RESUMEN
Community prevalence of infection is a widely used, standardized metric for evaluating malaria endemicity. Conventional methods for measuring prevalence include light microscopy and rapid diagnostic tests (RDTs), but their detection thresholds are inadequate for diagnosing low-density infections. The significance of submicroscopic malaria infections is poorly understood in Madagascar, a country of heterogeneous malaria epidemiology. A cross-sectional community survey in the western foothills of Madagascar during the March 2014 transmission season found malaria infection to be predominantly submicroscopic and asymptomatic. Prevalence of Plasmodium infection diagnosed by microscopy, RDT, and molecular diagnosis was 2.4%, 4.1%, and 13.8%, respectively. This diagnostic discordance was greatest for Plasmodium vivax infection, which was 98.5% submicroscopic. Village location, insecticide-treated bednet ownership, and fever were significantly associated with infection outcomes, as was presence of another infected individual in the household. Duffy-negative individuals were diagnosed with P. vivax, but with reduced odds relative to Duffy-positive hosts. The observation of high proportions of submicroscopic infections calls for a wider assessment of the parasite reservoir in other regions of the island, particularly given the country's current focus on malaria elimination and the poorly documented distribution of the non-P. falciparum parasite species.
Asunto(s)
Malaria Falciparum/epidemiología , Malaria Vivax/epidemiología , Plasmodium falciparum/genética , Plasmodium vivax/genética , Adolescente , Adulto , Enfermedades Asintomáticas , Niño , Preescolar , Estudios Transversales , Sistema del Grupo Sanguíneo Duffy/genética , Femenino , Expresión Génica , Encuestas Epidemiológicas , Humanos , Lactante , Madagascar/epidemiología , Malaria Falciparum/diagnóstico , Malaria Falciparum/parasitología , Malaria Vivax/diagnóstico , Malaria Vivax/parasitología , Masculino , Microscopía , Plasmodium falciparum/clasificación , Plasmodium falciparum/aislamiento & purificación , Plasmodium vivax/clasificación , Plasmodium vivax/aislamiento & purificación , Reacción en Cadena de la Polimerasa , Prevalencia , Receptores de Superficie Celular/deficiencia , Receptores de Superficie Celular/genética , Factores de Riesgo , Población RuralRESUMEN
A 30-year-old woman with a history of long-standing poor vision since her previous left ocular trauma in her early childhood presented with traumatic corneal perforation in her left eye. She underwent three amniotic membrane grafts along with tissue glue application, which failed to halt the progressive corneal thinning and recurrent perforation. Penetrating keratoplasty (PKP) was planned. However, a donor cornea was not immediately available for transplantation. Therefore, a Tutoplast((R))-processed pericardium graft was placed over the edges of the corneal lesion for a temporary tectonic purpose. Three days later, PKP was performed. A pericardium graft is an effective alternative method to maintain the structural integrity of the cornea while waiting for the arrival of a donor cornea for keratoplasty in the case of severe corneal perforation.