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Browsing Protocols by Author "Makuluni, Marina"

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    Differential diagnosis for malaria and trypanosomes in areas where the diseases co-exist
    (Kamuzu University of Health Sciences, 2021-01-13) Makuluni, Marina
    Type of study: This is a cross-section study to investigate the co-infection of trypanosome and malaria parasites in areas where trypanosomiasis is endemic in Malawi. Problem: Malaria is ubiquitous, treatment of Human African Trypanosomiasis (HAT) tends to be delayed as the first diagnostic measure for any patient presenting with these symptoms gets malaria treatment first (Darby et al., 2008). Malaria in Malawi is mainly caused by Plasmodium falciparum and diagnosis requires a Malaria Rapid Diagnostic Test (mRDT) at the point of care which is an antibody/antigen test and microscopy of stained blood films is sometimes used. There are two main mRDT in use in Malawi, one developed based on Plasmodium histidine-rich protein (HRP) 2 (pHRP-2) antigen and the other based on Plasmodium lactate dehydrogenase (LDH) (pLDH) antigen both of which mainly target P. falciparum. HAT in Malawi is caused by T.brucei rhodesiense and standard of care diagnosis requires microscopy of stained blood smears although not sensitive when parasitemia is low (Manful et al., 2010). Published reports have revealed that Trypanosome parasite hide underneath the skin of some individuals although there may be no circulating parasites in the blood as one way of invading host adaptive immunity. The parasites may reside underneath the skin for years without being detected in blood circulation. This complicates the diagnosis of HAT as such individuals are diagnosed as microscopically negative for HAT disease and often sent home on antimalaria treatment without further diagnosis. Main objective: To investigate differential diagnosis of Malaria and Trypanosomiasis in Rumphi and Nkhokakota Specific Objectives: 1. To assess the magnitude of HAT patients that are missed out when using microscopy for diagnosis in comparison with a diagnostic HAT PCR. 2. To identify individuals co-infected with Malaria and Trypanosomes 3. To determine whether HAT positive individuals detected are infected with cutaneous trypanosomes. 4. To Identify differences in T.b. rhodesiense parasite gene expression when isolated in skin and or blood. Methodology: Patients that were pre-screened by medical personnel at the hospital for febrile symptoms and sent for Malaria test at the laboratory will be recruited for a period of two weeks to meet our sample size of 123 participants for both Nkhotakota and Rumphi district hospitals. Venous blood specimen will be collected from each participant for further laboratory analysis. Firstly, the blood will be parasites will be sent for treatment immediately following standard treatment guidelines for each disease used to screen for Malaria parasites using Malaria Rapid Diagnostic (RDT) test. Microscopy will be used to confirm individuals who are Malaria RDT positive. Lastly, the other part of the blood will be used for microscopic examination for diagnosis of HAT disease at the district hospital Blood samples that are microscopic negative for HAT will further be tested using a diagnostic HAT PCR at the College of Medicine to rule out any HAT cases that might be missed by the low sensitivity microscopic examination. Individuals that are HAT positive by either microscopy or PCR will be requested to have a small skin snip for further laboratory examination to identify cutaneous Trypanosomes. All participants who are positive for either Malaria or Trypanosome Expected Findings/Dissemination Study This study is expecting to identify the HAT cases that are missed during diagnosis in the two HAT endemic district hospitals of Malawi. The study will also help identify factors that influence mis-diagnosis of HAT in endemic areas of Malawi. Findings from this study will be disseminated at COMREC, College of Medicine Neglected Tropical Disease Research group, Trypanogen Project, Peer reviewed journals and research conferences.