Malaria Control & Elimination

I am pleased to introduce International Journal of Malaria Control & Elimination (MCCE) which is an open access electronic journal aiming to provide an online compendium for anatomical variations in gross, radiological, neuroanatomical, surgical anatomy, and case reports in clinical anatomy. We have been started in year 2008 International Journal of Malaria Control & Elimination (ISSN: 2470-6965) is growing continuously. It is our pleasure to announce that during year 2019, all issues of volume 12 were published online on time and the print issues were also brought out and dispatched within 30 days of publishing the issue online.
The Journals aims to flourish and to maintain the standards in research and practice, provide platform and opportunity for researcher to present their research work and analytical assessment of research and probably it is much in deed for students, teachers and professors.
Journal of Malaria Control & Elimination focuses on all the broader as well as specific areas of research in the fields such as, malaria, malaria control, cerebral malaria, malaria vaccines, antimalarial, neonatal malaria, malaria parasites etc.
During the calendar year 2019, International Journal of Malaria Control & Elimination received a total of 30 papers, out of which 2 articles were rejected in the preliminary screening due to plagiarism or being out of the format and peer review process. During 2019 around 16 articles were subjected for publication after they are accepted in the peer review process. In the 4 issues of Volume 12 published during the year 2019, a total of 16 articles were published (at an average of 3 articles per issue of which, articles were published from authors all around the world. A total of 30 research scientists from all over the world reviewed the 16 articles published in volume 12. Average publication period of an article was further reduced to 14-21 days.
During the calendar year 2019, a total of three Editors, ten Reviewers joined the board of IJAV and contributed their valuable services towards contribution as well as publication of articles, and their valuable reviewer comments will beneficial to publish quality of article in the Journal.
I take this opportunity to acknowledge the contribution of Editor-in-chief and Associate Editor during the final editing of articles published and bringing out issues of MCCE in time. I would also like to express my gratitude to all the authors, reviewers, the publisher, language editor, honorary editors, the scientific advisory and the editorial board of MCCE, the office bearers for their support in bringing out the new volume (Volume 9) of MCCE for the calendar year 2020 and look forward to their unrelenting support further to release more issues for International Journal of Malaria Control & Elimination MCCE in scheduled time.

The aim of this research was to isolate and identify environmental bacteria from various raw water sources as well as the drinking water distributions system in Bakura, Zamfara State, Nigeria and to determine their antibiotic resistance profiles. Water samples from five different sites (raw and drinking water) were tested for the presence of faecal indicator bacteria as well as Aeromonas and Pseudomonas species. Faecal and total Coliforms were detected in the treated water samples from the Bakura’s dam and in the mixed water samples, with Pseudomonas spp. being the most prevalent organism. The most prevalent multiple antibiotic resistance phenotype observed was KF-AP-C-E-OT-K-TM-A. All organisms tested were resistant to erythromycin, trimethoprim, and amoxicillin. All isolates were susceptible to ciprofloxacin and faecal Coliforms and Pseudomonas spp. to neomycin and slightly streptomycin. Cluster analysis based on the zone of inhibition diameter data shows that the isolates had similar chemical exposure histories. Isolates were identified using gyrB, toxA, ecfX, arA, and hylH gene fragments and gyrB, ecfX, and hylH fragments were amplified. These results demonstrate that (i) the drinking water from Bakura contain various bacterial species and at times faecal and total Coliforms. (ii)The various bacteria are resistant to various classes of antibiotics.
Water is considered a vehicle for the propagation and dissemination of human associated bacteria. Safe drinking water is a fundamental human right and if contaminated with opportunistic pathogenic environmental bacteria, it may have health implications for consumers. Human health should therefore be protected by preventing microbial contamination of water that is intended for consumption. In rural communities, untreated surface water from rivers, dams, and streams is directly used for drinking and other domestic purposes. These unprotected water sources can be contaminated with microbes through rainfall run-off and agricultural inputs, mixing with sewage effluents and faeces from wild life, which render them unacceptable for human consumption. Faecal coliforms, Aeromonas and Pseudomonas, are used as indicators of faecal contamination in water and the presence of these pathogens may have severe health implications on consumers especially those that are immunocompromised.
Water samples were collected from five sampling points around Mafikeng, namely, both raw and treated (drinking) water from a karstic groundwater source, the Molopo Eye, both raw water and treated (drinking) water from the Modimola dam, and finally mixed water, treated water from both sources mixed in the Signal hill reservoir and distributed to some areas in the city. These sampling points were chosen for the study because water from Molopo eye and Modimola dam, after purification, is used for human consumption, and for recreational, agricultural, and industrial purposes. As few small scale of farmers live near these two water resources and the Modimola Dam receives treated sewage effluent from the Mmabatho sewage treatment plant, which is the major source of pathogens, it is therefore important to investigate the microbiological quality of water at these points.
An evaluation of the bacteriological quality of drinking water in the present study confirmed the presence of various bacterial species including opportunistic pathogens such as Aeromonas and Pseudomonas spp. These organisms were resistant to several classes of antibiotics. Undesirable properties of water quality caused by the presence of drug-resistant bacteria can pose a negative impact on human health.
The data on multiple antibiotic resistance (MAR) profiles of bacterial isolates from water and the resistance patterns of organisms in drinking water in Mafikeng suggested that there has been an indiscriminate use of the antibiotics tested. The high prevalence of multiple antibiotic-resistant organisms in the drinking water distribution system could potentially pose a threat to humans consuming this water. The presence of MAR organisms in the drinking water of Mafikeng, South Africa, is an important health concern due to the risk of developing waterborne diseases and the health risks associated with immunocompromised patients living in the area. It is therefore imperative to monitor the quality of water and strict quality control measures should be put in place to ensure the effective treatment of drinking water. Since the Modimola dam is the recipient of treated waste water as well as the water source for drinking water production, extremely strict measures should guide the waste water treatment plant. The quality of effluent leaving in this plant should be extremely high. This would decrease the load of microorganisms allowed to enter the dam. Such measures will improve the overall quality of water available for drinking water production, preventing outbreaks and spreading water borne diseases. Antibiotic resistance surveillance can be used as tool to control the problem of antibiotic resistance and to educate the public on the consequences of the misuse of antibiotics and also to regulate the usage of drugs in both human and veterinary medicine. It is also helpful to formulate guidelines for the optimal use of antibiotics. Further studies should be conducted to assess the level of antibiotics in water and the potential risks associated with human consumption of polluted water. It is also very important that findings from studies such as this one should be disseminated to the relevant stakeholders and the affected communities.
 

Fungal infections represent the invasion of tissues by one or more species of fungi which can range from superficial infections to cutaneous and subcutaneous infections, to serious deep tissue, blood, lung or systemic diseases. For almost five decades, the worldwide incidence of fungal infections has increased dramatically. Several factors have contributed significantly to this increase which includes indiscriminate and widespread use of broad-spectrum antibiotics to suppress or kill bacteria, use of corticosteroids, anti-cancer drugs and invasive surgical procedures, among others. The complex interplay between host and microbe is especially evident in the pathogenesis of fungal diseases. In the ecology of organisms as well as host-microbe interactions, fungi which were once classified as saprobic organisms or commensals in their respective ecological niches have now been recognized as opportunistic pathogens or disease-causing agents which possess latent capabilities to cause life-threatening infections in immune-deficient hosts, particularly Acquired Immune Deficiency Syndrome (AIDS) patients. There are also great similarities between fungal cells and animal cells since they are both eukaryotes, which significantly complicate therapeutic approaches to fight fungal diseases which frequently occur in hosts with compromised immunity. Certain fungi, like Candida albicans are particularly commensals, forming part of the normal flora while others like Cryptococcus neoformans, are environmental opportunists that take advantage of the abrogated host’s system. Some fungi are dimorphic in nature occurring as mold forms in the environment transforming into yeast phase in tissues which are able to produce infections even in healthy hosts. They cause diseases called endemic mycoses, which are group of diseases caused by diverse fungi that share common characteristics. In the Asia-Pacific region, the epidemiology of fungal infections is not well described and the information regarding incidence is lacking. There were several researchers who conducted reviews of fungal infections in the region. Surveys conducted showed rising incidence of fungal diseases. The occurrences of such fungal infections in the Asia-Pacific region do exist and pose significant impact or threat on public health. Although the means of diagnosing and treating fungal infections have greatly improved over the last decade, fungi still represent a serious threat to the health of immunocompromised and immunodeficient patients. In addition to the more commonly encountered fungi, recent years have also seen the emergence of life-threatening infections that had been previously seen in clinical practice. Many of these fungi are difficult to detect and treat and their emergence as serious agents of disease among specific patient cohorts presents new challenges to the delivery of safe and effective antifungal therapy. As an offshoot of the Fulbright Visiting Scholar Program where several diagnostic methods were studied and done at Duke University Medical Center, this study will discuss more on the growing concern about opportunistic fungal infections, epidemiology and diagnostic procedures applicable in the Philippines. Mycological methods would include sample/specimen collection, use of appropriate culture media, diagnostic methods, virulence tests using animal models and histopathology techniques.
Fungal diseases kill more than 1.5 million and affect over a billion people. However, they are still a neglected topic by public health authorities even though most deaths from fungal diseases are avoidable. Serious fungal infections occur as a consequence of other health problems including asthma, AIDS, cancer, organ transplantation and corticosteroid therapies. Early accurate diagnosis allows prompt antifungal therapy; however this is often delayed or unavailable leading to death, serious chronic illness or blindness. Recent global estimates have found 3,000,000 cases of chronic pulmonary aspergillosis, ~223,100 cases of cryptococcal meningitis complicating HIV/AIDS, ~700,000 cases of invasive candidiasis, ~500,000 cases of Pneumocystis jirovecii pneumonia, ~250,000 cases of invasive aspergillosis, ~100,000 cases of disseminated histoplasmosis, over 10,000,000 cases of fungal asthma and ~1,000,000 cases of fungal keratitis occur annually. Since 2013, the Leading International Fungal Education (LIFE) portal has facilitated the estimation of the burden of serious fungal infections country by country for over 5.7 billion people (>80% of the world’s population). These studies have shown differences in the global burden between countries, within regions of the same country and between at risk populations. Here we interrogate the accuracy of these fungal infection burden estimates in the 43 published papers within the LIFE initiative.
 

After the ban in the use of antibiotic growth promoter, the search of an alternative led to the utilization of the plants which have been using by ethnic people as a part of their meal from ancient time and Moringaoleifera is one of those plants. Leaves of M. oleifera are known to have an important component of macronutrients, micronutrients and of anti-nutritive factors etc. In the aim to give more knowledge about it, leaves are collected, dried, pulverized and soaked in ethanol-water (50/50). The mixing obtained is homogenized, filtered and evaporated to obtain hydro alcoholic extract (HAE). This extract was used to determine its contents in some chemical groups such as total phenols, tannin, total flavonoids and polysaccharides. Antibiotic resistance has progressed substantially in the recent years and is showing an ever increasing therapeutic problem. One of the methods to reduce the resistance to antibiotics is by using antibiotic resistance inhibitors from plants and some bio enhancers. Bioenhancers are drug facilitator which do not show the typical drug activity but in combination enhance the activity of other molecule in several way including increase in the bioavailability of drug across the membrane, potentiating the drug molecules by conformational interaction, acting as receptor for drug molecules and making target cell more receptive to drugs and by promoting the uptake of drugs in combination therapy. The aim of this study was to evaluate the antibacterial and bioenhancing properties of hydro-alcoholic leaves extract of M. oleifera (HAE-MO) alone and in combination with solar heat distilled cow urine distillate (SHD-CUD) against pathogenic S. aureus isolated from urinary tract infected equines. The antibacterial activity of HAE-MO and SHD-CUD at 12.5%, 25%, 50% and 100% concentrations was determined in vitro and compared with sensitivity testing of standard antibiotic Imepeneme using disc diffusion method. The results obtained showed that 25%, 50% and 100% concentration of HAE-MO had moderate inhibitory effects on S. aureus when used alone while only 100% concentration of SHD-CUD showed some inhibitory effect on S. aureus when used alone. Furthermore, HAE-MO at 12.5%, 25%, 50% and 100% in combination with SHD-CUD at 100% concentrations showed very high inhibitory effects of on pathogenic S. aureus.  These results were compared with standard antibiotics Amoxiclav and Imepeneme, which showed high and moderate sensitivity against S. aureus respectively. These results provide valuable information that M. oleifera possess great promise as highly effective antibacterial agents. The antibacterial effect of HAE-MO in combination with SHD-CUD was higher than the inhibition caused by extract alone and is suggestive of bioenhancing role of cow urine distillate and M. oleifera. Moreover, inhibition of test bacteria was also observed with less concentration (12.5%) of extract on combining with SHD-CUD. Results indicate the potential of M. oleifera for further work on isolation and characterization of the active principle responsible for antibacterial activity and its exploitation as therapeutic agent.
Staphylococcus aureus is a Gram-positive, round-shaped bacterium that is a part of the Firmicutes, and it is a common member of the microbiota of the body, frequently found in the upper respiratory tract and on the skin. It is often positive for catalase and nitrate reduction and is a facultative anaerobe that can reside without the need for oxygen. Although S. aureus usually acts as a commensal of the human microbiota it can also become an opportunistic pathogen, being a common cause of skin infections comprising abscesses, respiratory infections such as sinusitis, and food poisoning. Pathogenic strains often support infections by producing virulence factors such as potent protein toxins, and the expression of a cell-surface protein that binds and inactivates antibodies. The emergence of antibiotic-resistant strains of S. aureus such as methicillin-resistant S. aureus (MRSA) is a worldwide problem in clinical medicine. Despite much research and development, no vaccine for S. aureus has been approved.
An estimated 20% to 30% of the human population are long-term carriers S. aureus which can be found as part of the normal skin flora, in the nostrils, and as a normal inhabitant of the lower reproductive tract of women. S. aureus can bring a range of illnesses, from minor skin infections, such as pimples, impetigo, boils, cellulitis, folliculitis, carbuncles, scalded skin syndrome, and abscesses, to life-ending diseases such as pneumonia, meningitis, osteomyelitis, endocarditis, toxic shock syndrome, bacteremia, and sepsis. It is still one of the five most common causes of hospital-acquired infections and is often the cause of wound infections following surgery. Each year, around 500,000 patients in hospitals of the United States face a staphylococcal infection, chiefly by S. aureus. Up to 50,000 fatalities each year in the USA are linked with S. aureus infections.
 

The paravertebral spread that happens after erector spinae plane block may be volume-dependent. This cadaveric study was undertaken to compare the extent of paravertebral spread in erector spinae plane block using different types of dye volumes. After randomization, fourteen erector spinae plane blocks were performed bilaterally with either 10 ml or 30 ml dye at the level of T5 in seven un-embalmed cadavers. Direct visualization of paravertebral space by endoscopy was done immediately after injections. The back regions were also dissected and dye spread and nerve involvements were investigated. A total of five 10 ml injections and seven 30 ml injections were completed for both endoscopic and anatomical analysis. No paravertebral spread was observed by endoscopy after any of the 10 ml injections. Dye spread to spinal nerves at intervertebral foramen was identified by endoscopy at adjacent levels of T5 (median: three levels) in all 30 ml injections. Upon anatomical dissection, all blocks were consistently joined with posterior and lateral spread to back muscles and fascial layers, especially in 30 ml injections, which showed greater dye expansion. In one 30 ml injection, sympathetic nerve involvement and epidural spread was observed at injection site level. Although paravertebral spread following erector spinae plane block increased in a volume-dependent manner, this increase was variable and not pronounced. As injectate volume increased for erector spinae block, injectate spread to the back muscles and fascial layers seemed to be more predominantly increased, rather than the extent of paravertebral spread.
Conventional thoracic paravertebral block is a well-developed technique for analgesia of the thoracic wall in various clinical settings, including thoracic surgery, breast surgery, rib fractures, and chronic neuropathic pain. However, there is a potential risk of pneumothorax or unintentional neuraxial injection. Recently, an erector spinae plane (ESP) block with the, use of a more superficial needle placement than that used in the conventional method was introduced and is gaining popularity. The ESP block targets the fascial plane deep to the erector spinae muscles at the tip of the transverse processes. Therefore, this technique is less probable to approach the pleura and incur attendant risks than the conventional method.
The Institutional Review Board approved the study for exemption from formal review. All cadavers used in the present study were legally donated to the Surgical Anatomy Education Centre at our institution. Twelve ESP blocks were arranged on the right and left sides of the posterior thoracic region in seven unembalmed cadavers except for two cases of unexpected pleural puncture using the 10 ml injection. Each cadaver underwent one ESP block with 10 ml of dye and one with 30 ml of dye, and the choice of which side was used for which volume was made randomly.
The anatomical dissection, most of the dye was located in the fascial layer of the erector spinae muscle group and external intercostal muscles in both ESP blocks (10 ml and 30 ml). In the 30 ml ESP blocks, we observed dye spread to posterior fascial layers of the erector spinae muscles in the craniocaudal direction, but dye spread was barely observed in the retro laminar plane medially and vertically. Above all, lateral spread to the posterior layer of the thoracolumbar fascia and external intercostal muscles was predominantly observed when a larger extent of dye spread occurred using 30 ml of dye (Fig 3A). No dye penetrated the external intercostal muscles; therefore, no dye was noticed in the space between the internal and innermost intercostal muscles, and no intercostal nerve involvement was observed regardless of the volume of dye used (Fig 3B). The number of stained thoracic spinal nerves in the intervertebral foremen was exactly the same with the endoscopic evaluation and the anatomical dissection. There was no clear intersegmental dye spread between corresponding vertebral levels within the paravertebral space in all blocks. In one 30 ml ESP block, sympathetic nerve involvement and epidural spread was observed, but they were limited to the T5 injection site level.
In conclusion, ESP blocks with a low volume of injectate, such as 10 ml, do not result in paravertebral spread. Although paravertebral spread following ESP block volume-dependently increased in this study, injectate spread to the back muscles and fascial layers seemed to be more predominantly increased compared with the extent of paravertebral spread. These findings should be verified by calculating the extent of sensory blocks and the actual analgesic effects following ESP blocks with different injectate volumes in living subjects.
 

Malaria remains a problem for many countries classified as malaria free through cases coming from endemic regions. Imported cases to non-endemic countries often result in delays in treatment, are expensive to treat, and can sometimes cause secondary local transmission. The movement of malaria in endemic countries has also contributed to the spread of drug resistance and threatens long-term eradication goals. Here we focused on quantifying the international movements of malaria to improve our understanding of these phenomena and facilitate the design of mitigation strategies.
Malaria remains a major public health problem and a real threat to global health. According to WHO in 2015, there was an estimate of 212 million malaria cases with 429,000 deaths worldwide. This disease is endemic in tropical and subtropical countries with a high risk for travelers. Morocco was certified in 2010 by WHO as free from endemic malaria transmission. Nevertheless, an increasing number of imported cases are reported each year. Thus, we studied its epidemiological characteristics to determine its trends and to guide recommendations for its control.
A retrospective descriptive study was conducted on reported cases from the surveillance system of parasitic diseases at the Directorate of Epidemiology and Disease Control between 2011 and 2016. Frequencies and proportions were calculated on socio-demographics data and trends.
Our records showed a total of 2422 imported malaria cases including 26 deaths. The 3-year moving average reveals a slight constant trend increase (2%). Imported malaria was predominant among Moroccans (82.3%) than foreigners (17.7%). Males were over represented with a sex ratio of 12.2:1. The disease was reported by both civilian and military sectors (56% versus 44%). The median age was 32 years (range: 1 to 80). Outside the military, workers accounted for 48.6%, students 17% and the truckers 11.5%. Plasmodium falciparum was predominant (66%). Almost all of cases (96%) came from African countries. In 54% of cases, chemoprophylaxis was not taken by travelers.
Imported malaria is an important cause of morbidity and mortality. Prevention strategies for travelers need to be strengthened in order to educate them on the need for prophylaxis and the importance of preventive measures. In addition, targeting high-risk groups and strengthening continuous education training for clinicians would significantly reduce the risk of imported malaria in Morocco.
Since the elimination of the autochthonous malaria in Morocco in 2010, the control of imported malaria, based on epidemiological monitoring of the parasite carriers and on vector control, is a priority. This retrospective study is focused on imported malaria cases identified by optical microscopy at the Laboratory of Public Health in Marrakesh, Morocco, from 1996 to 2016. 208 cases were observed. Males accounted for 89% of cases. The cases were imported from 24 African countries, especially from Equatorial Guinea (28%), Guinea Conakry (11%), Ivory Coast (9%), Burkina Faso (8%) and Mali (7%). The highest incidence was recorded in 2012 and 2014 with 32 cases each. Plasmodium falciparum was the most frequent parasite (85%) followed by Plasmodium ovale (12%), while lower rates were detected for Plasmodium malariae (3 cases) and Plasmodium vivax (2 cases). Increasing malaria cases have been recorded since 1996. This may be related to Morocco's openness to the sub-Saharan Africa with an increase in international travels and migration flow from malaria endemic countries. To keep the status of autochthonous malaria free country, since 2011 the Ministry of Health has developed and implemented a strategy adapted to Moroccan context, to maintain malaria elimination and prevent its reintroduction.
Information about imported malaria is to an extent captured by national authorities where, for most high-income countries, malaria is a notifiable disease. Such deficiencies have prompted the initiation of surveillance networks such as GeoSentinel and EuroTravNet, which now play a key part in the surveillance of imported malaria, in the identification of changing trends in malaria importation, in tracking drug-resistance patterns, and in establishing the changing profile of malaria risk at traveller destinations. Nevertheless, nationally reported data continue to be widely collected and still provide valuable information about the trends, composition, and drivers of imported malaria for most non-endemic countries, with annual data compilations and analyses of statistics providing the main source of information guiding national policies on imported malaria. However, a contemporary global assembly of such nationally reported data, and assessment of patterns and variations has not previously been undertaken.