lack of reports on cryptosporidiosis in Mexico, we conducted a parasitologic study in children with diarrhea and other clinical symptoms. The main objectives were 1) to determine the prevalence of cryptosporidiosis in children less than one year of age in Mexico City, and 2) to correlate Cryptosporidium infection with gastrointestinal symptoms. Two hundred fecal samples from children seen at the Gabriel Mancera Familiar Medicine Unit of the Instituto Mexicano del Seguro Social were studied. Children were divided into two groups. Group A was composed of sick children with 6–8 watery diarrheic episodes every 24 hours attended at the emergency service. Group B was composed of healthy babies getting routine check ups. Only children in group A were found to be infected with intestinal protozoa (50% with Giardia lamblia, 41% with Cryptosporidium spp., and 4% with Entamoeba histolytica). The results suggested a high incidence of Cyrptosporidium infections in children in Mexico City, which make these observations useful for future studies.
DENGUE HEMORRHAGIC FEVER CAUSED BY SEQUENTIAL DENGUE 1–3 VIRUS INFECTIONS OVER A LONG TIME INTERVAL: HAVANA EPIDEMIC, 2001–2002
Authors: ALVAREZ MAYLING , RODRIGUEZ-ROCHE ROSMARI , BERNARDO LÍDICE , VÁZQUEZ SUSANA , MORIER LUIS , GONZALEZ DANIEL , CASTRO OSVALDO , KOURI GUSTAVO , HALSTEAD SCOTT B. , GUZMAN MARIA G.
Published: September 2018

A dengue epidemic caused by dengue virus 3 (DENV-3) occurred in Cuba in 2001–2002. It included cases of dengue hemorrhagic fever/dengue shock syndrome (DHF/DSS). We report neutralizing antibody studies on sera from 54 of 78 DHF/DSS patients that provide evidence of infections occurring in the sequence DENV-1 followed by DENV-3. No sera showed infection in the sequence DENV-2 followed by DENV-3. Some sera showed a pattern of infection in the sequence DENV-1 followed by DENV-2 and then DENV-3. However definitive categorization of a tertiary infection was not possible because of broadly reactive antibodies, which could have been raised by infections in the sequence DENV-1 then DENV-3.
ROLE OF VIRUSES IN KENYAN CHILDREN PRESENTING WITH ACUTE ENCEPHALOPATHY IN A MALARIA-ENDEMIC AREA
Authors: SCHUBART CHRISTIAN D. , MTURI NEEMA , BELD MARCEL G. H. M. , WERTHEIM PAULINE M. , NEWTON CHARLES R. J. C.
Published: September 2018

In malaria-endemic areas, it is difficult to differentiate between cerebral malaria (CM), bacterial meningitis, and viral encephalitis. We examined the cerebrospinal fluid of 49 children who fulfilled the World Health Organization’s (WHO) definition of CM and in 47 encephalopathic children, without malaria, looking for viruses with polymerase chain reaction. In the children with CM, four (9%) had evidence of Herpes simplex virus 1 in the cerebrospinal fluid, whereas in the encephalopathy group without malaria, six (12%) were positive. A significant proportion of children who fulfil the WHO clinical definition of CM may have viral encephalitis.
VENEREAL TRANSMISSION OF CHANDIPURA VIRUS BY PHLEBOTOMUS PAPATASI (SCOPOLI)
Authors: MAVALE M. S. , FULMALI P. V. , GEEVARGHESE G. , ARANKALLE V. A. , GHODKE Y. S. , KANOJIA P. C. , MISHRA A. C.
Published: September 2018

Experiments were conducted in the laboratory on Phlebotomus papatasi to determine the possible role of males in maintaining or sustaining the Chandipura virus (CHPV) activity in nature. This study indicated that infected males are capable of passing on the virus to female sand flies while mating. The infection rate was found to be 12.5% in uninfected females when mated with infected males. The occurrence of venereal transmission of this virus may have epidemiologic importance in the natural cycle of CHPV.
DEATHS CAUSED BY MALARIA IN SWITZERLAND 1988–2002
Authors: CHRISTEN DANIEL , STEFFEN ROBERT , SCHLAGENHAUF PATRICIA
Published: September 2018

Despite sophisticated intensive medicine, between one and three malaria-associated deaths occur annually in Switzerland. In this retrospective study, 33 deaths (25 men and 8 women) caused by falciparum malaria reported in Switzerland from 1988 to 2002 were analyzed. The case fatality ratio (CFR) for the falciparum infections for the 15-year period was 1.2%, with a peak of 2.2% in 1991. Sub-Saharan Africa was the source of all the imported fatal infections. Non-immune Europeans had a significantly higher case fatality ratio than the non-Europeans (1.7% versus 0.2%; P < 0.001). Careless use or non-use of prophylaxis, sometimes because of physicians giving unsatisfactory pre-travel advice, and initially missed diagnosis post-travel were factors that contributed to the development of severe infections leading to death. Travelers should be sensitized to the risk of malaria by well-informed general practitioners. Updated information is readily available (www.safetravel.ch). Regarding diagnosis and treatment, greater physician awareness of the disease is needed, and expert advice should be sought without hesitation. Rapid malaria tests may be a useful diagnostic adjunct in centers where microscopic expertise is lacking. Falciparum malaria in a non-immune patient is an emergency requiring immediate treatment.
TRICHOMONAS EMPYEMA WITH RESPIRATORY FAILURE
Authors: WANG HUA-KUNG , JERNG JIH SHUIN , SU KUA-EYRE , CHANG SHAN-CHWEN , YANG PAN-CHYR
Published: September 2018

Pulmonary trichomoniasis is rare, and few cases of trichomonas empyema have been reported in the literature. We describe a rare case of a non-immunocompromised 55-year-old man with Trichomonas empyema presenting with bilateral pleural effusion leading to respiratory failure. Examination of the pleural effusion showed numerous motile organisms by fresh wet preparation that were identified as Trichomonas species by Liu stain. The patient was successfully treated with metronidazole, ampicillin/clavunalate, fibrinolytic therapy, and thoracotomy decortication.
ROLES OF SPECIFIC PLASMODIUM FALCIPARUM MUTATIONS IN RESISTANCE TO AMODIAQUINE AND SULFADOXINE-PYRIMETHAMINE IN BURKINA FASO
Authors: DOKOMAJILAR CHRISTIAN , LANKOANDE ZAMBENDE MOISE , DORSEY GRANT , ZONGO ISSAKA , OUEDRAOGO JEAN-BOSCO , ROSENTHAL PHILIP J.
Published: September 2018

We evaluated associations between key polymorphisms in target genes and responses to treatment with sulfadoxine-pyrimethamine (SP) or amodiaquine (AQ) for uncomplicated Plasmodium falciparum malaria in Bobo-Dioulasso, Burkina Faso. Presence of the dihydrofolate reductase (dhfr) 108N or 59R mutations (but not dhfr 51I or dihydropteroate synthetase [dhps] 437G) and P. falciparum chloroquine resistance transporter (pfcrt) 76T or P. falciparum multidrug resistance 1 (pfmdr1) 86Y or 1246Y mutations (but not pfmdr1 184F) predicted recrudescence after treatment with SP and AQ, respectively. Treatment led to significant increases in the prevalence of the same mutations (except 1246Y) in new infections that presented after therapy. The dhfr 164L and dhps 540E mutations were not seen in any isolates. These results clarify the key roles of a small number of mutations in P. falciparum resistance to SP and AQ in west Africa.
A CASE OF FATAL PLASMODIUM FALCIPARUM MALARIA COMPLICATED BY ACUTE DENGUE FEVER IN EAST TIMOR
Authors: WARD DAVID IAN
Published: September 2018

A case is reported of a seven-year-old girl who had concurrent infections with Plasmodium falciparum malaria and dengue in a remote area of East Timor. The diagnosis of malaria was delayed because of two false-negative results with malaria rapid diagnosis test cards. Diagnosis was eventually made on microscopic examination of the patient’s blood. Despite treatment, the patient subsequently died. This case serves as a reminder of the fallibility of rapid diagnostic tests, and the importance of examining the patient’s blood microscopically if malaria is suspected.
IMPACT OF SINGLE AND MULTIPLE RESIDUAL SPRAYINGS OF PYRETHROID INSECTICIDES AGAINST TRIATOMA DIMIDIATA (REDUVIIADE; TRIATOMINAE), THE PRINCIPAL VECTOR OF CHAGAS DISEASE IN JUTIAPA, GUATEMALA
Authors: HASHIMOTO KEN , CORDON-ROSALES CELIA , TRAMPE RANFERY , KAWABATA MASATO
Published: September 2018

This study investigated the impact of single, double, and triple insecticide sprayings on indoor infestation of Triatoma dimidiata in Jutiapa, Guatemala. Up to three successive insecticide sprayings were applied in villages, where the indoor infestation index was > 5% before each spraying round or located adjacent to the persistently infested villages. Among 64 villages with single spraying, the mean indoor infestation index reduced from 20.8% to 1.4% after 12 months, but rose to 8.1% after 33 months. In 40 double-sprayed villages, it decreased from 41.9% to 11.9% by the first spraying and to 4.8% by the second spraying. For 12 villages with triple spraying, it reduced from 40.6% to 13.2%, 10.9%, and 4.1% through each spraying round. Geographic analysis showed that originally highly infested villages were spatially clustered and were likely to remain infested after the sprayings. Indoor infestation of T. dimidiata can be controlled with less than three rounds of spraying.
DETECTION SENSITIVITY AND QUANTITATION OF PLASMODIUM FALCIPARUM VAR GENE TRANSCRIPTS BY REAL-TIME RT-PCR IN COMPARISON WITH CONVENTIONAL RT-PCR
Authors: GATTON MICHELLE L. , PETERS JENNIFER M. , GRESTY KARRYN , FOWLER ELIZABETH V. , CHEN NANHUA , CHENG QIN
Published: September 2018

Antigenic variation in Plasmodium falciparum erythrocyte membrane protein 1, caused by a switch in transcription of the encoding var gene, is an important feature of malaria. In this study, we quantified the relative abundance of var gene transcripts present in P. falciparum parasite clones using real-time reverse transcription-polymerase chain reaction (RT-PCR) and conventional RT-PCR combined with cloning and sequencing, with the aim of directly comparing the results obtained. When there was sufficient abundance of RNA for the real-time RT-PCR assay to be operating within the region of good reproducibility, RT-PCR and real-time RT-PCR tended to identify the same dominant transcript, although some transcript-specific issues were identified. When there were differences in the estimated relative amounts of minor transcripts, the RT-PCR assay tended to produce higher estimates than real-time RT-PCR. These results provide valuable information comparing RT-PCR and real-time RT-PCR analysis of samples with small quantities of RNA as might be expected in the analysis of field or clinical samples.
OVIPOSITION BEHAVIOR OF FEMALE ANOPHELES GAMBIAE IN WESTERN KENYA INFERRED FROM MICROSATELLITE MARKERS
Authors: CHEN HONG , FILLINGER ULRIKE , YAN GUIYUN
Published: September 2018

Anopheles gambiae females in a relatively isolated hut and all larvae from larval habitats within 100 m of the hut were collected in August 2001 in western Kenya. Among 42 aquatic habitats, 16 had A. gambiae larvae. Two hundred fifty larvae and 58 adults were genotyped using nine microsatellite markers to infer sibling relationship between the larvae and maternity between the females and larvae. The pairwise genetic relatedness of A. gambiae larvae per habitat ranged from −0.4112 to 0.9375, indicating that full siblings, half siblings, and genetically unrelated individuals presented at those habitats with multiple larvae. From a likelihood analysis, it was estimated that 56.6% of females had larvae in multiple habitats. These results substantiate that one A. gambiae female uses multiple breeding sites for oviposition, and thus, average genetic relatedness for breeding sites with high larval populations tends to be low.
A FAMILIAL CASE OF VISCERAL LARVA MIGRANS AFTER INGESTION OF RAW CHICKEN LIVERS: APPEARANCE OF SPECIFIC ANTIBODY IN BRONCHOALVEOLAR LAVAGE FLUID OF THE PATIENTS
Authors: MORIMATSU YOSHITAKA , AKAO NOBUAKI , AKIYOSHI HIROYA , KAWAZU TAKETOSHI , OKABE YOSHINOBU , AIZAWA HISAMICHI
Published: September 2018

We report a familial case of visceral larva migrans (VLM) caused by Toxocara canis larvae. Patient 1 was a 45-year-old man who presented to our university hospital complaining of mild fever, general fatigue, and headache. Patient 2 was a 71-year-old man and was the father of Patient 1; he presented complaining of cough and hyper-viscous white sputum. Laboratory data from both patients showed extensive eosinophilia, their chest X-ray findings revealed multiple pulmonary infiltrates, and their bronchoalveolar lavage fluid (BALF) showed an elevated eosinophil count. The diagnosis of VLM was made based on a positive result in a serological test using T. canis larval excretory–secretory both in the serum and BALF. T. canis larvae were identified in meat that was prepared from chicken taken from the same source as that ingested. This is the first report to identify antibodies in BALF in patients with VLM.
YELLOW FEVER VACCINE-ASSOCIATED VISCEROTROPIC DISEASE (YEL-AVD) AND CORTICOSTEROID THERAPY: ELEVEN UNITED STATES CASES, 1996–2004
Authors: VELLOZZI CLAUDIA , MITCHELL TARISSA , MILLER ELAINE , CASEY CHRISTINE G. , EIDEX RACHEL BARWICK , HAYES EDWARD B. , _ _
Published: September 2018

During 1996 through 2004, 29 cases of yellow fever vaccine-associated viscerotropic disease (YEL-AVD) have been reported worldwide; 17 were fatal. Stress-dose corticosteroid (SDS) therapy has recently been found to improve survival among patients with septic shock but benefit for the treatment of YEL-AVD patients in septic shock is unknown. We retrospectively reviewed medical records of 11 U.S. YEL-AVD cases reported to the Vaccine Adverse Event Reporting System (VAERS) from 1996 through 2004. Four of 11 case-patients received SDS; 3 of these 4 (75%) survived. Seven patients did not receive SDS and 2 (29%) survived. Altered mental status was documented on admission for 5 of the 11 patients; 4 of these 5 did not receive SDS and died, whereas one received SDS and survived. The use of stress-dose steroids might be a factor that influenced the survival of these YEL-AVD patients and should be further evaluated in the management of both YEL-AVD and wild-type yellow fever septic shock.
SURVEILLANCE OF EGYPTIAN FLEAS FOR AGENTS OF PUBLIC HEALTH SIGNIFICANCE: ANAPLASMA, BARTONELLA, COXIELLA, EHRLICHIA, RICKETTSIA, AND YERSINIA PESTIS
Authors: LOFTIS AMANDA D. , REEVES WILL K. , SZUMLAS DANIEL E. , ABBASSY MAGDA M. , HELMY IBRAHIM M. , MORIARITY JOHN R. , DASCH GREGORY A.
Published: September 2018

Serologic surveys in Egypt have documented human and animal exposure to vector-borne bacterial pathogens, but the presence and distribution of these agents in arthropods has not been determined. Between July 2002 and July 2003, fleas were collected from 221 mammals trapped in 17 cities throughout Egypt. A total of 987 fleas were collected, representing four species (Ctenocephalides felis, Echidnophaga gallinacea, Leptopsylla segnis, and Xenopsylla cheopis); 899 of these fleas were X. cheopis from rats (Rattus spp.). Fleas were tested for DNA from Anaplasma spp., Bartonella spp., Coxiella burnetii, Ehrlichia spp., Rickettsia spp., and Yersinia pestis. Rickettsia typhi, the agent of murine typhus, was detected in X. cheopis and L. segnis from rats from nine cities. A spotted-fever group Rickettsia sp. similar to “RF2125” was detected in E. gallinacea, and two unidentified spotted fever group Rickettsia were detected in two X. cheopis. Novel Bartonella genotypes were detected in X. cheopis and L. segnis from three cities. Coxiella burnetii was detected in two fleas. Anaplasma, Ehrlichia, and Y. pestis were not detected.
COMPARISON OF ALTITUDE EFFECT ON MYCOBACTERIUM TUBERCULOSIS INFECTION BETWEEN RURAL AND URBAN COMMUNITIES IN PERU
Authors: SAITO MAYUKO , PAN WILLIAM K. , GILMAN ROBERT H. , BAUTISTA CHRISTIAN T. , BAMRAH SAPNA , MARTÍN CHRISTOPHER A. , TSIOURIS SIMON J. , ARGÜELLO D. FERMÍN , MARTINEZ-CARRASCO GABRIELA
Published: September 2018

The mechanism of high altitude effect on tuberculosis (TB) infection has not been fully established. We previously reported a lower positive tuberculin skin test (TST) prevalence in high altitude villages compared with sea level communities in Peru. In this study, four additional communities were tested to assess whether decreased TB transmission was also in urban environments at high altitude. TST results from 3,629 individuals in nine communities were analyzed using generalized estimating equations to account for community clustering. Positive TST prevalence was not significantly different between the urban highland and the urban non-highland communities after adjusting for age, household contacts with a TST-positive person or a TB case, and presence of a Bacillus Calmette-Guérin vaccination scar. The effect of population concentration and increased contact with active TB overwhelmed the protective effect of altitude in urban highlands. Highland cities require the same preventive efforts against TB as non-highland communities.
HELICOBACTER PYLORI INFECTION IN CHILDREN OF LOW AND HIGH SOCIOECONOMIC STATUS IN NORTHEASTERN BRAZIL
Authors: PARENTE JOSÉ MIGUEL L. , DA SILVA BENEDITO BORGES , PALHA-DIAS MÍRIAN P. S. , ZATERKA SCHLIOMA , NISHIMURA NANCY F. , ZEITUNE JOSÉ MURILO
Published: September 2018

This survey was designed to evaluate the prevalence of Helicobacter pylori infection in asymptomatic children from families of low and high socioeconomic status living in two neighboring communities in Teresina in northeastern Brazil. The study included 303 children, 163 (53.8%) males and 140 (46.2%) females, ranging in age from 6 months to 12 years. Helicobacter pylori status was determined by the H. pylori stool antigens test, in which sensitivity and specificity values for Brazilian children were 96.9% and 100%, respectively. The prevalence rates were 55.0% (93 of 169) and 16.4% (22 of 134) for children of low and high socioeconomic status, respectively (P < 0.001). Infection with H. pylori occurred early in life (before 2 years of age) in both groups (22.9% versus 14.3%; P = 0.061) and increased as the children became older. The rate of infection in children 11–12 years of age living in the poor area was as high as the levels found in Brazilian adults. An improved standard of living is followed by a sharp decrease in the prevalence rates in children, even in a developing country such as Brazil.
USEFULNESS OF NESTED PCR FOR THE DIAGNOSIS OF SCRUB TYPHUS IN CLINICAL PRACTICE: A PROSPECTIVE STUDY
Authors: KIM DONG-MIN , YUN NA RA , YANG TAE YOUNG , LEE JI HYUN , YANG JONG TAE , SHIM SOO-KYOUNG , CHOI EUN-NA , PARK MI-YEOUN , LEE SEUNG-HYUN
Published: September 2018

The aims of this study were to determine the diagnostic accuracy and clinical usefulness of using nested polymerase chain reaction (PCR) for the diagnosis of scrub typhus through a prospective comparison of nested PCR and indirect immunofluorescent antibody assay (IFA). We conducted a multi-center prospective study of patients who were suffering with possible scrub typhus infection. Whole blood samples were collected for PCR testing, and sera were obtained for serology evaluation using the indirect IFA and the passive hemagglutination assay (PHA). We prospectively studied 135 patients with possible scrub typhus. One hundred eighteen patients were confirmed as having scrub typhus, 7 patients were undetermined, and 10 patients were confirmed as having other diseases. The results of nested PCR assay showed a sensitivity of 82.2% and a specificity of 100%. Ninety-six of the 118 patients were positive for IgM on their admission day. Of the 22 patients who were negative for IgM antibody at admission, 19 had positive results for nested PCR of the buffy coat. The nested PCR assay of the buffy coat is useful as a rapid and reliable test for confirming the diagnosis of scrub typhus.
OUTBREAK OF CYCLOSPORIASIS AT A NAVAL BASE IN LIMA, PERU
Authors: TORRES-SLIMMING PAOLA A. , MUNDACA CARMEN C. , MORAN MANUEL , QUISPE JOSE , COLINA OLGA , BACON DAVID J. , LESCANO ANDRES G. , GILMAN ROBERT H. , BLAZES DAVID L.
Published: September 2018

Cyclospora cayetanensis is emerging as an important cause of food-borne diarrheal outbreaks, especially in developed regions like the United States and Europe. We describe an outbreak of cyclosporiasis in Peruvian naval recruits that we believe to be the first among a local population in a developing region.
CHINESE HERBAL MEDICINE YIN-CHEN-EXTRACT AS AN ADJUNCT TO ANTHELMINTIC ALBENDAZOLE USED AGAINST ANGIOSTRONGYLUS CANTONENSIS-INDUCED EOSINOPHILIC MENINGITIS OR MENINGOENCEPHALITIS
Authors: LAI SHIH-CHAN
Published: September 2018

The effects of albendazole and Yin-Chen-Extract co-therapy on Angiostrongylus cantonensis-induced eosinophilic meningitis in BALB/c mice were evaluated. Assay indicators for the therapeutic effect include worm recovery, histopathological score of the fourth ventricle, tissue-type plasminogen activator, urokinasetype plasminogen activator, matrix metalloproteinase-9, cerebrospinal fluid total protein, leukocyte counts, and proinflammatory cytokines. As a result, albendazole and Yin-Chen-Extract co-therapy significantly decreased (P < 0.05) these factors. Although Yin-Chen-Extract may possess pharmacologic activities beneficial to the inhibition of parasite-induced inflammation, many of these hypothetical benefits await scientific testing and confirmation before application. This study suggests that the combination of Yin-Chen-Extract and albendazole has synergistic effects in managing eosinophilic meningitis or eosinophilic meningoencephalitis.
EVIDENCE FOR TRANSMISSION OF PLASMODIUM VIVAX AMONG A DUFFY ANTIGEN NEGATIVE POPULATION IN WESTERN KENYA
Authors: RYAN JEFFREY R. , STOUTE JOSÉ A. , AMON JOSEPH , DUNTON RAYMOND F. , MTALIB RAMADHAN , KOROS JOSEPH , OWOUR BOAZ , LUCKHART SHIRLEY , WIRTZ ROBERT A. , BARNWELL JOHN W. , ROSENBERG RONALD
Published: September 2018

We present evidence that a parasite with characteristics of Plasmodium vivax is being transmitted among Duffy blood group–negative inhabitants of Kenya. Thirty-two of 4,901 Anopheles gambiae and An. funestus (0.65%) collected in Nyanza Province were ELISA positive for the P. vivax circumsporozoite protein VK 247. All positives were found late in the rainy season, when An. funestus predominated, and disproportionately many were found at a single village. A P. vivax specific sequence of the SSU rRNA gene was amplified from three of six ELISA-positive mosquitoes. Erythrocytes from 31 children, including 9 microscopically diagnosed as infected with P. vivax, were negative by flow cytometry for the Fy3 or Fy6 epitopes, which indicate Duffy blood group expression. A DNA fragment specific for the C terminus of the gene for P. vivax merozoite surface protein 1 (MSP-1) was amplified from the blood of four of these children and subsequently sequenced from two.
EFFICACY OF THREE CHLOROQUINE–PRIMAQUINE REGIMENS FOR TREATMENT OF PLASMODIUM VIVAX MALARIA IN COLOMBIA
Authors: ÁLVAREZ GONZALO , PIÑEROS JUAN-GABRIEL , TOBÓN ALBERTO , RÍOS ALEXANDRA , MAESTRE AMANDA , BLAIR SILVIA , CARMONA-FONSECA JAIME
Published: September 2018

Plasmodium vivax malaria is an important cause of morbidity in Central and South America. In Colombia, this is the most prevalent malaria infection, representing 75% of the reported cases. To define the efficacy of the chloroquine and primaquine regimen to eliminate hypnozoites and prevent relapses, we conducted a random controlled clinical trial of three primaquine regimens in an open-label study. We evaluated the anti-relapse efficacy of total primaquine doses of 45, 105, and 210 mg administered at a dosage of 15 mg/day in 210 adults with P. vivax infection from the northwestern region of Colombia. Cure rates for blood-stage P. vivax malaria by day 28 of follow-up were 100% in all groups. Post-treatment reappearance of parasitemia during the six months of follow-up was 45%, 36.6% and 17.6%, respectively, for each group. When compared with other groups, administration of 210 mg was a significant protection factor for reappearance of parasitemia in a malaria-endemic area.