RESUMEN
Forty-six patients in a remote health post of Amazonas, Venezuela, accidentally received artesunate in a dose of 10 mg/kg/day combined with mefloquine. This corresponds to the upper limit of the therapeutic range recommended by the WHO (2-10 mg/kg/day). Side effects were retrospectively investigated and a pharmacovigilance report was written. The main side effects were vomiting and diarrhea. Four patients developed complications with signs of dehydration. It is suggested to re-assess the therapeutic range of artesunate when given in combination with mefloquine and to establish a worldwide centralized antimalarial toxicity reporting system.
Asunto(s)
Artemisininas/administración & dosificación , Artemisininas/efectos adversos , Diarrea/inducido químicamente , Malaria Falciparum/tratamiento farmacológico , Mefloquina/administración & dosificación , Mefloquina/efectos adversos , Vómitos/inducido químicamente , Adolescente , Adulto , Antimaláricos/administración & dosificación , Antimaláricos/efectos adversos , Artesunato , Diarrea/epidemiología , Quimioterapia Combinada , Femenino , Humanos , Malaria Falciparum/epidemiología , Masculino , Persona de Mediana Edad , Farmacovigilancia , Estudios Retrospectivos , Venezuela/epidemiología , Vómitos/epidemiología , Adulto JovenRESUMEN
The quality of routine malaria diagnosis is a crucial topic of malaria control. The aim of this assessment was to monitor and evaluate the quality of routine malaria diagnosis in Amazonas (Venezuela) and to improve the quality control system. The traditional non-blinded quality control system was found to be overburdened with diagnostic samples. A modified sampling system with fewer samples to be tested was proposed. Expert microscopists blindly double-checked 1000 slides and 550 rapid diagnostic tests (RDT) (OptiMAL-IT) from health posts (HP). For Plasmodium vivax, HP microscopy and OptiMAL-IT showed sensitivies of 86% and 63%, respectively. For P. falciparum, HP microscopy and OptiMAL-IT showed sensitivities of 68% and 89%, respectively. Both methods lost accuracy when fewer parasites occurred in the sample. HP microscopists from different municipalities displayed significant differences in diagnostic quality. Overall, quality of routine malaria diagnosis in the Venezuelan Amazon is good but not optimal. The change from the traditional non-blinded quality control system to blinded cross-checking of a minimal selection of samples is - comparatively - a low cost intervention with possibly high impact on the quality of routine malaria diagnosis. The introduction of RDTs should be discussed carefully in order not to displace an existing network of HP microscopists.
Asunto(s)
Malaria/diagnóstico , Microscopía/normas , Plasmodium falciparum/aislamiento & purificación , Plasmodium vivax/aislamiento & purificación , Juego de Reactivos para Diagnóstico/normas , Animales , Método Doble Ciego , Humanos , Malaria/epidemiología , Microscopía/métodos , Control de Calidad , Sensibilidad y Especificidad , Venezuela/epidemiologíaRESUMEN
Inequitable access to healthcare has a profound impact on the health of marginalised groups that typically suffer an excess burden of infectious disease morbidity and mortality. The Yanomami are traditionally semi-nomadic people living in widely dispersed communities in Amazonian Venezuela and Brazil. Only communities living in the vicinity of a health post have relatively constant access to healthcare. To monitor the improvement in the development of Yanomami healthcare a cross-sectional survey of 183 individuals was conducted to investigate malaria and anaemia prevalence in communities with constant and intermittent access to healthcare. Demographic and clinical data were collected. Malaria was diagnosed by microscopy and haemoglobin concentration by HemoCue. Prevalence of malaria, anaemia, splenomegaly, fever and diarrhoea were all significantly higher in communities with intermittent access to healthcare (anaemia 80.8% vs. 53.6%, P<0.001; malaria 18.2% vs. 6.0%, P=0.013; splenomegaly 85.4% vs.12.5%, P<0.001; fever 50.5% vs. 28.6%, P=0.003; diarrhoea 30.3% vs.10.7% P=0.001). Haemoglobin level (10.0 g/dl vs. 11.5 g/dl) was significantly associated with access to healthcare when controlling for age, sex, malaria and splenomegaly (P=0.01). These findings indicate a heavy burden of anaemia in both areas and the need for interventions against anaemia and malaria, along with more frequent medical visits to remote areas.
Asunto(s)
Anemia/epidemiología , Reforma de la Atención de Salud/normas , Accesibilidad a los Servicios de Salud/normas , Servicios de Salud del Indígena/normas , Malaria/epidemiología , Adolescente , Anemia/dietoterapia , Estudios Transversales , Femenino , Servicios de Salud del Indígena/legislación & jurisprudencia , Humanos , Malaria/tratamiento farmacológico , Masculino , Embarazo , Complicaciones Hematológicas del Embarazo/epidemiología , Complicaciones Parasitarias del Embarazo/epidemiología , Saneamiento/normas , Migrantes , Venezuela/epidemiologíaRESUMEN
To improve practical, accurate diagnosis of malaria in the Amazon rainforest of Venezuela, two rapid diagnostic tests (RDT) (OptiMAL-IT) and FalciVax) and a laboratory light microscope, used in the field with a battery-operated head lamp as an external light source, were evaluated against the standard laboratory microscope procedure for malaria detection. One hundred and thirty-six Yanomami patients were studied for the presence of malaria parasites. Thirty-three patients (24%) were positive for malaria (Plasmodium falciparum, P. vivax, P. malariae). Twenty-one (64%) of the positive patients had <100 parasites/microl. Both RDTs showed poor sensitivity (24.2% for OptiMAL-IT) and 36.4% for FalciVax) but good specificity (99% both for OptiMAL-IT) and FalciVax). Field and laboratory microscopy showed sensitivities of 94% and 91%, respectively. The kappa coefficient was 0.90, indicating a high agreement between field and laboratory microscopy. We conclude that (i) adequate slide reading cannot be substituted by either of the two RDTs in the Venezuelan Amazon and (ii) the use of a light source such as that described above makes slide reading more feasible than hitherto in remote areas without electricity.