Prevalence estimates of Opisthorchis viverrini and Clonorchis sinensis infection in the Greater Mekong subregion:a systematic review and meta-analysis

Background Opisthorchiasis and clonorchiasis,caused by Opisthorchis viverrini and Clonorchis sinensis,respectively,are significant yet neglected foodborne trematodiases in the Great Mekong Subregion(GMS).Despite the reporting of the prevalence of these human liver flukes in the region over the past decades,there has been a lack of a comprehensive and systematic consolidation of this data.Therefore,we aimed to conduct a thorough systematic review and meta-analysis to synthesize and analyze time-trend prevalence estimates of both O.viverrini and C.sinensis across the GMS for the past 30 years.Methods This study undertakes a systematic review using a comprehensive search for published articles in PubMed,EMBASE,Scopus,Cochrane and Thai Journal Online databases until early 2023.The pooled prevalence of O.viverrini and C.sinensis infection was analyzed through a random-effects meta-analysis,with meta-regression analysis used to quantify associations with study characteristics.Sub-group analysis was conducted,whenever comparison data were available,to assess the risk of O.viverrini and C.sinensis infection in each GMS country.Heterogeneity among studies was assessed using the Q statistic and quantified by using the I^(2)Index.Results From a total of 2997 articles,155 articles comprising 218 datasets and 751,108 participants were included for review.The GMS prevalence of O.viverrini was 21.11%[45,083/260,237;95%confidence interval(CI):17.74-24.47%].Pooled prevalence estimates were highly observed in Laos(34.06%,95%CI:26.85-41.26%),followed by Thailand(18.19%,95%CI:13.86-22.51%),and Cambodia(10.48%,95%CI:5.52-15.45%).Myanmar and Vietnam had limited data sources for calculation.Clonorchis sinensis infection in GMS was 25.33%(95%CI:18.32-32.34%),with Guangxi,China,exhibiting the highest prevalence rates at 26.89%(95%CI:18.34-35.43%),while Vietnam had a prevalence rate of 20.30%(95%CI:9.13-31.47%).O.viverrini prevalence decreased significantly over time,whereas C.sinensis infection appeared to be stable consistently over time in both China and Vietnam.Conclusions This comprehensive study,drawing from the largest datasets to date,offers an in-depth systematic prevalence review of human liver flukes in the Greater Mekong Subregion.It underscores the imperative for systematic surveillance,data collection,and the implementation of intervention and control measures for these infectious diseases of poverty.

Prevalence and hematological indicators of G6PD deficiency in malaria-infected patients

Background:This study aimed to evaluate the prevalence and alteration of hematological parameters in malaria patients with a glucose-6-phosphate dehydrogenase(G6PD)deficiency,in the western region of Thailand,an endemic region for malaria.Methods:Data about patients with malaria hospitalized between 2013 and 2015 were collected.Clinical and sociodemographic characteristics such as age and gender,diagnosis on admission,and parasitological results were mined from medical records of the laboratory unit of the Phop Phra Hospital in Tak Province,Thailand.Venous blood samples were collected at the time of admission to hospital to determine G6PD deficiency by fluorescence spot test and detect malaria parasites by thick and thin film examination.Other data such as complete blood count and parasite density were also collected and analyzed.Results:Among the 245 malaria cases,28(11.4%)were diagnosed as Plasmodium falciparum infections and 217 cases(88.6%)were diagnosed as P.vivax infections.Seventeen(6.9%)patients had a G6PD deficiency and 228(93.1%)patients did not have a G6PD deficiency.Prevalence of male patients with G6PD deficiency was higher than that of female patients(P<0.05,OR=5.167).Among the patients with a G6PD deficiency,two(11.8%)were infected with P.falciparum,while the remaining were infected with P.vivax.Malaria patients with a G6PD deficiency have higher monocyte counts(0.6×10^(3)/μL)than those without a G6PD deficiency(0.33×10^(3)/μL)(P<0.05,OR=5.167).Univariate and multivariate analyses also confirmed that malaria patients with a G6PD deficiency have high monocyte counts.The association between G6PD status and monocyte counts was independent of age,gender,nationality,Plasmodium species,and parasite density(P<0.005).Conclusion:This study showed a prevalence of G6PD deficiency in a malaria-endemic area.This study also supported the assertion that patients with G6PD-deficient red blood cells had no protection against the P.falciparum infection.In addition,malaria patients with a G6PD deficiency had higher monocyte counts than those without a G6PD deficiency.These findings will help to recognize and diagnose malaria patients with a G6PD deficiency,as well as to identify the risks and protective factors against malaria in endemic areas.

Prevalence of and risk factors for severe malaria caused by Plasmodium and dengue virus co-infection: a systematic review and meta-analysis

Background:Co-infection with both Plasmodium and dengue virus(DENV)infectious species could have serious and fatal outcomes if left undiagnosed and without timely treatment.The present study aimed to determine the pooled prevalence estimate of severe malaria among patients with co-infection,the risk of severe diseases due to co-infection,and to describe the complications of severe malaria and severe dengue among patients with coinfection.Methods:Relevant studies published between databases between 12 September 1970 and 22 May 2020 were identified and retrieved through a search of the ISI Web of Science,Scopus,and MEDLINE.The pooled prevalence and 95%confidence interval(CI)of severe malaria among patients with Plasmodium and DENV co-infection was estimated with a random-effects model to take into account the between-study heterogeneity of the included studies.The risks of severe malaria and severe diseases due to co-infection were estimated with the pooled odds ratio(OR)and 95%CI with a random-effects model.Results:Of the 5653 articles screened,13 studies were included in the systematic review and meta-analysis.The results demonstrated that the pooled prevalence estimate of severe malaria among patients with co-infection was 32%(95%CI:18-47%,I 2=92.3%).Patients with co-infection had a higher risk of severe diseases than those with DENV mono-infection(odds ratio[OR]=3.94,95%CI:1.96-7.95,I 2=72%).Patients with co-infection had a higher risk of severe dengue than those with DENV mono-infection(OR=1.98,95%CI:1.08-3.63,I 2=69%).The most severe complications found in severe dengue were bleeding(39.6%),jaundice(19.8%),and shock/hypotension(17.9%),while the most severe complications found in severe malaria were severe bleeding/bleeding(47.9%),jaundice(32.2%),and impaired consciousness(7.43%).Conclusions:The present study found that there was a high prevalence of severe malaria among patients with Plasmodium and DENV co-infection.Physicians in endemic areas where these two diseases overlap should recognize that patients with this co-infection can develop either severe malaria or severe dengue with bleeding complications,but a greater risk of developing severe dengue than severe malaria was noted in patients with this co-infection.Trial registration:The protocol of this study was registered at PROSPERO:CRD42020196792.

Differentiating between dengue fever and malaria using hematological parameters in endemic areas of Thailand

Background:Dengue fever(DF)and malaria are the two major public health concerns in tropical countries such as Thailand.Early differentiation between dengue and malaria could help clinicians to identify patients who should be closely monitored for signs of dengue hemorrhagic fever or severe malaria.This study aims to build knowledge on diagnostic markers that are used to discriminate between the infections,which frequently occur in malaria-endemic areas,such as the ones in Thailand.Methods:A retrospective study was conducted in Phop Phra Hospital,a hospital located in the Thailand-Burma border area,a malaria-endemic area,between 2013 and 2015.In brief,data on 336 patients infected with malaria were compared to data on 347 patients infected with DF.Results:White blood cells,neutrophil,monocyte,eosinophil,neutrophil-lymphocyte ratio,and monocyte-lymphocyte ratio were significantly lower in patients with DF compared to patients with malaria(P<0.0001).In contrast,red blood cells,hemoglobin,hematocrit,mean corpuscular volume,mean corpuscular hemoglobin,and mean corpuscular hemoglobin concentration were significantly higher in patients with DF as compared to patients with malaria(P<0.0001).A decision tree model revealed that using neutrophils,lymphocyte,MCHC,and gender was guided to discriminate between dengue and malaria infection.Conclusion:This study concluded that several hematological parameters were different for diagnosing DF and malaria.A decision tree model revealed that using neutrophils,lymphocyte,MCHC,and gender was guided to discriminate patients with dengue and malaria infection.In addition,using these markers will thus lead to early detection,diagnosis,and prompt treatment of these tropical diseases.