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This study aimed to evaluate the accuracy of the thick blood smear (TBS) versus quantitative polymerase chain reaction (qPCR) for the diagnosis of malaria associated with pregnancy (MAP) caused by P. falciparum or P. vivax in Colombia in its gestational malaria (GM), placental malaria (PM), and congenital malaria (CM) forms as well as to compare its accuracy in different subgroups of pregnant women according to the presence of fever, anemia and a history of malaria. This was a diagnostic evaluation of 829 pregnant women, 579 placentas, 381 umbilical cord samples, and 221 neonatal peripheral blood samples. Accuracy was evaluated based on the parameters of sensitivity, specificity, predictive values, likelihood ratios, and validity index, with their 95% confidence intervals. The frequency of GM was 36% (n = 297/829), PM 27% (n = 159/579), and CM 16.5% (n = 63/381) in umbilical cord samples and 2% (n = 5/221) in neonatal peripheral blood samples. For GM, the sensitivity was 55%, with higher rates in those infected with P. vivax (68%), with a history of malaria (69%), and with fever (96%). These three subgroups presented the best results in terms of the negative likelihood ratio and validity index. For PM, sensitivity was 8%; in subgroup analyses in terms of species, symptomatology (anemia and fever), and history of malaria, it was 1-18%, and the negative likelihood ratio was >0.80 in all subgroups. No false positives were recorded in any of the subgroups. The TBS did not detect any cases of CM. This study found the TBS yielded satisfactory results in terms of diagnosing GM for P. vivax, pregnant women with previous malaria and febrile. It also showed that the TBS is not useful for diagnosing PM and CM. It is necessary to conduct surveillance of MAP with molecular methods in in groups where TBS is deficient (asymptomatic GM, P. falciparum, and pregnant women without history of malaria) to optimize the timely treatment of PM and CM, avoid the deleterious effects of MAP and achieve the malaria elimination goals in Colombia.

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Dentre as hemoparasitoses com maior frequência de transmissão por carrapatos pode-se destacar a Erliquiose, a Hepatozoonose, a Anaplasmose e a Babesiose. A coinfecção por esses agentes são frequentes na rotina clínica; no entanto, poucas são as descrições sobre a ocorrência simultânea desses agentes em hemogramas. Sendo assim, o objetivo deste trabalho foi relatar os casos de quatro cães diagnosticados com coinfecção por Ehrlichia spp. e Hepatozoon canis, os quais foram atendidos no Hospital Veterinário Adílio Santos de Azevedo (HV-ASA) do Instituto Federal de Educação, Ciência e Tecnologia da Paraíba (IFPB), campus Sousa. Durante a avaliação clínica, relatou-se que os pacientes apresentavam, de maneira em comum, oligodipsia e hiporexia, além de histórico de presença de carrapatos. Em seguida, foram realizados hemogramas, que revelaram que todos os animais apresentavam anemia leve a moderada. Além disso, notou-se que o animal 1 estava com trombocitopenia e os animais 2 e 3, neutrofilia. Na pesquisa de hemoparasitas em esfregaço sanguíneo, observou-se coinfecção por H. canis e E. spp. nos quatro animais. Desta forma, este relato demonstrou a importância do uso do hemograma e da pesquisa dos agentes causadores das hemoparasitoses, através do esfregaço sanguíneo. Ressalte-se que o esfregaço sanguíneo, embora seja um método inespecífico e de baixa sensibilidade, pode e deve ser adotado como rotina, por ser uma técnica simples, rápida, barata, pouco invasiva e de diagnóstico definitivo.

Among the hemoparasitoses with the highest frequency of transmission by ticks, ehrlichiosis, hepatozoonosis, anaplasmosis, and babesiosis may be highlighted. The coinfection with these agents is frequent in clinical routine; however, there are few descriptions of the simultaneous occurrence of these agents in blood counts. Therefore, this work aimed to report the cases of four dogs diagnosed with Ehrlichia spp. and Hepatozoon canis, which were treated at the Adílio Santos de Azevedo Veterinary Hospital (HV-ASA), of the Federal Institute of Education, Science, and Technology of Paraíba (IFPB), Sousa campus. During the clinical evaluation, it was reported that the patients had oligodipsia and hyporexia in common, in addition to a history of tick presence. Then, blood counts were performed, which revealed that all animals had mild to moderate anemia. In addition, it was noted that animal 1 had thrombocytopenia and animals 2 and 3 had neutrophilia. In the investigation of hemoparasites in blood smears, co-infection with H. canis and E. spp. was observed in the four animals. Thus, this report demonstrated the importance of using the blood count and researching the causative agents of hemoparasitosis, through the blood smear. It should be noted that the blood smear, although it is a non-specific and low-sensitivity method, can and should be adopted as a routine, as it is a simple, fast, inexpensive, minimally invasive, and definitive diagnostic technique.

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A babesiose canina é uma doença transmitida pela picada de carrapatos, como o Rhipicephalus sanguineus, vetor de Babesia vogeli, um hemoprotozoário de extrema importância na Medicina Veterinária. Esse protozoário parasita os eritrócitos, levando a uma hemólise. O animal infectado pode apresentar febre, letargia, anorexia, anemia, mucosas pálidas ou ictéricas, hematúria e hepatoesplenomegalia. O diagnóstico presuntivo da babesiose canina pode se basear em histórico, anamnese ou exame físico, porém a confirmação é obtida por meio do exame parasitológico. Durante o atendimento, um cão, macho, cinco anos, boxer, apresentou apatia, hiporexia, hematúria, hipertermia. Para confirmação de diagnóstico foram solicitados os exames complementares: hemograma, alanina aminotransferase e creatinina. A única alteração encontrada foi diminuição de plaquetas, porém no esfregaço sanguíneo foram observadas estruturas de Babesia sp. livres e parasitando hemácias.(AU)

Canine babesiosis is a disease transmitted through tick bites, such as Rhipicephalus sanguineus, vector of Babesia vogeli, a hemoprotozoan of extreme importance in Veterinary Medicine. This protozoan parasites erythrocytes leading to hemolysis. The infected animal may have fever, lethargy, anorexia, anemia, pale or jaundiced mucous membranes, hematuria and hepatosplenomegaly. The presumptive diagnosis of babesiosis can be based on history, anamnesis or physical examination, but the confirmation is obtained through parasitological examination. During the service, a male dog, five years old, boxer, presented apathy, hyporexia, hematuria, hyperthermia. To confirm the diagnosis, a complete blood count, alanine aminotransferase and creatinine were requested. The only alteration found was a decrease in platelets, however, in the blood smear, Babesia sp. were detected free and parasitizing red blood cells.(AU)

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Abstract Objective We evaluated the relevance of using the smudge cell percentage in the blood smear as a prognostic marker in CLL. Methods In this prospective study, 42 untreated Senegalese patients with CLL were enrolled. The diagnosis was established, based on the peripheral blood count and flow cytometry using the Matutes score. Cytogenetic aberrations, assessed by fluorescence in situ hybridization (FISH), were available for 30 patients, while the immunoglobulin heavy chain genes (IGVH) mutation status was performed by next-generation sequencing (NGS) in 24 patients. The SC percentage was determined in the blood smear, as previously described. Statistical analyses were executed using the GraphPad Prism 8. Results The mean age was 63 years (48 - 85) and the male: female sex ratio was 4.66. A low SC (< 30%) percentage was correlated with Binet stage B/C (p= 0.0009), CD38 expression (p= 0.039), unmutated IGVH status (p= 0.0009) and presence of cytogenetic abnormalities (for del 13q, p= 0.0012, while for other cytogenetic aberrations, p= 0.016). An inverse correlation was found between the SC percentage and the absolute lymphocyte count (r= -0.51) and patients with higher percentage of SCs had a prolonged survival. However, there was no correlation between the SC percentage and age (p= 0.41) or gender (median, 19% for males vs. 20% for females; p= 0.76). Conclusion When less than 30%, the SC was associated with a poor prognosis in CLL. Easy and affordable, the percentage of SCs in a blood smear could be a reliable prognostic marker, accessible to all CLL patients, mainly those in developing countries.

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PURPOSE: Hepatozoonosis and piroplasmosis are diseases caused by apicomplexan protozoa that affect different types of animals, including mammals. The present study aimed to evaluate the occurrence of Hepatozoon spp. and piroplasms in wild mammals kept in captivity in rehabilitation centers in the states of Minas Gerais and Goiás, Brazil. METHODS: For this, blood samples from 152 animals were collected and analyzed by conventional optical microscopy and polymerase chain reaction (PCR). In addition, positive PCR samples were submitted to sequencing for molecular characterization of the specimens found. RESULTS: Microscopic analysis revealed 53 of the 152 animals (28.3%) parasitized by piroplasms. No Hepatozoon sp. was observed. On the other hand, using the primers HepF300/HepR900 and Piro1F/Piro5R, both amplifying fragments of the 18S rDNA gene, eight animals (5.2%) were positive for Hepatozoon spp. and 40 (26.3%) for piroplasms. From the sequencing of the positive samples Hepatozoon canis, Hepatozoon felis, Theileria cervi, Theileria equi and Cytauxzoon felis were identified. In addition to the aforementioned hemoparasites, some animals were found parasitized by microfilaria. Such data ratify the presence of hemoparasites in captive wild animals, and are unprecedented in the two geographical regions covered by the present study. 19.7% of mammals harbored ectoparasites of the genera Amblyomma and Rhipicephalus. CONCLUSION: Wild mammals are infected by several pathogens that can also infect domestic animals, some of them potentially zoonotic which can directly contribute to mortality and species reduction. Therefore, a deep understanding of the parasites, the hosts and the diseases is extremely necessary so that prevention, control and treatment measures are effectively applied.

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This research aims to determine whether the combination of epidemiological and clinical features can predict malaria. Diagnostic investigation detected 22.3% of individuals with Plasmodium vivax (P. vivax) malaria, with significant predominance of the male gender. The malaria triad (fever, chills and headache) had a more expressive frequency (81.1%) in individuals with positive thick blood than those with negative thick blood smear (65.1%), although there was no statistical significance. Among the variables analysed as predictive for positive thick blood smear, it was observed that personal history of travel to an endemic malaria area and past malaria infection (PMI) were significantly associated with malaria, even in multiple logistic regression. Fever had the higher sensitivity (94.6%) and past malaria history had the greater specificity (68.2%), with accuracy of 23.5% and 67.5%, respectively. In combined analysis, fever with chills had the highest sensitivity (91.9%), but low accuracy (38.5%). High specificity (91.5%) was found in the association of malaria triad, PMI and history of travel to endemic malaria area (which along with anorexia, was higher 94.6%), with good accuracy (80.7%), suggesting that the screening of patients for performing thick blood smear can be based on these data. The epidemiological features and the malaria triad (fever, chills and headache) can be predictors for identification of malaria patients, concurring to precocious diagnosis and immediate treatment of individuals with malaria.

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OBJECTIVE: We evaluated the relevance of using the smudge cell percentage in the blood smear as a prognostic marker in CLL. METHODS: In this prospective study, 42 untreated Senegalese patients with CLL were enrolled. The diagnosis was established, based on the peripheral blood count and flow cytometry using the Matutes score. Cytogenetic aberrations, assessed by fluorescence in situ hybridization (FISH), were available for 30 patients, while the immunoglobulin heavy chain genes (IGVH) mutation status was performed by next-generation sequencing (NGS) in 24 patients. The SC percentage was determined in the blood smear, as previously described. Statistical analyses were executed using the GraphPad Prism 8. RESULTS: The mean age was 63 years (48 - 85) and the male: female sex ratio was 4.66. A low SC (< 30%) percentage was correlated with Binet stage B/C (p = 0.0009), CD38 expression (p = 0.039), unmutated IGVH status (p = 0.0009) and presence of cytogenetic abnormalities (for del 13q, p = 0.0012, while for other cytogenetic aberrations, p = 0.016). An inverse correlation was found between the SC percentage and the absolute lymphocyte count (r = -0.51) and patients with higher percentage of SCs had a prolonged survival. However, there was no correlation between the SC percentage and age (p = 0.41) or gender (median, 19% for males vs. 20% for females; p = 0.76). CONCLUSION: When less than 30%, the SC was associated with a poor prognosis in CLL. Easy and affordable, the percentage of SCs in a blood smear could be a reliable prognostic marker, accessible to all CLL patients, mainly those in developing countries.

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Leukaemia is a dysfunction that affects the production of white blood cells in the bone marrow. Young cells are abnormally produced, replacing normal blood cells. Consequently, the person suffers problems in transporting oxygen and in fighting infections. This article proposes a convolutional neural network (CNN) named LeukNet that was inspired on convolutional blocks of VGG-16, but with smaller dense layers. To define the LeukNet parameters, we evaluated different CNNs models and fine-tuning methods using 18 image datasets, with different resolution, contrast, colour and texture characteristics. We applied data augmentation operations to expand the training dataset, and the 5-fold cross-validation led to an accuracy of 98.61%. To evaluate the CNNs generalisation ability, we applied a cross-dataset validation technique. The obtained accuracies using cross-dataset experiments on three datasets were 97.04, 82.46 and 70.24%, which overcome the accuracies obtained by current state-of-the-art methods. We conclude that using the most common and deepest CNNs may not be the best choice for applications where the images to be classified differ from those used in pre-training. Additionally, the adopted cross-dataset validation approach proved to be an excellent choice to evaluate the generalisation capability of a model, as it considers the model performance on unseen data, which is paramount for CAD systems.

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A anemia hemolítica imunomediada (AHIM) é uma reação de hipersensibilidade tipo II onde ocorre o aumento da destruição das hemácias. Ela pode ser dividida em primaria, caracterizada por não ter uma causa subjacente, e em secundária, pode ser causada por agentes infecciosos, como a micoplasmose, neoplasias, medicamentos e transfusões. O objetivo desse trabalho foi realizar uma análise clínica e laboratorial de um cão com anemia hemolítica imunomediada decorrente da Mycoplasma spp. Uma cadela da raça Pit Bull, com 05 meses de idade, foi levada ao hospital apresentando vômitos, diarreia e anorexia. No exame físico, foi possível observar a presença de carrapatos e mucosas ictéricas. Nos exames hematológicos foi possível evidenciaras alterações morfológicas de hemácias que caracterizavam anemia hemolítica imunomediada e a presença do parasita Mycoplasma spp. Nas análises bioquímicas se observou níveis séricos aumentados de creatinina e ureia. Pode-se concluir que, a observação de Mycoplasma spp. em esfregaços sanguíneos associada às alterações morfológicas eritrocitárias são de relevante importância para o diagnóstico de AHIM, auxiliando assim na instituição da melhor conduta terapêutica, contribuindo para o prognóstico do paciente.(AU)

Immune-mediated hemolytic anemia (AHIM) is a type II hypersensitivity reaction, where red blood cell destruction occurs or increases. It can be divided into primary, characterized by not having an underlying cause, and secondary, which can be caused by infectious agents, such as mycoplasmosis, neoplasms, drugs and transfusions. The objective of this work was to perform a clinical and laboratory analysis of a dog with immune-mediated hemolytic anemia due to Mycoplasma spp. A five-months-old female Pit Bull dog was taken to the hospital presenting vomiting, diarrhea and anorexia. On physical examination, it was possible to observe the presence of ticks and icteric mucous membranes. In hematological exams, it was possible to show morphological changes in red blood cells that characterize immune-mediated hemolytic anemia and the presence of the parasite Mycoplasma spp. In the biochemical analyzes it was observed increased serum levels of creatinine and urea. It can be concluded that the observation of Mycoplasma spp. in blood vessels associated with erythrocyte morphological changes are of relevant importance for the diagnosis of AHIM, thus assisting in the practice of a better method of therapy, contributing to the patient's prognosis.(AU)

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Abstract Canine visceral leishmaniasis (CVL) is a zoonotic disease of high lethality caused by Leishmania infantum in the Americas. In the infected dog, the amastigotes are scarce in blood, especially in the late phase of the disease. This study aimed to report a rare case of L. infantum amastigotes found in neutrophils from peripheral blood of a naturally infected dog in terminal phase of CVL, also describing its clinical status before and after treatment with miltefosine 2%. The dog, which presented as polysymptomatic and with classical signs and symptoms of CVL was submitted to the following tests: Dual Path Platform (DPP) rapid test, ELISA and parasitological examination of peripheral blood. Hematological and biochemical parameters were obtained before and after treatment. All diagnostic tests were positive for CVL. The identification of L. infantum amastigotes inside neutrophils from peripheral blood was confirmed through microscopy, and the species was confirmed by molecular analysis. At the end of the treatment, peripheral parasitemia was not detected, and improvements were observed in clinical and laboratorial parameters. Finally, this atypical finding can be used as example to raise discussions about the real immunological role of neutrophils in late phases of CVL and its clinical/therapeutic implications.

Resumo A leishmaniose visceral canina (LVC) é uma doença zoonótica de alta letalidade causada por Leishmania infantum nas Américas. No cão infectado, as formas amastigotas são escassas no sangue, principalmente na fase tardia da doença. Este estudo teve como objetivo relatar um caso raro de amastigotas de L. infantum encontradas em neutrófilos do sangue periférico de um cão naturalmente infectado e terminal da LVC, descrevendo também seu estado clínico antes e após o tratamento com miltefosina a 2%. O cão, que se apresentou como polissintomático e com sinais e sintomas clássicos da LVC foi submetido aos seguintes testes: teste rápido Dual Path Platform (DPP), ELISA e exame parasitológico de sangue periférico. Os parâmetros hematológicos e bioquímicos foram obtidos antes e após o tratamento. Todos os testes diagnósticos foram positivos para LVC. A identificação de formas amastigotas de L. infantum, dentro de neutrófilos do sangue periférico foi confirmada por microscopia, e a espécie foi confirmada por análise molecular. Ao final do tratamento, não foi detectada parasitemia periférica, observando-se melhora dos parâmetros clínicos e laboratoriais. Por fim, esse achado atípico pode ser usado como exemplo para levantar discussões sobre o real papel imunológico dos neutrófilos nas fases tardias da LVC e suas implicações clínicas/terapêuticas.

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A babesiose canina é uma hemoparasitose, causada por um protozoário do gênero Babesia spp., que parasita os eritrócitos de animais infectados. Este estudo teve como objetivo analisar o perfil hematológico e epidemiológico de cães diagnosticados com babesiose, através da visualização, no esfregaço sanguíneo, de merozoítos no interior dos eritrócitos, na cidade de Fortaleza/CE, durante cinco anos (2015 a 2019). No período, foram observados 38 cães acometidos. O segundo semestre, o período seco, foi o que apresentou um maior número de casos (60,5%). Observou-se maior frequência em cães machos (57,8%), sem raça definida (57,8%), com menos de um ano de idade (73,6%). As alterações hematológicas mais frequentes foram trombocitopenia (86,8%) e anemia (81,5%). Sugere-se, nesses casos, a inclusão da babesiose como diagnóstico diferencial. Apesar da baixa sensibilidade, a pesquisa de hemoparasitos, no esfregaço sanguíneo, pode ser utilizada na rotina clínica.

Canine babesiosis is a hemoparasitosis caused by a protozoan of the genus Babesia spp., that parasitize the erythrocytes of infected animals. This study aimed to analyze the hematological and epidemiological profile of dogs diagnosed with babesiosis, through visualization in blood smear of merozoites inside erythrocytes, in the city of Fortaleza/CE, for five years (2015 to 2019). During the period, 38 affected dogs were observed. The second half, the dry period, was the one with the highest number of cases (60.5%). A higher frequency was observed in male dogs (57.8%), mixed breed (57.8%) under one year of age (73.6%). The most frequent hematological changes were thrombocytopenia (86.8%) and anemia (81.5%). In these cases, it is suggested to include babesiosis as a differential diagnosis. Despite the low sensitivity, the search for hemoparasites in the blood smear can be used in the clinical routine.

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Canine visceral leishmaniasis (CVL) is a zoonotic disease of high lethality caused by Leishmania infantum in the Americas. In the infected dog, the amastigotes are scarce in blood, especially in the late phase of the disease. This study aimed to report a rare case of L. infantum amastigotes found in neutrophils from peripheral blood of a naturally infected dog in terminal phase of CVL, also describing its clinical status before and after treatment with miltefosine 2%. The dog, which presented as polysymptomatic and with classical signs and symptoms of CVL was submitted to the following tests: Dual Path Platform (DPP) rapid test, ELISA and parasitological examination of peripheral blood. Hematological and biochemical parameters were obtained before and after treatment. All diagnostic tests were positive for CVL. The identification of L. infantum amastigotes inside neutrophils from peripheral blood was confirmed through microscopy, and the species was confirmed by molecular analysis. At the end of the treatment, peripheral parasitemia was not detected, and improvements were observed in clinical and laboratorial parameters. Finally, this atypical finding can be used as example to raise discussions about the real immunological role of neutrophils in late phases of CVL and its clinical/therapeutic implications.(AU)

A leishmaniose visceral canina (LVC) é uma doença zoonótica de alta letalidade causada por Leishmania infantum nas Américas. No cão infectado, as formas amastigotas são escassas no sangue, principalmente na fase tardia da doença. Este estudo teve como objetivo relatar um caso raro de amastigotas de L. infantum encontradas em neutrófilos do sangue periférico de um cão naturalmente infectado e terminal da LVC, descrevendo também seu estado clínico antes e após o tratamento com miltefosina a 2%. O cão, que se apresentou como polissintomático e com sinais e sintomas clássicos da LVC foi submetido aos seguintes testes: teste rápido Dual Path Platform (DPP), ELISA e exame parasitológico de sangue periférico. Os parâmetros hematológicos e bioquímicos foram obtidos antes e após o tratamento. Todos os testes diagnósticos foram positivos para LVC. A identificação de formas amastigotas de L. infantum, dentro de neutrófilos do sangue periférico foi confirmada por microscopia, e a espécie foi confirmada por análise molecular. Ao final do tratamento, não foi detectada parasitemia periférica, observando-se melhora dos parâmetros clínicos e laboratoriais. Por fim, esse achado atípico pode ser usado como exemplo para levantar discussões sobre o real papel imunológico dos neutrófilos nas fases tardias da LVC e suas implicações clínicas/terapêuticas.(AU)

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A anemia hemolítica imunomediada (AHIM) é uma reação de hipersensibilidade tipo II onde ocorre o aumento da destruição das hemácias. Ela pode ser dividida em primaria, caracterizada por não ter uma causa subjacente, e em secundária, pode ser causada por agentes infecciosos, como a micoplasmose, neoplasias, medicamentos e transfusões. O objetivo desse trabalho foi realizar uma análise clínica e laboratorial de um cão com anemia hemolítica imunomediada decorrente da Mycoplasma spp. Uma cadela da raça Pit Bull, com 05 meses de idade, foi levada ao hospital apresentando vômitos, diarreia e anorexia. No exame físico, foi possível observar a presença de carrapatos e mucosas ictéricas. Nos exames hematológicos foi possível evidenciaras alterações morfológicas de hemácias que caracterizavam anemia hemolítica imunomediada e a presença do parasita Mycoplasma spp. Nas análises bioquímicas se observou níveis séricos aumentados de creatinina e ureia. Pode-se concluir que, a observação de Mycoplasma spp. em esfregaços sanguíneos associada às alterações morfológicas eritrocitárias são de relevante importância para o diagnóstico de AHIM, auxiliando assim na instituição da melhor conduta terapêutica, contribuindo para o prognóstico do paciente.

Immune-mediated hemolytic anemia (AHIM) is a type II hypersensitivity reaction, where red blood cell destruction occurs or increases. It can be divided into primary, characterized by not having an underlying cause, and secondary, which can be caused by infectious agents, such as mycoplasmosis, neoplasms, drugs and transfusions. The objective of this work was to perform a clinical and laboratory analysis of a dog with immune-mediated hemolytic anemia due to Mycoplasma spp. A five-months-old female Pit Bull dog was taken to the hospital presenting vomiting, diarrhea and anorexia. On physical examination, it was possible to observe the presence of ticks and icteric mucous membranes. In hematological exams, it was possible to show morphological changes in red blood cells that characterize immune-mediated hemolytic anemia and the presence of the parasite Mycoplasma spp. In the biochemical analyzes it was observed increased serum levels of creatinine and urea. It can be concluded that the observation of Mycoplasma spp. in blood vessels associated with erythrocyte morphological changes are of relevant importance for the diagnosis of AHIM, thus assisting in the practice of a better method of therapy, contributing to the patient's prognosis.

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BACKGROUND: Gestational malaria is associated with negative outcomes in maternal and gestational health; timely diagnosis is crucial to avoid complications. However, the limited infrastructure, equipment, test reagents, and trained staff make it difficult to use thick blood smear tests in rural areas, where rapid testing could be a viable alternative. The purpose of this study was to estimate the cost-effectiveness of rapid tests type III (Plasmodium falciparum/Plasmodium spp P.f/pan) versus microscopic tests for the diagnosis and treatment of gestational malaria in Colombia. METHODS: Cost-effectiveness analyses of gestational malaria diagnosis from an institutional perspective using a decision tree. Standard costing was performed for the identification, measurement and assessment phases, with data from Colombian tariff manuals. The data was collected from Health Situation Analysis, SIVIGILA and meta-analysis. Average and incremental cost-effectiveness ratio were estimated. The uncertainty was assessed through probabilistic sensitivity analysis. RESULTS: The cost of rapid diagnostic tests in 3,000 pregnant women with malaria was US$66,936 and 1,182 disability adjusted life years (DALYs) were estimated. The cost using thick blood smear tests was US$50,838 and 1,023 DALYs, for an incremental cost-effectiveness of US$ 101.2. The probabilistic sensitivity analysis of rapid diagnostic tests determined that they are highly cost-effective in 70% of the cases, even below the US$1,200 threshold; also, they showed an incremental net monetary benefit of $150,000 when payer's willingness is US$1,000. CONCLUSION: The use of rapid diagnostic tests for timely diagnosis and treatment of gestational malaria is a highly cost-effective strategy in Colombia, with uncertainty analyses supporting the robustness of this conclusion and the increased net monetary benefit that the health system would obtain. This strategy may help in preventing the negative effects on maternal health and the neonate at a low cost.

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Babesia is tick-transmitted protozoan parasites that infect mammalian hosts and have a major impact on farm and pet health-associated costs worldwide. This study aimed to test the prevalence of Babesia spp. infection in a small cohort of dogs at a veterinary hospital and to perform molecular characterization of the Babesia species causing the infection. For the PCR assay, 5 mL of blood was collected by venipuncture of the cephalic or radial veins in 300 dogs of different ages, sex, and breeds, which were presented to the veterinary hospital of the Federal University of Uberlândia between March 2015 and April 2016. In addition, a drop of blood was collected from the marginal blood vessels of the ear of dogs included in this study. Ninety-two (30.67%) were positive for Babesia spp., as determined by microscopic observation of the blood smear, revealing the presence of intra-erythrocyte merozoites. For molecular characterization by PCR, 17 samples were chosen from dogs who were tested positive for Babesia spp. by blood smears. Among them, B. vogeli was found to infect all 17 dogs, as determined by 99-100% sequence identity (closest GenBank match KT246307) using primers PIRO A/PIRO B. Our results indicate that the species observed in these dogs was B. vogeli.

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Abstract Background: There is great interest in reducing the number of automated complete blood counts requiring manual blood smear reviews without sacrificing the quality of patient care. This study was aimed at evaluating and establishing appropriate screening criteria for manual blood smear reviews to improve the performance in a hematology laboratory. Method: A total of 1977 consecutive samples from the daily workload were used to evaluate four sets of screening criteria for manual blood smear reviews to identify samples with positive smear findings. Three sets of screening criteria were arbitrarily proposed in this study: Group 1 (narrow ranges), Group 2 (intermediate ranges), and Group 3 (wide limits) and one set (Group 4) was adapted from the International Society for Laboratory Hematology. All samples were run on Sysmex hematology analyzers and were investigated using manual blood smear reviews. Diagnostic accuracy and agreement were performed for each set of screening criteria, including an investigation of microscopic review rate and efficiency. Results: The microscopic review rates for Groups 1, 2, 3 and 4 were 73.85%, 54.52%, 46.33% and 46.38%, respectively; the false-negative rates were 0.50%, 1.97%, 2.73% and 3.95%, respectively. The efficiency and negative predictive values of Group 3 were 73.04% and 4.91%, respectively. Conclusions: Group 3 had the best relationship between safety (false-negative rate: ≤3%) and efficiency to estimate the limits of automation in performing complete blood counts. This study strengthens the importance of establishing screening criteria for manual blood smear reviews, which account for the different contexts in which hematological determinations are performed. Each laboratory should optimize the screening criteria for manual blood smear reviews in order to maximize their efficiency and safety.

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BACKGROUND: There is great interest in reducing the number of automated complete blood counts requiring manual blood smear reviews without sacrificing the quality of patient care. This study was aimed at evaluating and establishing appropriate screening criteria for manual blood smear reviews to improve the performance in a hematology laboratory. METHOD: A total of 1977 consecutive samples from the daily workload were used to evaluate four sets of screening criteria for manual blood smear reviews to identify samples with positive smear findings. Three sets of screening criteria were arbitrarily proposed in this study: Group 1 (narrow ranges), Group 2 (intermediate ranges), and Group 3 (wide limits) and one set (Group 4) was adapted from the International Society for Laboratory Hematology. All samples were run on Sysmex hematology analyzers and were investigated using manual blood smear reviews. Diagnostic accuracy and agreement were performed for each set of screening criteria, including an investigation of microscopic review rate and efficiency. RESULTS: The microscopic review rates for Groups 1, 2, 3 and 4 were 73.85%, 54.52%, 46.33% and 46.38%, respectively; the false-negative rates were 0.50%, 1.97%, 2.73% and 3.95%, respectively. The efficiency and negative predictive values of Group 3 were 73.04% and 4.91%, respectively. CONCLUSIONS: Group 3 had the best relationship between safety (false-negative rate: ≤3%) and efficiency to estimate the limits of automation in performing complete blood counts. This study strengthens the importance of establishing screening criteria for manual blood smear reviews, which account for the different contexts in which hematological determinations are performed. Each laboratory should optimize the screening criteria for manual blood smear reviews in order to maximize their efficiency and safety.

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A pesar de la disponibilidad de modernos equipos automatizados, el estudio de la morfología eritrocitaria en extendidos de sangre periférica continúa desempeñando un rol fundamental en el diagnóstico de las anemias. En 2005, el Grupo Internacional de Consenso para la Revisión en Hematología publicó un documento con los criterios homogéneos de acción recomendados para la selección de los frotis sanguíneos que deben ser analizados mediante microscopía. Recientemente, el Comité Internacional de Estandarización en Hematología (ICSH) elaboró una serie de recomendaciones para unificar la nomenclatura y graduar los hallazgos morfológicos anormales en el estudio de la sangre periférica. El objetivo de este trabajo fue presentar a los lectores una revisión del tema y las últimas recomendaciones de los grupos de expertos a nivel nacional e internacional para el estudio de las anemias mediante la evaluación de la morfología eritrocitaria en el frotis de sangre periférica.

Despite the availability of modern automated equipment, the study of red cell morphology in peripheral blood smears continues to play a key role in the diagnosis of anemias. In 2005, the International Consensus Group for Hematology Review published a document with uniform criteria recommended action for the selection of blood smears to be analyzed by microscopy. Recently, the International Committee for Standardization in Hematology (ICSH) produced a series of recommendations to unify the nomenclature and graduate abnormal morphological findings in the study of peripheral blood. The aim of our work was to present readers with a review of the topic and the latest recommendations of the expert groups at national and international levels for the study of anemias by evaluating red cell morphology in the peripheral blood smear.

Apesar da disponibilidade de equipamentos automatizados modernos, o estudo da morfologia eritrocitária em esfregaços de sangue periférico continua a desempenhar um papel fundamental no diagnóstico das anemias. Em 2005, o Grupo Internacional de Consenso em Revisões Hematológicas publicou um documento com os critérios uniformes de ação recomendados para a seleção dos esfregaços sanguíneos que devem ser analisados através do microscópio. Recentemente, a Comissão Internacional de Padronização em Hematologia (ICSH) produziu uma série de recomendações para unificar a nomenclatura e graduar os achados morfológicos anormais no estudo do sangue periférico. O objetivo deste trabalho foi apresentar aos leitores uma revisão do tema e as últimas recomendações dos grupos de especialistas em nível nacional e internacional para o estudo de anemias através da avaliação da morfologia eritrocitária no esfregaço de sangue periférico.

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BACKGROUND: Malaria is a worldwide public health problem; parasites from the genus Plasmodium spp. are the aetiological agent of this disease. The parasite is mainly diagnosed by microscope-based techniques. However, these have limited sensitivity. Many asymptomatic infections are sub-microscopic and can only be detected by molecular methods. This study was aimed at comparing nested PCR results to those obtained by microscope for diagnosing malaria and to present epidemiological data regarding malaria in Colombia's Amazon department. METHODS: A total of 1392 blood samples (taken by venepuncture) from symptomatic patients in Colombia's Amazon department were analysed in parallel by thick blood smear (TBS) test and nested PCR for determining Plasmodium spp. infection and identifying infecting species, such as Plasmodium vivax, Plasmodium malariae and/or Plasmodium falciparum. Descriptive statistics were used for comparing the results from both tests regarding detection of the disease, typing infecting species and their prevalence in the study region. Bearing the microscope assay in mind as gold standard, PCR diagnosis performance was evaluated by statistical indicators. CONCLUSION: The present study revealed great differences between both diagnostic tests, as well as suggesting high P. malariae prevalence from a molecular perspective. This differed profoundly from previous studies in this region of Colombia, usually based on the TBS test, suggesting that diagnosis by conventional techniques could lead to underestimating the prevalence of certain Plasmodium spp. having high circulation in this area. The present results highlight the need for modifying state malaria surveillance schemes for more efficient strategies regarding the detection of this disease in endemic areas. The importance of PCR as a back-up test in cases of low parasitaemia or mixed infection is also highlighted.

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Na clínica médica de equinos, explora-se o perfil hematológico do animal, geralmente, com a finalidade de encontrar alterações que não foram constatadas ao exame clínico. A pesquisa de hematozoários em equinos, muitas vezes, apresenta resultados conflitantes entre o quadro clínico apresentado pelo animal e o resultado laboratorial, levantando a hipótese de que a técnica de pesquisa de hematozoários seja a responsável por falhas diagnósticas. Este estudo visa comparar os valores obtidos em exames hematológicos de 15 equinos de esporte e 15 equinos de tração (carroceiros), levando-se em consideração diferenças como características nutricionais, estado de higidez e tipo de atividade realizada, e comparar as diferentes técnicas de pesquisa de hematozoários, como esfregaço sanguíneo e PCR. Verificou-se que apenas os equinos de tração apresentaram valores médios de hemácias, hematócrito e hemoglobina abaixo do considerado fisiológico para a espécie, embora 100% dos animais, de ambos os grupos experimentais, tenham sido considerados positivos para hemoparasitoses por PCR. Verifica-se a superioridade do método de pesquisa de hemoparasitas por PCR, em comparação com esfregaço sanguíneo, realizado por diferentes técnicas, visto que apenas 33,3% dos animais foram considerados positivos para Theileria equi por esta técnica, enquanto que o PCR revelou 100% de positividade, para Theileria equi, Babesia caballi e infecção mista. Nenhum dos animais estudados foi diagnosticado com Anaplasma phagocytophilum (Ehrlichia equi) e Ehrlichia risticcii (Neoricketsia risticii). Verifica-se, então, que muitos dos diagnósticos de ausência de hemoparasitose por exame hematológico e ou esfregaço sanguíneo são errôneos, devido à baixa sensibilidade da técnica e podem repercutir em falha no tratamento ou disseminação dos hemoparasitos e das hemoparasitoses. Ressalta-se, então, a importância de exames como o PCR na elaboração de diagnóstico definitivo.(AU)

The blood profile is usually explored in equine medicine to find changes not detected through clinical examination. The haematozoa search in horses, often presents conflicting results between the clinical picture presented by the animal and the laboratory result, raising the hypothesis that the hematozoa search technique is responsible for diagnostic failures. Thus, this study aims to compare the values obtained from blood tests in 15 sports horses and 15 traction horses (cart horses), taking into account differences such as nutritional characteristics, state of health and type of activity performed, and to compare the different techniques with hematozoa search, as blood smear and PCR. It was found that only the traction horses showed mean values of red blood cells, hematocrit and hemoglobin below the considered physiological for the species, although 100% of the animals of both experimental groups were considered positive for hemoparasitoses by PCR. It was verified the superiority of hemoparasites search method by PCR, compared with blood smear performed by different techniques, since only 33.3% of the horses were considered positive for Theileria equi by this technique, while the PCR showed 100% positive for Theileria equi, Babesia caballi and mixed infection. None of the animals studied was diagnosed with Anaplasma phagocytophilum (Ehrlichia equi) and Ehrlichia risticcii (Neoricketsia risticii). It is shown that many cases of hemoparasitosis absence of diagnostic by hematological exams and or blood smears are erroneous due to the low sensitivity of the technique and may impact on treatment failure or spread of blood parasites and hemoparasitoses. It is noteworthy to stres the importance of tests such as PCR for the definitive diagnosis.(AU)

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