Malaria is the most common vector-borne parasitic infection causing significant human morbidity a... more Malaria is the most common vector-borne parasitic infection causing significant human morbidity and mortality in nearly 90 tropical/sub-tropical countries worldwide. Significant differences exist in the incidence of malaria cases, dominant Plasmodium species, drug-resistant strains and mortality rates in different countries. Six Gulf Cooperation Council (GCC) countries (Bahrain, Kuwait, Qatar, Oman, Saudi Arabia and United Arab Emirates, UAE) in the Middle East region with similar climates, population demographics and economic prosperity are aiming to achieve malaria elimination. In this narrative review, all studies indexed in PubMed describing epidemiological characteristics of indigenous and imported malaria cases, vector control status and how malaria infections can be controlled to achieve malaria elimination in GCC countries were reviewed and discussed. These studies have shown that indigenous malaria cases are absent in Bahrain, Kuwait, Qatar and UAE and have progressively de...
The OptiMAL test (Flow Inc., Portland, Oreg.), which detects a malaria parasite lactate dehydroge... more The OptiMAL test (Flow Inc., Portland, Oreg.), which detects a malaria parasite lactate dehydrogenase (pLDH) antigen, has not been evaluated for its sensitivity in the diagnosis of malaria infection in various epidemiological settings. Using microscopy and a PCR as reference standards, we performed a comparison of these assays with the OptiMAL test for the detection of Plasmodium falciparum and Plasmodium vivax infection in 550 immigrants who had come from areas where malaria is endemic to reside in Kuwait, where malaria is not endemic. As determined by microscopy, 125 (23%) patients had malaria, and of these, 84 (67%) were infected with P. vivax and 36 were infected with P. falciparum ; in 5 cases the parasite species could not be determined due to a paucity of the parasites. The PCR detected malaria infection in 145 (26%) patients; 102 (70%) of the patients had P. vivax infection and 43 had P. falciparum infection. Of the five cases undetermined by microscopy, the PCR detected P. ...
Objectives: To develop and evaluate a rapid method for the diagnosis of malaria infection by micr... more Objectives: To develop and evaluate a rapid method for the diagnosis of malaria infection by microscopy of stained blood films. Subjects and Methods: Blood specimens were collected from randomly selected confirmed malaria cases (n = 75) and suspected malaria cases (n = 175). The microscopy was done on each set of blood films stained by modified and the standard Giemsa staining methods. Results: All the 75 previously diagnosed malaria cases were confirmed by the microscopy of blood films stained by both methods. Forty-nine (28%) of the 175 cases suspected for malaria infection showed malarial parasites on microscopy of blood films stained by both methods. However, due to homogeneous staining and clearer background of the blood films it was possible to determine the parasite species in 65% of the cases on microscopy of the thick films stained with the modified method compared to only 20% with the standard method. Further, the turnaround time for reporting the microscopy test result wa...
Objective: Imported malaria continues to be a problem in Kuwait since most patients present with ... more Objective: Imported malaria continues to be a problem in Kuwait since most patients present with very low levels of parasitaemia. The diagnosis is often delayed or missed because of the low sensitivity of the standard stained blood smear test used for the identification of malarial parasites. In this study, we standardized a highly sensitive polymerase chain reaction (PCR) to detect malarial parasites. Methods: A total of 100 individuals presenting with various forms of infection were screened with the standard Giemsa-stained smears and were compared with the PCR for diagnosis and the sensitivity of the two methods. Results: Our results show that PCR is a highly sensitive and specific technique to detect low levels of Plasmodium falciparum parasites in clinical samples, and at least 6 cases (12%) who were microscopically negative had PCR-detectable parasitaemia. Conclusion: The PCR is a highly sensitive assay which can detect very low levels of malarial parasites and thus is of grea...
Objectives: This study investigates the prevalence of drug-resistant malaria infection in Kuwait ... more Objectives: This study investigates the prevalence of drug-resistant malaria infection in Kuwait in patients with malaria infection to the two most important and primary antimalarial drugs, chloroquine and mefloquine. Study Subjects and Methods: In vitro screening of malarial parasites to chloroquine and mefloquine was done during 1994–1996 in all those cases who presented with malaria-like symptoms and had a parasite density of ≥1,000 asexual pure Plasmodium falciparum parasites per microlitre of blood and had not taken any antimalarial drugs during the last 3 weeks. Results: During 1987–1997 the total number of malaria cases detected ranged between 650 and 1,350 each year. More than 75% of the cases had Plasmodium vivax infection. The majority of these cases (>98%) were detected in individuals coming from various malaria-endemic areas to reside or work in Kuwait. Of the 575 cases tested for drug resistance 42 isolates (7.3%) were resistant to chloroquine (MIC >8 pmol) and 6 ...
Background: The objective of this study was to document the status of malaria infection and effec... more Background: The objective of this study was to document the status of malaria infection and effect of preventive measures on the epidemiologic profile of imported malaria cases in Kuwait during 1985-2000. Methods: The study included screening of two groups of individuals for malaria infection by microscopy; (1) all migrant workers from malaria-endemic countries on their first entry to Kuwait; and (2) all suspected malaria cases already residing in the country. The study period was divided into prewar (1985-1990), postwar (1992-1997) and proactive preventive (1998-2000) periods. During the proactive preventive period, the home countries were also involved in screening for malaria infection in all prospective immigrants to Kuwait. Results: The annual incidence of malaria cases detected during the prewar, postwar and proactive preventive periods ranged between 465 and 1,229, 654 and 1,379, and 248 and 393, respectively. Plasmodium vivax infection was detected in 71% of the cases and P. falciparum in 27%. The number of malaria cases detected increased to >1,300 after the war during 1992-1993. However, the number of malaria cases dropped significantly to less than 400 during 1998-2000 (p<.05). The majority (87%) of malarial infections detected were acquired in Asian countries: India, 39%; Pakistan, 20%; other Asian countries (Sri Lanka, Bangladesh, Nepal, Afghanistan), 28%. Less than 1% of the cases were seen among Kuwaitis returning from malaria-endemic countries. The number of malaria cases among the newly arrived immigrants decreased significantly from 38% to 59%, to 19% to 27%, during 1998-2000. The majority (>80%) of malaria patients were young male adults between 21 and 40 years of age. The data on drug resistance were not well defined, due to limited testing. Conclusion: This study suggests that the proactive preventive program to screen all prospective immigrants for malaria infection in their home countries significantly reduced the numbers of imported infections to <400 cases/year, a drop of 52.6%. In addition, it also identified a group of settled immigrants, the majority of whom were at high risk for acquisition of malaria infection during their visit to home countries. There is an urgent need to target this group for prevention strategies such as education/information and other preventive measures against malaria infection.
The main objective of this study was to determine the prevalence of filarial infection among migr... more The main objective of this study was to determine the prevalence of filarial infection among migrant workers in Kuwait. The study was conducted from April 2000 to November 2003. A total of 1050 migrant workers (>90 % from the Indian subcontinent) from filarial endemic countries and 260 individuals residing in Kuwait as controls (50 healthy Kuwaiti blood donors, 50 microfilaria-negative individuals from endemic areas and 160 patients with other parasitic infections) were screened for filarial infection. All specimens were tested for microfilaraemia by microscopy of nucleopore-filtered blood (NFB) and detection of circulating filarial antigen (CFA) by an immunochromatographic test (ICT) and the TropBio assay. The overall prevalence of filarial antigenaemia was 18·3 % (192 individuals) using the ICT and 20·3 % (213 individuals) using the TropBio assay. Thirty-two cases (3 %) of Wuchereria bancrofti were detected by microscopy and the mean microfilaria count in these cases was 816 mi...
MERLOT Journal of Online Learning and Teaching, 2008
This study measures student learning, satisfaction, and interaction dynamics within Webbased onli... more This study measures student learning, satisfaction, and interaction dynamics within Webbased online learning programs. The population of this study was students (n= 208) enrolled in multiple academic disciplines at an East Coast US university. A Web-based ...
The present study evaluates the performances of three noninvasive serological assays for the dete... more The present study evaluates the performances of three noninvasive serological assays for the detection of immunoglobulin G antibodies to leishmania antigen for the diagnosis of imported cases of kala azar (visceral leishmaniasis [VL]) in a country, Kuwait, where the disease is not endemic. A total of 323 individuals including 21 patients with documented cases of VL, 72 individuals with suspected cases of VL, 155 patients with other parasitic infections, and 75 healthy control individuals were tested by indirect hemagglutination assay (IHA; Behring Diagnostics GmbH, Marburg, Germany), indirect fluorescent-antibody assay (IFA; bioMerieux sa, Marcy l'Etoile, France), and a qualitative membrane-based immunoassay with recombinant leishmania antigen K39 (strip-test; Intersep Ltd, Berkshire, United Kingdom). Our data show that IHA is the most sensitive test (100%), followed by IFA (86.6%) and the strip-test (80.0%). The strip-test was the most specific (100%) of the three assays, follo...
Malaria is the most common vector-borne parasitic infection causing significant human morbidity a... more Malaria is the most common vector-borne parasitic infection causing significant human morbidity and mortality in nearly 90 tropical/sub-tropical countries worldwide. Significant differences exist in the incidence of malaria cases, dominant Plasmodium species, drug-resistant strains and mortality rates in different countries. Six Gulf Cooperation Council (GCC) countries (Bahrain, Kuwait, Qatar, Oman, Saudi Arabia and United Arab Emirates, UAE) in the Middle East region with similar climates, population demographics and economic prosperity are aiming to achieve malaria elimination. In this narrative review, all studies indexed in PubMed describing epidemiological characteristics of indigenous and imported malaria cases, vector control status and how malaria infections can be controlled to achieve malaria elimination in GCC countries were reviewed and discussed. These studies have shown that indigenous malaria cases are absent in Bahrain, Kuwait, Qatar and UAE and have progressively de...
The OptiMAL test (Flow Inc., Portland, Oreg.), which detects a malaria parasite lactate dehydroge... more The OptiMAL test (Flow Inc., Portland, Oreg.), which detects a malaria parasite lactate dehydrogenase (pLDH) antigen, has not been evaluated for its sensitivity in the diagnosis of malaria infection in various epidemiological settings. Using microscopy and a PCR as reference standards, we performed a comparison of these assays with the OptiMAL test for the detection of Plasmodium falciparum and Plasmodium vivax infection in 550 immigrants who had come from areas where malaria is endemic to reside in Kuwait, where malaria is not endemic. As determined by microscopy, 125 (23%) patients had malaria, and of these, 84 (67%) were infected with P. vivax and 36 were infected with P. falciparum ; in 5 cases the parasite species could not be determined due to a paucity of the parasites. The PCR detected malaria infection in 145 (26%) patients; 102 (70%) of the patients had P. vivax infection and 43 had P. falciparum infection. Of the five cases undetermined by microscopy, the PCR detected P. ...
Objectives: To develop and evaluate a rapid method for the diagnosis of malaria infection by micr... more Objectives: To develop and evaluate a rapid method for the diagnosis of malaria infection by microscopy of stained blood films. Subjects and Methods: Blood specimens were collected from randomly selected confirmed malaria cases (n = 75) and suspected malaria cases (n = 175). The microscopy was done on each set of blood films stained by modified and the standard Giemsa staining methods. Results: All the 75 previously diagnosed malaria cases were confirmed by the microscopy of blood films stained by both methods. Forty-nine (28%) of the 175 cases suspected for malaria infection showed malarial parasites on microscopy of blood films stained by both methods. However, due to homogeneous staining and clearer background of the blood films it was possible to determine the parasite species in 65% of the cases on microscopy of the thick films stained with the modified method compared to only 20% with the standard method. Further, the turnaround time for reporting the microscopy test result wa...
Objective: Imported malaria continues to be a problem in Kuwait since most patients present with ... more Objective: Imported malaria continues to be a problem in Kuwait since most patients present with very low levels of parasitaemia. The diagnosis is often delayed or missed because of the low sensitivity of the standard stained blood smear test used for the identification of malarial parasites. In this study, we standardized a highly sensitive polymerase chain reaction (PCR) to detect malarial parasites. Methods: A total of 100 individuals presenting with various forms of infection were screened with the standard Giemsa-stained smears and were compared with the PCR for diagnosis and the sensitivity of the two methods. Results: Our results show that PCR is a highly sensitive and specific technique to detect low levels of Plasmodium falciparum parasites in clinical samples, and at least 6 cases (12%) who were microscopically negative had PCR-detectable parasitaemia. Conclusion: The PCR is a highly sensitive assay which can detect very low levels of malarial parasites and thus is of grea...
Objectives: This study investigates the prevalence of drug-resistant malaria infection in Kuwait ... more Objectives: This study investigates the prevalence of drug-resistant malaria infection in Kuwait in patients with malaria infection to the two most important and primary antimalarial drugs, chloroquine and mefloquine. Study Subjects and Methods: In vitro screening of malarial parasites to chloroquine and mefloquine was done during 1994–1996 in all those cases who presented with malaria-like symptoms and had a parasite density of ≥1,000 asexual pure Plasmodium falciparum parasites per microlitre of blood and had not taken any antimalarial drugs during the last 3 weeks. Results: During 1987–1997 the total number of malaria cases detected ranged between 650 and 1,350 each year. More than 75% of the cases had Plasmodium vivax infection. The majority of these cases (>98%) were detected in individuals coming from various malaria-endemic areas to reside or work in Kuwait. Of the 575 cases tested for drug resistance 42 isolates (7.3%) were resistant to chloroquine (MIC >8 pmol) and 6 ...
Background: The objective of this study was to document the status of malaria infection and effec... more Background: The objective of this study was to document the status of malaria infection and effect of preventive measures on the epidemiologic profile of imported malaria cases in Kuwait during 1985-2000. Methods: The study included screening of two groups of individuals for malaria infection by microscopy; (1) all migrant workers from malaria-endemic countries on their first entry to Kuwait; and (2) all suspected malaria cases already residing in the country. The study period was divided into prewar (1985-1990), postwar (1992-1997) and proactive preventive (1998-2000) periods. During the proactive preventive period, the home countries were also involved in screening for malaria infection in all prospective immigrants to Kuwait. Results: The annual incidence of malaria cases detected during the prewar, postwar and proactive preventive periods ranged between 465 and 1,229, 654 and 1,379, and 248 and 393, respectively. Plasmodium vivax infection was detected in 71% of the cases and P. falciparum in 27%. The number of malaria cases detected increased to >1,300 after the war during 1992-1993. However, the number of malaria cases dropped significantly to less than 400 during 1998-2000 (p<.05). The majority (87%) of malarial infections detected were acquired in Asian countries: India, 39%; Pakistan, 20%; other Asian countries (Sri Lanka, Bangladesh, Nepal, Afghanistan), 28%. Less than 1% of the cases were seen among Kuwaitis returning from malaria-endemic countries. The number of malaria cases among the newly arrived immigrants decreased significantly from 38% to 59%, to 19% to 27%, during 1998-2000. The majority (>80%) of malaria patients were young male adults between 21 and 40 years of age. The data on drug resistance were not well defined, due to limited testing. Conclusion: This study suggests that the proactive preventive program to screen all prospective immigrants for malaria infection in their home countries significantly reduced the numbers of imported infections to <400 cases/year, a drop of 52.6%. In addition, it also identified a group of settled immigrants, the majority of whom were at high risk for acquisition of malaria infection during their visit to home countries. There is an urgent need to target this group for prevention strategies such as education/information and other preventive measures against malaria infection.
The main objective of this study was to determine the prevalence of filarial infection among migr... more The main objective of this study was to determine the prevalence of filarial infection among migrant workers in Kuwait. The study was conducted from April 2000 to November 2003. A total of 1050 migrant workers (>90 % from the Indian subcontinent) from filarial endemic countries and 260 individuals residing in Kuwait as controls (50 healthy Kuwaiti blood donors, 50 microfilaria-negative individuals from endemic areas and 160 patients with other parasitic infections) were screened for filarial infection. All specimens were tested for microfilaraemia by microscopy of nucleopore-filtered blood (NFB) and detection of circulating filarial antigen (CFA) by an immunochromatographic test (ICT) and the TropBio assay. The overall prevalence of filarial antigenaemia was 18·3 % (192 individuals) using the ICT and 20·3 % (213 individuals) using the TropBio assay. Thirty-two cases (3 %) of Wuchereria bancrofti were detected by microscopy and the mean microfilaria count in these cases was 816 mi...
MERLOT Journal of Online Learning and Teaching, 2008
This study measures student learning, satisfaction, and interaction dynamics within Webbased onli... more This study measures student learning, satisfaction, and interaction dynamics within Webbased online learning programs. The population of this study was students (n= 208) enrolled in multiple academic disciplines at an East Coast US university. A Web-based ...
The present study evaluates the performances of three noninvasive serological assays for the dete... more The present study evaluates the performances of three noninvasive serological assays for the detection of immunoglobulin G antibodies to leishmania antigen for the diagnosis of imported cases of kala azar (visceral leishmaniasis [VL]) in a country, Kuwait, where the disease is not endemic. A total of 323 individuals including 21 patients with documented cases of VL, 72 individuals with suspected cases of VL, 155 patients with other parasitic infections, and 75 healthy control individuals were tested by indirect hemagglutination assay (IHA; Behring Diagnostics GmbH, Marburg, Germany), indirect fluorescent-antibody assay (IFA; bioMerieux sa, Marcy l'Etoile, France), and a qualitative membrane-based immunoassay with recombinant leishmania antigen K39 (strip-test; Intersep Ltd, Berkshire, United Kingdom). Our data show that IHA is the most sensitive test (100%), followed by IFA (86.6%) and the strip-test (80.0%). The strip-test was the most specific (100%) of the three assays, follo...
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