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Abstract

In August, 1997, a woman with no history of travel to malarious regions developed Plasmodium vivax malaria. She lived in a rural area of Italy where indigenous Anophyles labranchiae mosquitoes were present. An environmental investigation was done within a 3 km radius of the patient's house. Adult mosquitoes and larvae were collected and examined by PCR with the gene for plasmodium circumsporozoite protein as target. About 200 people living in the area were interviewed to detect possible carriers of P. vivax. None of the mosquitoes captured were carrying any malarial organisms. The house-to-house investigation identified a 7-year-old girl who had had a feverish illness a few days after her arrival in Italy from India, and who, 3 months later, still had P. vivax in her blood; she and her mother had antimalarial antibodies. These investigations suggest that the index case of malaria was caused by local anopheline mosquitoes infected with exogenous P. vivax.

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... Un cas de paludisme importé d'Inde, trois mois auparavant et encore porteur de gamétocytes de Plasmodium vivax, a ainsi été détecté. L'étude entomologique n'avait pas permis d'identifier d'anophèle porteur du plasmodium [11]. Cette histoire estivale ressemble à celle du cas de paludisme autochtone de Porto en Corse, si ce n'est que le cas importé de Madagascar était en phase de primo invasion et non de portage chronique de Plasmodium vivax. ...
... Ce premier cas de paludisme autochtone survenu en Corse depuis 1972, suite à 1 cas de paludisme à Plasmodium vivax importé de Madagascar début juillet 2006 à Porto, n'est pas un phénomène isolé puisque d'autres pays européens ont récemment documenté ce risque [11,12,13]. Il s'agit d'une alerte qui montre que les mesures de surveillance épidémiologique et entomologique et les actions de lutte anti-vectorielle doivent être maintenues, voire renforcées en Corse, surtout lors des épisodes de canicule. ...
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Dengue and chikungunya are two arboviruses and have circulated intensively in 2006 in the Caribbean region and in the Indian Ocean. The estimation of the imported number of cases in metropolitan France, based on the laboratory data is presented here. In 2006, 783 imported chikungunya and 228 dengue cases have been identified in metropolitan France. The time distribution of the Chikungunya cases matches the kinetic of the outbreak in Reunion Island. Imported cases have been identified aeverywhere in France, but most of them occurred in patients living in Paris region and in Southern France. These results show that the important number of imported arboviral cases in 2006 in metropolitan France is correlated to the intensity of the virus circulation in countries of travel, especially in overseas territories. Since the vector Aedes albopictus has been identified in southern France, the risk of introduction and autochthonous transmission is real. For travelers to countries where these viruses circulate, since neither vaccine nor treatment is available, individual protection measures must be encouraged.
... In Europe malaria are currently reported as imported cases. Sporadic non-imported/indigenous cases of malaria caused by P. vivax were reported through the last years, as occurred in Italy in 1997 [12], in Corsica during the summer of 2006 [13] and in Spain in October 2010 [14]. Even if in 2016, the WHO European Region was declared malaria free [15], nevertheless an outbreak of vivax malaria occurred in Greece [16] in the district of Lakonia, Peloponnese between 2011 and 2012 and after an initial successful control of the situation in the two following years (0 local transmission in 2014) some indigenous cases have been still registered in the year 2015-2018 (10 cases in 2018). ...
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Plasmodium vivax has been considered for years as responsible for a mild form of malaria, due to the absence in the majority of its infections of the severe form of the disease, typical instead of the deadly human parasite P. falciparum. In the last decade, studies on vivax malaria have had a partial step ahead especially after the completion of the whole genome project, but there is still a gap of knowledge in the biology of this parasite. Moreover , the emergence of P. vivax antimalarial resistance in 1980s and its subsequent spread in the Southeast Asia have indicated new concerns about the possibility to control this parasite. P. vivax drug resistance poses a major threat to endemic countries and without important international efforts, we could assist in a near future to the paradox of seeing different malaria co-endemic countries, that have successfully controlled/eliminated P. falciparum, still fighting against P. vivax.
... Together with the presence of competent vectors, favourable climatic conditions and evidence of a changing climate this may lead to the re-emergence of malaria in countries where this disease was previously eliminated. Locally transmitted cases have been reported in Germany [7], the Netherlands [8], Spain [9], France [10], Italy [11], Greece [12], and the UK [13]. The dominant Anopheles vector species in Europe are currently An. ...
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Background Malaria is one of the most life-threatening vector-borne diseases globally. Recent autochthonous cases registered in several European countries have raised awareness regarding the threat of malaria reintroduction to Europe. An increasing number of imported malaria cases today occur due to international travel and migrant flows from malaria-endemic countries. The cumulative factors of the presence of competent vectors, favourable climatic conditions and evidence of increasing temperatures might lead to the re-emergence of malaria in countries where the infection was previously eliminated. Methods We performed a systematic literature review following PRISMA guidelines. We searched for original articles focusing on rising temperature and the receptivity to malaria transmission in Europe. We evaluated the quality of the selected studies using a standardised tool. Results The search resulted in 1′999 articles of possible relevance and after screening we included 10 original research papers in the quantitative analysis for the systematic review. With further increasing temperatures studies predicted a northward spread of the occurrence of Anopheles mosquitoes and an extension of seasonality, enabling malaria transmission for annual periods up to 6 months in the years 2051–2080. Highest vector stability and receptivity were predicted in Southern and South-Eastern European areas. Anopheles atroparvus, the main potential malaria vector in Europe, might play an important role under changing conditions favouring malaria transmission. Conclusion The receptivity of Europe for malaria transmission will increase as a result of rising temperature unless socioeconomic factors remain favourable and appropriate public health measures are implemented. Our systematic review serves as an evidence base for future preventive measures.
... Other nonendemic countries have also reported malaria recently. After 40 years of being malaria free, transmission of P. vivax malaria by local vectors has been reported in Italy (105,106). In France, about 5,000 imported cases are reported per year, but local transmission has rarely been reported. ...
... The high density of Anopheles species in many southern European regions (Romi et al. 1997;Ponçon et al. 2007;Marí and Peydró 2010) and the increasing importation of malaria infections in the last two decades have led to the reappearance of autochthonous malaria cases in Italy (Baldari et al. 1998), Greece (Kampen et al. 2002), France (Doudier et al. 2007) and Spain (Santa-Olalla Peralta et al. 2010). As a consequence of mass immigration and travel from malaria-endemic countries to Greece, 85 human malaria cases were recorded in 2015 (six locally acquired), 88 in 2016 (five locally acquired) and 75 in 2017 (five locally acquired) (HCDCP 2015(HCDCP , 2016(HCDCP , 2017. ...
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Malaria is one of the most severe health problems facing the world today. Until the mid-twentieth century, Europe was an endemic area of malaria, with the Balkan countries being heavily infested. Sibling species belonging to the Anopheles maculipennis complex are well-known as effective vectors of Plasmodium in Europe. A vast number of human malaria cases in the past in the former Yugoslavia territory have stressed the significance of An. maculipennis complex species as primary and secondary vectors. Therefore, the present study evaluates the species composition, geographic distribution and abundance of these malaria vector species. Mosquitoes were collected in the northern Serbian province of Vojvodina and analysed by PCRRFLP, multiplex PCR and sequencing of the ITS2 intron of genomic rDNA. Four sibling species of the An. maculipennis complex were identified. Both larvae and adults of the recently described species An. daciae were identified for the first time in Serbia. In 250 larval samples, 109 (44%) An. messeae, 90 (36%) An. maculipennis s.s., 33 (13%) An. daciae and 18 (7%) An. atroparvus were identified. In adult collections, 81 (47%) An. messeae, 55 (32%) An. daciae, 33 (19%) An. maculipenniss.s., and 3 (2%) An. atroparvus were recorded. The most abundant species in Vojvodina was An. messeae, whereas An. atroparvus was confirmed a rare species in all parts. Since this species is a potentially, highly competent malarial vector, low population density could be crucial to prevent a new establishment of endemic malaria transmission in Serbia.
... This non-linear correlation reflects in the results of some authors, who found that the elongation of the malaria mosquito season rather increases the risk of malaria transmission in the future in the temperate areas than in the subtropical or tropical regions of the Earth (Martens and Thomas 2005;Martens et al., 1995). In addition, the increasing length and frequency of above-average summer temperatures in association with heat waves due to climate change also may has unexpected positive impact on malaria transmission (Baldari et al., 1998, Krüger et al., 2001. Climatic change also can cause the redistribution of the dominant malaria vectors in the temperate zone of Europe, although this topic has not been studied sufficiently yet. ...
Article
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Anopheles maculipennis is one of the potential vectors of Plasmodium vivax caused malaria in Europe. Although potential malaria vectors are present in the continent, malaria was eradicated in historical times and recently absent in Central and East Europe and the North Balkan. Climate change may trigger the re-emergence of malaria in Europe positively affecting the seasonal patterns of the potential Anopheline vectors. The increasing length of the larva season of mosquito vectors is one of the risk factors of the re-emerging of malaria. The monthly relative abundance values of the larvae of Anopheles maculipennis were modeled for the reference period 1961–1990 and the periods 2011–2040 and 2041–2070 based on the REMO climate model for Central and East Europe and the North Balkan region. Strong, significant correlation (r²=0.94, p<0.0001) was found between the monthly relative abundances of larvae and monthly mean air temperature values in Hungary between March and November. The threshold of the larval activity of Anopheles maculipennis was found to be about 4 °C. Comparing the modeled relative abundances for 1961–1990, 2011–2040, and 2041–2070, April and October months showed the most notable changes. The model predicts that in Southeast Hungary, East Croatia, North Serbia, South Romania, and North Bulgaria, the main season will increase by +1 to +2 months to the period of 2041–2070 comparing to the reference period. The model also indicates that the complete main Anopheles maculipennis larva season of the mosquito will increase by two months in Southeast Hungary and at least 1 month in the other parts of the south Pannonian Ecoregion, in the North Balkan region including South Romania and North Bulgaria for 2041–2070.
... Retrospective applications of morbidity and mortality associated with Italy's 1880-1962 struggles with malaria and eventual eradication (see Snowden, 2008) provide a means to conceptualize the consequences of this parasite on the economic, social, and political realms of the Imperial Italian context. One example is Grosseto (Tuscany) where endemic malaria in the mid-19th century CE (1840-1841) led to a 60% mortality rate in 20-50 year olds, generally perceived as the most resistant age group to infection, with the exception of pregnant women within whom malaria may be more severe, which may further contribute to high mortality patterns (Baldari et al., 1998;Brabin, 1983;Sallares, 2002;Scheidel, 2003). This epidemiological pattern of malaria is retrospectively linked to funerary inscriptions in the Late Antique (4th-5th c. ...
Article
Plasmodium falciparum is a significant human pathogen, particularly in the historical context of the ancient Mediterranean region. The causative species of malaria are “invisible” in the historical record, while malaria as a disease entity is indirectly supported by evidence from literary works (e.g., the Hippocratic Corpus, Celsus’ De Medicina) and non-specific skeletal pathological responses. Although ancient DNA may demonstrate the presence of a pathogen, there remain theoretical and methodological challenges in contextualizing such molecular evidence. Here we present a framework to explore the biosocial context of malaria in 1st–4th c. CE central-southern Italy using genomic, literary, epidemiological, and archaeological evidence to highlight relationships between the Plasmodium parasite, human hosts, Anopheles vector, and environment. By systematically integrating these evidentiary sources, our approach highlights the importance of disease ecology (e.g., climate and landscape) and human-environment interactions (e.g., land use patterns, such as agriculture or infrastructure activities) that differentially impact the potential scope of malaria in the past.
... There is evidence also of their capacities to transmit Plasmodium malariae (Toty et al., 2010). Their responsibilities in the transmission of Plasmodium vivax have been recently reported (Baldari et al., 1998). ...
Article
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We evaluated in the present study the effect of deltamethrin resistance on the fitness cost of the filed populations of Anopheles labranchiae. A susceptible population was used as reference to do different comparisons. We selected the most resistant larvae population collected from northern Tunisia. Eggs were used for study of life history traits including developmental time, larvae mortality, fertility, hatchability and adult sex-ratio. Our results showed that deltamethrin resistance affected negatively (p <. 0.05) the developmental time with the median range of 70. h, mortality with the rate of 7 folds in resistant population and hatchability which are lower than in susceptible population. Whereas, no significant differences were detected in adult sex-ratio and fertility of the two studied populations. Our results could help to determine the evolution of population dynamics of the resistant studied population in the areas where insecticide resistance is reported and resistance management is needed.
... It is also known that before the eradication of the malaria in Hungary, Plasmodium vivax caused the 90% and Plasmodium falciparum the 10% of the malaria cases. The resurgence of malaria in Europe is more than a fiction: Plasmodiuminfected people introduced tropical malaria during the 1997 heat-wave in Germany (Krüger et al., 2001) and Italy (Baldari et al., 1998), when local female Anopheles mosquitos bite infected passengers returning from endemic areas. The reverse case is also known, when introduced, infected malaria vectors caused malaria infection in the airport staff or the people living in the neighborhood of the airport (Giacomini et al., 1997 ). ...
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The potential resurgence of malaria in the temperate areas of Europe due to climate change is an actual topic of epidemiology. Although several ecological forecasting models were built for the prediction of the potential re-emergence of malaria in the recently non-endemic areas of the world, the simulations are mainly based on the recent climatic thresholds of the tropical and subtropical vectors and Plasmodium parasites, mainly of Plasmodium falciparum. We aimed to reanalyze the primarily Plasmodium vivax caused autochthon malaria disease data of the past model period of 1927-1934 in Hungary to gain reliable knowledge about the climatic thresholds and the determinants of the malaria season for a temperate climate in a Central European country. Multivariable and simple linear correlation and regression was performed to analyze the malaria data of 96 months dividing the season a first and a second half parts of the year. Two models were built on the gained correlations using unstandardized and standardized correlation weights. It was found, that both in the first and second halves of the year, the ambient mean temperature was the most important predictor of the relative malaria incidence, while precipitation influenced the first half of the season. Summer sum of precipitation above 200 mm was found as one of the most important determinant of the absolute annual case number of benign tertian malaria. The unstandardized weights-based modeled malaria seasons returned well the observed autochthon malaria seasons.
... drug resistance and man-made environmental modifications) makes it difficult to assess both whether climate change has already affected disease distributions, or to what extent it will do so in the future. In spite of this, there have been a number of assertions that global warming may have already affected some vector-borne diseases in Europe: TBE and ticks in Sweden (14, 17), Aedes albopictus in the Mediterranean (20,23), and malaria in Italy and Germany (24)(25)(26). ...
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The current, hot topic is the risk of introducing new vector-borne diseases and harmful ectoparasites into Europe, or of the geographic extension of the existing ones. There are many doubts that global warming affects the transfer of a number of vectorborne diseases. Special emphasis was placed on spreading the Lyme disease, tick-borne encephalitis, West Nile fever and leishmaniasis, the recurrence of malaria and dengue fever. Climate models predict a 2-5ºC temperature increase and a significant increase in rainfall in Europe in the following years. However, non-environmental variables such as socio-economic situation and agriculture should be considered. The main problem can be expected when new viruses emerge. As they change, their mutations can enter into the population and thus have “the greater potential” for the spread of the epidemic. The control network of the health system in our country and in Europe is very dense, and the outbreak of the virus can be always registered, giving the authorities enough time to take measures. Although modeling studies indicate that climate change could increase the risk of transmission of vector-transmitted diseases in Serbia and Europe, historical analyses indicate that, at least for malaria, socio-economic conditions in combination with effective surveillance and early treatment are likely to prevent further spread, which is the main task of the Public Health Institutes. Tropical medicine experts said that the so-called supervirus causes mutations of the virus, and represents the greatest danger for human population. The circumstances that allow such a development already exist, an additional climate change is not necessary. The challenge for future research is the mechanism of tropical viruses and their persistence in endemic foci in temperate climate area in Europe.
... As far as the European continent itself is concerned, since the late 1990s autochthonous malaria cases occurred in several countries, resulting from infection of local mosquitoes by travellers or immigrants from endemic regions. Locally transmitted cases have been reported in Spain [13], Germany [14], the Netherlands [15], France (Corsica) [16], Italy [17] and Greece [18]. ...
Article
Malaria was eradicated from Europe in the 1970’s through a combination of insecticide spraying, drug therapy and environmental engineering. Since then, it has been mostly imported into the continent by international travelers and immigrants from endemic regions. Despite the substantial number of imported malaria cases and the documented presence of suitable anopheline vectors, autochthonous transmission has not been widely observed in Europe, probably due to early diagnosis and treatment, afforded by efficient health care systems. Current climatic conditions are conducive to malaria transmission in several areas of Southern Europe and climate change might favor mosquito proliferation and parasite development, further facilitating malaria transmission. Moreover, the continuing massive influx of refugee and migrant populations from endemic areas could contribute to building up of an infectious parasite reservoir. Although the malariogenic potential of Europe is currently low, particularly in the northern and western parts of the continent, strengthening of disease awareness and maintaining robust public health infrastructures for surveillance and vector control are of the utmost importance and should be technically and financially supported to avert the possibility of malaria transmission in Europe’s most vulnerable areas.
... D'autre part, l'augmentation des températures observées ces dernières années dans notre pays pourrait être favorable à l'installation d'espèces anophèliennes vectrices, importées par les moyens de transport qui assurent de plus en plus de liaisons avec les pays tropicaux. Une telle situation a été observée dans plusieurs pays comme les Etats-Unis, l'Allemagne et l'Italie où on a noté une réintroduction temporaire du paludisme et ce suite à l'importation d'Anophèles vecteurs [17][18][19]. En dépit de ses avantages dans le dépistage du paludisme, la PCR ne peut remplacer les méthodes classiques de diagnostic de cette parasitose chez les sujets symptomatiques, en raison du temps de réalisation relativement long ; non compatible avec l'urgence diagnostique. Néanmoins, cette technique peut être indiquée pour la détection des faibles parasitémies en cas de forte suspicion et de négativité de l'examen microscopique, particulièrement chez les voyageurs sous chimioprophylaxie et en cas de difficultés dans l'identification des espèces plasmodiales [20]. ...
Article
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Background: In Tunisia, detection of Plasmodium in asymptomatic individuals from endemic countries is a critical measure in national program of malaria eradication. The screening is based on microscopic examination of thick and thin blood smears. However, the performance of this diagnosis is closely related to the experience of biologist and the parasitaemia. Aim: The objective of this study was to evaluate the contribution of the PCR in the screening of malaria. Methods: This prospective study involved 260 students from malaria endemic areas who were screened for malaria between september 2011 and june 2013. Each subject had a blood sample which was examined for malaria by microscopy and nested multiplex PCR. Results: PCR detected the presence of Plasmodium in 13 blood samples (5%). While microscopy was positive only in nine cases (3.5%). The discordances involved five negative samples at microscopy and which were positive in PCR and a negative sample in PCR which was positive at microscopy. A mixed infection with Plasmodium falciparum and Plasmodium malariae was identified by PCR. For this case, microscopy diagnosed only Plasmodium falciparum specie. Conclusion: PCR is more efficient than microscopy in detecting low parasitaemia ; particularly observed in asymptomatic subjects. This technique allows to reduce asymptomatic carriage of Plasmodium and reduce the risk of a resumption of transmission of malaria in our country.
... Indigenous Plasmodium strains that had evolved in parallel to their European vector mosquitoes, however, appeared to have become extinct. Subsequent autochthonous malaria cases, plenty of which were recorded in continental Europe in the past 20 years or so (Sartori et al. 1989;Nikolaeva 1996;Baldari et al. 1998;Kr€ uger et al. 2001;Cuadros et al. 2002;Kampen et al. 2002;Zoller et al. 2009;Santa-Ollala Peralta et al. 2010;Danis et al. 2011a), were most likely due to transmission of parasites imported with their human hosts from overseas endemic areas. Presumably due to missing coadaptation, experimental infection of European Anopheles species with tropical Plasmodium strains usually failed to produce infective parasite stages (Shute 1940;Ramsdale and Coluzzi 1975;Daškova and Rasnicyn 1982). ...
Chapter
The chikungunya fever epidemic in northern Italy in 2007 and the recent demonstration of the introduction of various exotic mosquito species alerted the European nations to a growing risk of invasion by vector mosquitoes and outbreaks of mosquito-borne infectious diseases. The importation of both mosquitoes and pathogens they are able to transmit is facilitated by increasing international trade and travel. Environmental and climatic changes do not only set the ground for the establishment of invasive mosquitoes away from their natural distribution areas but often also have beneficial effects on indigenous potential vector species, such as support of spread, growth in population density and extension of seasonal activity, thus increasing the probability of these biting a person or a reservoir animal infected with a mosquito-borne pathogen and transmitting it. While there is a considerable body of literature on invasive mosquito species and imported pathogens due to their relevance in their natural distribution areas, data on endemic mosquito species and mosquito-borne pathogens circulating in Europe are relatively scarce. With a few exceptions, these have in fact for several decades been of minor importance with respect to public health impact. Both the role of mosquitoes as vectors of disease agents and the scientific and political attention to mosquito-borne diseases, however, appear to be growing in Europe with ongoing globalization. We here discuss indigenous mosquito species that have historically been involved in pathogen transmission in Europe or have been demonstrated to be vectors elsewhere and that may contribute to future disease outbreaks in Europe. Likewise, we present mosquito-borne pathogens that have been circulating in Europe or are considered probable to be introduced and established in the future.
... On the other hand, visitors from malaria-endemic regions often ignore the possibility that they might be infected with malaria, as they are not sick due to the semi-immunity acquired from repeated infection since childhood. Due to indigenous vector-competent Anopheles spp. in Europe (for example, Anopheles sacharovi, Anopheles atroparvus and Anopheles labranchiae that take their bloodmeals on gametocyte-carrying people) single locally acquired malaria cases have been occurring in Bulgaria, Greece, Germany, Italy and Spain during the last 17 years (Sartori et al., 1989;Nikolaeva, 1996;Baldari et al., 1998;Krüger et al., 2001;Cuadros et al., 2002;Kampen et al., 2002). ...
Chapter
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Many urban planners and managers erroneously assume that pest-borne diseases are relics of the past. Since the mid-20th century, however, major changes in ecology, climate and human behaviour have favoured the proliferation of urban pests. Alarmingly, the dramatic rise in urban sprawl has led to city suburbs becoming the natural habitat of ticks, rodents and other pests. These changes make timely a new analysis of the effects of present-day urban pests on health. To this end, WHO invited international experts in various pest-related fields to identify the public health risk posed by various pests and to suggest appropriate prevention and control measures. This book presents their conclusions and formulates policy options for all levels of decision-making on the future management of pests and pest-related diseases.
... Negli ultimi anni vi sono stati inoltre rarissimi casi di malaria dovuti a modalità di trasmissione inconsueta come trapianto d'organo, trasfusione di sangue, punture accidentali con materiale contaminato e, infine, casi "criptici" (dovuti probabilmente a zanzare trasportate con il bagaglio). Secondo i dati di un recente studio condotto da ricercatori dell'I.S.S. (Istituto Superiore di Sanità) e del Ministero della Salute (pubblicato sul "Giornale italiano di medicina tropicale", vol.12, n. [1][2][3][4]2007), si conferma la tendenza verso una riduzione dei casi importati, con una percentuale dei decessi stabile e inferiore alla media europea (11). L'ultimo caso sporadico di malaria autoctono (plasmodio di importazione, ma trasmesso da una zanzara Anopheles "autoctona"), risale al 1997 e si è verificato nella provincia di Grosseto, dove una signora è stata infettata da P. vivax tramite una zanzara che aveva precedentemente punto una bambina indiana affetta da malaria (16). ...
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We report a case of Plasmodium falciparum in an Italian woman of thirty years old, back from Mozambico. The diagnostic suspect came from various factors: a recent stay in a country where the disease is endemic, fever and an inadeguate prophylaxis. The presence of Plasmodium falciparum in thin blood smear and in the immunochromatography assay positivity confirmed the diagnosis.
... Malaria was endemic in Europe for more than two millennia (Kuhn, Campbell-Lendrum, & Davies, 2002), but socio-economic and agricultural changes (Reiter, 2000), and the implementation of control campaigns led to its eradication in the 1970s (WHO, 1978). Since then, imported (Baldari et al., 1998;Castro, Cardoso, Queirós, & Gonçalves, 2004) and autochthonous cases (Danis et al., 2011;Vakali et al., 2012) have been reported in European malaria-free countries. ...
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Malaria was endemic in Europe for more than two millennia until its eradication in the 1970s. Recent autochthonous cases registered in Greece have increased the awareness regarding the threat of malaria re-emergence in Southern Europe. Currently, the presence of competent vectors, suitable environmental conditions and the evidences of a changing climate may increase the widespread re-emergence of malaria in Southern Europe. This work focused on determining the current relationships between environmental factors and the density of the former malaria vector Anopheles atroparvus in Portugal, a previously endemic country. Adult females were sampled and vector density was estimated in 22 sites in Southern Portugal between 2001 and 2010 and related with land cover and satellite-derived air temperature and vegetation indices. The relationship between vector density and local larval habitat, temperature and, in a broader sense, to environmental suitability, was assessed using a statistical modelling approach. Results showed that present environmental conditions are suitable for vector development at high densities and the spatial and temporal patterns closely resemble the ones registered in the past endemic period. The use of satellite-derived data, together with statistical models, allowed the extrapolation of suitable environmental conditions for vector development from site-level to the Portuguese mainland territory. This work also improved the baseline knowledge needed to understand the potential impacts of future environmental changes on vector density and, indirectly, on the risk of malaria re-emergence.
... En los años 90 se produjo un brote en el sur de la antigua Unión Soviética, debido a casos importados por las tropas procedentes de Afganistán. Esporádicamente se describe algún caso autóctono como el ocurrido en Italia en el que se han registrado casos de transmisión local de P.vivax y donde la densidad anophelina ha aumentado (Baldari, et al, 1998). ...
... Malaria was endemic in Europe for more than two millennia (Kuhn, Campbell-Lendrum, & Davies, 2002), but socio-economic and agricultural changes (Reiter, 2000), and the implementation of control campaigns led to its eradication in the 1970s (WHO, 1978). Since then, imported (Baldari et al., 1998;Castro, Cardoso, Queirós, & Gonçalves, 2004) and autochthonous cases (Danis et al., 2011;Vakali et al., 2012) have been reported in European malaria-free countries. ...
... In the Republic of Korea, malaria was eradicated in the late 1970s, but a single case, which occurred in 1993, resulted in the re-introduction of P. vivax malaria in the country in the years that followed [30]. During the past 20 years, few confirmed autochthonous cases of P. vivax malaria in the European Union have been reported in Italy (Maremma, 1997) [31], France (Corsica, 2006) [32] and Spain (Aragon, 2010) [33]. In Greece, autochthonous cases have been scarce but have occurred annually since 2009 [34]. ...
Article
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Plasmodium vivax malaria was common in Greece until the 1950s with epidemics involving thousands of cases every year. Greece was declared free of malaria by the World Health Organization in 1974. From 1974 to 2010, an average of 39 cases per year were reported, which were mainly imported. However, in 2009 and 2010 six and one autochthonous cases were reported culminating with a total of 40 autochthonous cases reported in 2011, of which 34 originated from a single region: Laconia of Southern Peloponnese. In this study the genotypic complexity of the P. vivax infections from the outbreak in Greece during 2011 is described, to elucidate the possible origin and spread of the disease. Three polymorphic markers of P. vivax were used; Pvmsp-3alpha and the microsatellites m1501 and m3502 on P. vivax isolates sampled from individuals diagnosed in Greece. Thirty-nine isolates were available for this study (20 autochthonous and 19 imported), mostly from Evrotas municipality in Laconia region, in southern Greece, (n = 29), with the remaining representing sporadic cases originating from other areas of Greece. Genotyping the Evrotas samples revealed seven different haplotypes where the majority of the P. vivax infections expressed two particular Pvmsp-3alpha-m1501-m3502 haplotypes, A10-128-151 (n = 14) and A10-121-142 (n = 7). These haplotypes appeared throughout the period in autochthonous and imported cases, indicating continuous transmission. In contrast, the P. vivax autochthonous cases from other parts of Greece were largely comprised of unique haplotypes, indicating limited transmission in these other areas. The results indicate that several P. vivax strains were imported into various areas of Greece in 2011, thereby increasing the risk of re-introduction of malaria. In the region of Evrotas ongoing transmission occurred exemplifying that further control measures are urgently needed in this region of southern Europe. In circumstances where medical or travel history is scarce, methods of molecular epidemiology may prove highly useful for the correct classification of the cases.
Article
Malaria caused by Plasmodium vivax is comparatively less virulent than Plasmodium falciparum, which can also lead to severe disease and death. It shows a wide geographical distribution. Chloroquine serves as a drug of choice, with primaquine as a radical cure. However, with the appearance of resistance to chloroquine and treatment has been shifted to artemisinin combination therapy followed by primaquine as a radical cure. Sulphadoxine‐pyrimethamine, mefloquine, and atovaquone‐proguanil are other drugs of choice in chloroquine‐resistant areas, and later resistance was soon reported for these drugs also. The emergence of drug resistance serves as a major hurdle to controlling and eliminating malaria. The discovery of robust molecular markers and regular surveillance for the presence of mutations in malaria‐endemic areas would serve as a helpful tool to combat drug resistance. Here, in this review, we will discuss the endemicity of P. vivax, a historical overview of antimalarial drugs, the appearance of drug resistance and molecular markers with their global distribution along with different measures taken to reduce malaria burden due to P. vivax infection and their resistance.
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Despite the eradication of malaria across most European countries in the 1960s and 1970s, the anopheline vectors are still present. Most of the malaria cases that have been reported in Europe up to the present time have been infections acquired in endemic areas by travelers. However, the possibility of acquiring malaria by locally infected mosquitoes has been poorly investigated in Europe, despite autochthonous malaria cases having been occasionally reported in several European countries. Here we present an update on the occurrence of potential malaria vector species in Europe. Adopting a systematic review approach, we selected 288 papers published between 2000 and 2021 for inclusion in the review based on retrieval of accurate information on the following Anopheles species: An. atroparvus, An. hyrcanus sensu lato (s.l.), An. labranchiae, An. maculipennis sensu stricto (s.s.), An. messeae/daciae, An. sacharovi, An. superpictus and An. plumbeus. The distribution of these potential vector species across Europe is critically reviewed in relation to areas of major presence and principal bionomic features, including vector competence to Plasmodium. Additional information, such as geographical details, sampling approaches and species identification methods, are also reported. We compare the information on each species extracted from the most recent studies to comparable information reported from studies published in the early 2000s, with particular reference to the role of each species in malaria transmission before eradication. The picture that emerges from this review is that potential vector species are still widespread in Europe, with the largest diversity in the Mediterranean area, Italy in particular. Despite information on their vectorial capacity being fragmentary, the information retrieved suggests a re-definition of the relative importance of potential vector species, indicating An. hyrcanus s.l., An. labranchiae, An. plumbeus and An. sacharovi as potential vectors of higher importance, while An. messeae/daciae and An. maculipennis s.s. can be considered to be moderately important species. In contrast, An. atroparvus and An. superpictus should be considered as vectors of lower importance, particularly in relation to their low anthropophily. The presence of gaps in current knowledge of vectorial systems in Europe becomes evident in this review, not only in terms of vector competence but also in the definition of sampling approaches, highlighting the need for further research to adopt the appropriate surveillance system for each species. Graphical Abstract
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Citation: Raele, D.A.; Severini, F.; Boccolini, D.; Menegon, M.; Toma, L.; Vasco, I.; Franco, E.; Miccolis, P.; Desiante, F.; Nola, V.; et al. Entomological Surveillance in Former Malaria-endemic Areas of Southern Italy. Pathogens 2021, 10, 1521. Abstract: Malaria still represents a potential public health issue in Italy, and the presence of former Anopheles vectors and cases imported annually merit continuous surveillance. In areas no longer endemic, the concurrent presence of gametocyte carriers and competent vectors makes re-emergence of local transmission possible, as recently reported in Greece. In October 2017, due to the occurrence of four suspected introduced malaria cases in the province of Taranto (Apulia region), entomological investigations were performed to verify the involvement of local anopheline species. In 2019-2020 entomological surveys were extended to other areas historically prone to malaria between the provinces of Taranto and Matera and the province of Foggia (Gargano Promontory). Resting mosquitoes were collected in animal shelters and human dwellings, larvae were sampled in natural and artificial breeding sites, and specimens were both morphologically and molecularly identified. A total of 2228 mosquitoes were collected, 54.3% of which were anophelines. In all the investigated areas, Anopheles labranchiae was the most widespread species, while Anopheles algeriensis was predominant at the Gargano sites, and Anopheles superpictus and Anopheles plumbeus were recorded in the province of Matera. Our findings showed a potentially high receptivity in the surveyed areas, where the abundance of the two former malaria vectors, An. labranchiae and An. superpictus, is related to environmental and climatic parameters and to anthropic activities.
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The correct identification of mosquito vectors is often hampered by the presence of morphologically indiscernible sibling species. The Maculipennis complex is one of these groups that include both malaria vectors of primary importance and species of low/negligible epidemiological relevance, of which distribution data in Italy are outdated. Our study was aimed at providing an updated distribution of Maculipennis complex in Northern Italy through the sampling and morphological/molecular identification of specimens from five regions. The most abundant species was Anopheles messeae (2032), followed by Anopheles maculipennis s.s. (418), Anopheles atroparvus (28) and Anopheles melanoon (13). Taking advantage of ITS2 barcoding, we were able to finely characterize tested mosquitoes, classifying all the Anopheles messeae specimens as Anopheles daciae, a taxon with debated rank to which we referred as species inquirenda (sp. inq.). The distribution of species was characterized by Ecological Niche Models (ENMs), fed by recorded points of presence. ENMs provided clues on the ecological preferences of the detected species, with An. daciae sp. inq. linked to stable breeding sites and An. maculipennis s.s. more associated to ephemeral breeding sites. We demonstrate that historical Anopheles malaria vectors are still present in Northern Italy.
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Background: Italy was declared malaria free by the World Health Organization in 1970. Despite this, nonimport malaria cases are on the increase in Italy and throughout the Mediterranean area. In Italy, in the period between 2011 and 2015, seven cases of locally acquired malaria have been reported, including one introduced case of Plasmodium vivax; moreover, the last certain case of introduced malaria (by P. vivax) has been reported in Tuscany in 1997. No case of introduced malaria from Plasmodium falciparum has been reported in Italy since 1970. Case Presentation: A cluster of four cryptic P. falciparum malaria cases were ascertained in migrant farm workers (three from Morocco and one from Sudan) in Apulia (southern Italy) with clinical onset between September 20 and 27, 2017. None of the patients reported a history of a recent trip to malaria-endemic areas or hospitalization or other risk factors. Typing of malaria was also confirmed using molecular biology methods in two different laboratories. There were no cases of severe malaria in our four patients, and only one in need of transfusion. All patients were discharged cured after being treated with mefloquine due to the unavailability of other antimalarials. Conclusions: In recent years, numerous reports of locally acquired malaria have been made in southern Europe. The cases described in this article represent the first cluster of malaria caused by P. falciparum in Europe. Today, clinical presentation in the diagnosis of malaria is more important than ever, since epidemiological criterion cannot be considered unfailing. The mode of transmission has not been proven and further biological and entomological studies are necessary to define our case as cryptic or confirm the presence of mosquitoes capable of transmitting P. falciparum and/or the capacity of Anopheles labranchiae, An. superpictus, or An. plumbeus to transmit it on Italian territory.
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Background: Historically, Anopheles atroparvus has been considered one of the most important malaria vectors in Europe. Since malaria was eradicated from the European continent, the interest in studying its vectors reduced significantly. Currently, to better assess the potential risk of malaria resurgence on the continent, there is a growing need to update the data on susceptibility of indigenous Anopheles populations to imported Plasmodium species. In order to do this, as a first step, an adequate laboratory colony of An. atroparvus is needed. Methods: Anopheles atroparvus mosquitoes were captured in rice fields from the Ebro Delta (Spain). Field-caught specimens were maintained in the laboratory under simulated field-summer conditions. Adult females were artificially blood-fed on fresh whole rabbit blood for oviposition. First- to fourth-instar larvae were fed on pulverized fish and turtle food. Adults were maintained with a 10% sucrose solution ad libitum. Results: An An. atroparvus population from the Ebro Delta was successfully established in the laboratory. During the colonization process, feeding and hatching rates increased, while a reduction in larval mortality rate was observed. Conclusions: The present study provides a detailed rearing and maintenance protocol for An. atroparvus and a publicly available reference mosquito strain within the INFRAVEC2 project for further research studies involving vector-parasite interactions.
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It has great importance to study the potential effects of climate change on Plasmodium vivax malaria in Greece because the country can be the origin of the spread of vivax malaria to the northern areas. The potential lengths of the transmission seasons of Plasmodium vivax malaria were forecasted for 2041–2060 and 2061–2080 and were combined. The potential ranges were predicted by Climate Envelope Modelling Method. The models show moderate areal increase and altitudinal shift in the malaria-endemic areas in Greece in the future. The length of the transmission season is predicted to increase by 1 to 2 months, mainly in the mid-elevation regions and the Aegean Archipelago. The combined factors also predict the decrease of vivax malaria-free area in Greece. It can be concluded that rather the elongation of the transmission season will lead to an increase of the malaria risk in Greece than the increase in the suitability values.
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Background: The European region achieved interruption of malaria transmission during the 1970s. Since then, malaria control programs were replaced by surveillance systems in order to prevent possible re-emergence of this disease. Sporadic cases of non-imported malaria were recorded in several European countries in the past decade and locally transmitted outbreaks of Plasmodium vivax, most probably supported by Anopheles sacharovi, have been repeatedly reported from Greece since 2009. The possibility of locally-transmitted malaria has been extensively studied in Italy where the former malaria vector An. labranchiae survived the control campaign which led to malaria elimination. In this study, we present paradigmatic cases that occurred during a 2017 unusual cluster, which caused strong concern in public opinion and were carefully investigated after the implementation of the updated malaria surveillance system. Methods: For suspected locally-transmitted malaria cases, alerts to Ministry of Health (MoH) and the National Institute of Health (ISS) were mandated by the Local Health Services (LHS). Epidemiological investigations on the transmission modes and the identification of possible infection's source were carried out by LHS, MoH and ISS. Entomological investigations were implemented locally for all suspected locally-transmitted cases that occurred in periods suitable to anopheline activity. Molecular diagnosis by nested-PCR for the five human Plasmodium species was performed to support microscopic diagnosis. In addition, genotyping of P. falciparum isolate was carried out to investigate putative sources of infection and transmission modalities. Results: In 2017, a cluster of seven non-imported cases was recorded from August through October. Among them, P. ovale curtisi was responsible of one case whereas six cases were caused by P. falciparum. Two cases were proved to be nosocomial while the other five were recorded as cryptic at the end of epidemiological investigations. Conclusions: The epidemiological evidence shows that the locally acquired events are sporadic, often remain unresolved and classified as cryptic ones despite investigative efforts. The "cluster" of seven non-imported cases that occurred in 2017 in different regions of Italy therefore represents a conscious alert that should lead us to maintain a constant level of surveillance in a former malaria endemic country.
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Background: Between 1999 and 2008 Russia experienced a flare-up of transmission of vivax malaria following its massive importation with more than 500 autochthonous cases in European Russia, the Moscow region being the most affected. The outbreak waned soon after a decrease in importation in mid-2000s and strengthening the control measures. Compared with other post-eradication epidemics in Europe this one was unprecedented by its extension and duration. Methods: The aim of this study is to identify geographical determinants of transmission. The degree of favourability of climate for vivax malaria was assessed by measuring the sum of effective temperatures and duration of season of effective infectivity using data from 22 weather stations. For geospatial analysis, the locations of each of 405 autochthonous cases detected in Moscow region have been ascertained. A MaxEnt method was used for modelling the territorial differentiation of Moscow region according to the suitability of infection re-emergence based on the statistically valid relationships between the distribution of autochthonous cases and environmental and climatic factors. Results: In 1999-2004, in the beginning of the outbreak, meteorological conditions were extremely favourable for malaria in 1999, 2001 and 2002, especially within the borders of the city of Moscow and its immediate surroundings. The greatest number of cases occurred at the northwestern periphery of the city and in the adjoining rural areas. A significant role was played by rural construction activities attracting migrant labour, vegetation density and landscape division. A cut-off altitude of 200 m was observed, though the factor of altitude did not play a significant role at lower altitudes. Most likely, the urban heat island additionally amplified malaria re-introduction. Conclusion: The malariogenic potential in relation to vivax malaria was high in Moscow region, albeit heterogeneous. It is in Moscow that the most favourable conditions exist for vivax malaria re-introduction in the case of a renewed importation. This recent event of large-scale re-introduction of vivax malaria in a temperate area can serve as a case study for further research.
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In August 2018 a Moroccan man living in Tuscany developed Plasmodium falciparum malaria. The patient declared having not recently visited any endemic country, leading to diagnostic delay and severe malaria. As susceptibility to P. falciparum of Anopheles species in Tuscany is very low, and other risk factors for acquiring malaria could not be completely excluded, the case remains cryptic, similar to other P. falciparum malaria cases previously reported in African individuals living in Apulia in 2017.
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Recently, five cases of malaria were reported in Italy. These people had not travelled abroad, prompting some media and political organizations to fuel a climate of fear by connecting the cases with migrants coming into the country. Here, we discuss scientific data highlighting the limited risk of malaria reintroduction in Italy.
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Malaria caused significant morbidity and mortality in Roman antiquity. Its impacts were far-reaching, affecting town and country alike, and hampering the capabilities of the empire’s military might. Various ancient authors provide us with insights into what understanding the Romans had of this disease, with various hypotheses into its causes, and rudimentary primary prevention. Notwithstanding, it was to take nearly two millennia before the true pathogenesis of malaria was elucidated. This article presents an insight into the ancient Roman concept of malaria, its cause, and ancient approaches to primary prevention, with reference to primary sources in translation.
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Recently in Italy a case of malaria was reported (November 2009). The patient was an Italian man of 44 years of age who had not travelled out of the country. The man apparently contracted malaria during a 2 weeks stay in August 2009 in a former malaria endemic area, the “Agro Pontino” (60-100 km South of Rome). Although confirmation of the Plasmodium species and the results of the epidemiological investigation undertaken by the Ministry of Health are still not available, the case seems unlikely to be linked with accidental contact of the patient with imported vectors or contaminated blood. This case raised concern over the possible recrudescence of malaria in Italy, especially in light of current and future climate change. Given the importance of the topic, this article will provide a brief review of the history of malaria in the Agro Pontino and the recent discussions that have appeared in scientific journals concerning the link between malaria and climate change.
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Objective: The Guidelines for Blood Grouping and Blood Transfusion (Haemotherapy) of donors with exposure to malaria are at present restrictive and are being updated. In this study we would like to investigate whether these guidelines could be loosened due to safe serological test methods and made compatible with the recommendations of the European Council, without the risk of endangering blood recipients. Sources: The guidelines for blood grouping and blood transfusion (Haemotherapy), recommendations of the European Council and the WHO regarding blood and blood products, standards for blood banks and transfusion services of the American Association of Blood Banks, and screening of the malaria-relevant publications in tropical medicine und serological diagnosis in recent years. Results: A 6-month ban for immigrants from malaria-endemic areas without history of malaria infection and a 5-year ban after malaria disease seem to be sufficient if the indirect immunofluorescent test is negative after that time. A 12-month ban is recommended for returnees from endemic areas if immunological tests cannot be performed.
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In Tunisia, malaria transmission has been interrupted since 1980. However, the growing number of imported cases and the persistence of putative vectors stress the need for additional studies to assess the risk of malaria resurgence in the country. In this context, our aim was to update entomological data concerning Anopheles mosquitoes in Tunisia. From May to October of 2012, mosquito larval specimens were captured in 60 breeding sites throughout the country and identified at the species level using morphological keys. Environmental parameters of the larval habitats were recorded. Specimens belonging to the An. maculipennis complex were further identified to sibling species by the rDNA-internal transcribed spacer 2 (ITS2) polymerase chain reaction (PCR) technique. In total, 647 Anopheles larvae were collected from 25 habitats. Four species, including An. labranchiae, An. multicolor, An. sergentii, and An. algeriensis, were morphologically identified. rDNA-ITS2 PCR confirmed that An. labranchiae is the sole member of the An. maculipennis complex in Tunisia. An. labranchiae was collected throughout northern and central Tunisia, and it was highly associated with rural habitat, clear water, and sunlight areas. Larvae of An. multicolor and An. sergentii existed separately or together and were collected in southern Tunisia in similar types of breeding places. © The American Society of Tropical Medicine and Hygiene.
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El transporte inadvertido de mosquitos vivos en aeronaves provenientes de países tropicales en que las enfermedades de transmisió n vectorial son endeicas plantea un serio problema. Encuestas realizadas en aeropuertos internacionales han revelado un nú mero considerable de insectos vivos, en particular de mosquitos, a bordo de aeronaves procedentes de países en que el paludismo y los arbovirus son endeicos. En algunos casos, diversas especies de mosquitos se han establecido en países en que hasta ese momento no eran conocidas. Una importante consecuencia del transporte de mosquitos a bordo de aeronaves han sido los numerosos casos de «paludismo de aeropuerto» registrados en Europa, Amé rica del Norte y otros lugares. Es realmente necesario desinsectar en todos los casos las aeronaves que se dirijan de aeropuertos situados en zonas donde las enfermedades tropicales son endeicas a zonas no endeicas. Se reseñ an a continuació n los mé todos y materiales disponibles para la desinsectació n de las aeronaves y las recomendaciones de la OMS para su uso. Artículo publicado en ingle en el Bulletin of the World Health Organization, 2000, 78 (8): 995–1004. Introducció n Desde los comienzos del trafico aéreo internacional, preocupa la posibilidad de que las aeronaves introduzcan mosquitos transmisores de enfermeda-des y, con ellos, las correspondientes enfermedades en países que anteriormente no las conocían (1, 2). Ya a comienzos de los años treinta se examinaron posibles maneras de desinsectar una aeronave para evitar esas situaciones. Juntamente con sus centros colaboradores, la OMS ha ensayado diversos materiales y métodos de desinsectación de aeronaves in situ, y en base a sus resultados ha formulado diversas recomendaciones. El método recomendado con preferencia es el denominado «blocks away» (predespegue), consis-tente en rociar el interior de la aeronave con insecticida en aerosol inmediatamente antes de entrar en pista para el despegue (3, 4). Muchos países insisten en que se desinsecten las aeronaves a su llegada, especialmente si proceden de áreas en que las enfermedades transmitidas por vectores son endémicas. La aspersión de una aero-nave a su llegada al país de destino es habitual cuando los servicios de salud de ese país no están seguros de que se haya aplicado algún tipo de tratamiento en una etapa anterior del vuelo. Es más, en algunos casos se ha propuesto suspender el derecho al aterrizaje salvo que la tripulación aporte pruebas de que se ha practicado una desinsectación. Se ha expresado preocupación por los efectos adversos que sobre pasajeros y tripulaciones podría tener el rociamiento con piretroides como medio de desinsectación de las aeronaves. Un estudio detallado de la OMS concluyó que los materiales o métodos recomendados para la desinsectación de las aero-naves, no entrañaba ningún riesgo toxicológico y podían utilizarse sin peligro en presencia de los pasajeros y de la tripulación (5). Según ciertos informes, tanto el método pre-despegue como otros tipos de desinsectación mediante aerosol practicados con pasajeros a bordo, como el método predescenso (6), son de eficacia limitada, dándose casos de mosquitos que han sobrevivido a la desinsectación predespegue de una aeronave (7). Es lógico que algunos mosquitos consigan sobrevivir si el tratamiento no se realiza adecuadamente, y si los aerosoles no cubren todos los espacios en que se alojan los vectores, en particular los compartimentos de equipaje situados sobre los asientos. Resulta, pues, necesario mejorar los métodos de desinsectación (8).
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Le transport involontaire de moustiques vivants à bord d'aeonefs en provenance de pays tropicaux où des maladies à transmission vectorielle sont endeiques pose un graveproblè me. Des contrô les effectue dans des aé roports internationaux ont ré vé lé de nombreux cas de deouverte d'insectes vivants, en particulier de moustiques, à bord d'aeonefs en provenance de pays où le paludisme et les arboviroses sont endeiques. Dans certains cas, desespè ces de moustiques se sont eablies dans des pays où elles n'eaient pas connues auparavant. Le transport de moustiques infecte à bord des aé ronefs a des conseuences graves comme en teoignent les nombreux cas de « paludisme aé roportuaire » signalé s en Europe, en Ameique du Nord et ailleurs. Il est neessaire de deinsectiser les aeonefs en provenance d'aeoports situe dans des zones d'endeie des maladies tropicales et desservant des zones non endeiques. L'article dé crit les mé thodes et mateiels disponibles pour la deinsectisation des aé ronefs et rappelle les recommandations de l'OMS concernant leur application. Article publieén anglais dans Bulletin of the World Health Organization, 2000, 78 (8) : 995-1004.
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The increase in temperatures recorded since the mid-nineteenth century is unprecedented in the history of mankind. The consequences of climate changes are numerous and can affect human health through direct (extreme events, natural disasters) or indirect (alteration of the ecosystem) mechanisms. Climate changes have repercussions on ecosystems, agriculture, social conditions, migration, conflicts and the transmission mode of infectious diseases. Vector-borne diseases are infections transmitted by the bite of infected arthropods such as mosquitoes, ticks, triatomines, sand flies and flies. Epidemiological cornerstones of vector-borne diseases are: the ecology and behaviour of the host, the ecology and behaviour of the vector, and the population's degree of immunity. Mosquito vectors related to human diseases mainly belong to the genus Culex, Aedes and Mansonia. Climate changes in Europe have increased the spread of new vectors, such as Aedes albopictus, and in some situations have made it possible to sustain the autochthonous transmission of some diseases (outbreak of Chukungunya virus in northern Italy in 2007, cases of dengue in the South of France and in Croatia). Despite the eradication of malaria from Europe, anopheline carriers are still present, and they may allow the transmission of the disease if the climatic conditions favour the development of the vectors and their contacts with plasmodium carriers. The tick Ixodes ricinus is a vector whose expansion has been documented both in latitude and in altitude in relation to the temperature increase; at the same time the related main viral and bacterial infections have increased. In northern Italy and Germany, the appearance of Leishmaniasis has been associated to climatic conditions that favour the development of the vector Phlebotomus papatasi and the maturation of the parasite within the vector, although the increase of cases of visceral leishmaniasis is also related to host immune factors, particularly immunodepression caused by the human immunodeficiency virus (HIV). Despite the importance of global warming in facilitating the transmission of certain infectious diseases, due consideration must be taken of the role played by other variables, such as the increase in international travel, migration and trade, with the risk of importing parasites and vectors with the goods. In addition, the control of certain infections was possible in the past through improvements in socio-economic conditions of affected populations. However, the reduction in resources allocated to health care has recently led to the re-emergence of diseases that were considered eradicated.
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Global estimates of the potential impact of climate change on malaria transmission were calculated based on future climate scenarios produced by the HadCM2 and the more recent HadCM3 global climate models developed by the UK Hadley Centre. This assessment uses an improved version of the MIASMA malaria model, which incorporates knowledge about the current distributions and characteristics of the main mosquito species of malaria.The greatest proportional changes in potential transmission are forecast to occur in temperate zones, in areas where vectors are present but it is currently too cold for transmission. Within the current vector distribution limits, only a limited expansion of areas suitable for malaria transmission is forecast, such areas include: central Asia, North America and northern Europe. On a global level, the numbers of additional people at risk of malaria in 2080 due to climate change is estimated to be 300 and 150 million for P. falciparum and P. vivax types of malaria, respectively, under the HadCM3 climate change scenario. Under the HadCM2 ensemble projections, estimates of additional people at risk in 2080 range from 260 to 320 million for P. falciparum and from 100 to 200 million for P. vivax. Climate change will have an important impact on the length of the transmission season in many areas, and this has implications for the burden of disease. Possible decreases in rainfall indicate some areas that currently experience year-round transmission may experience only seasonal transmission in the future. Estimates of future populations at risk of malaria differ significantly between regions and between climate scenarios.
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Increasingly intense economic activities are triggering a range of global environmental risks to health and well-being of unprecedented scale and of a systemic nature. Climate change is a burgeoning reality. The global mean surface temperature has increased by 0.74±0.18°C over the last 100 years, while the global average sea level has risen by 1.8 mm per year since 1961, and Arctic sea ice is shrinking by 2.7±0.6% per decade. In addition, the sea surface temperature is rising, mountain glaciers are retreating at increasing rates, surface ocean waters are getting more acidic and more frequent extreme weather events have been observed. Human beings are exposed to climate change through changing weather patterns (for example more intense and frequent extreme events) and indirectly through changes in water, air, food quality and quantity, ecosystem functions, agriculture and the economy. Today, it is certain that climate change contributes to the global burden of disease and premature deaths. Emerging evidence of the effects of climate change on human health show that climate change has not only altered the distribution of some infectious disease vectors and the seasonal distribution of some allergenic pollen species, but has also increased the risk of heat-wave-related deaths. In the future, exposure to the effects of climate change is likely to lead to various trends related to human health, such as an increase in undernutrition globally and in the number of people suffering from diseases and injuries directly related to heat-waves, floods, storms, fires and drought. The incidence of diarrhoeal diseases and the frequency of cardiorespiratory diseases as a result of higher concentrations of ground level ozone are also likely to increase. Climate change is expected to have mixed effects on infectious diseases, and might bring some benefits to health, through, for example, fewer deaths from exposure to the cold. However, this is expected to be outweighed by the negative effects of rising temperatures worldwide, in particular in developing countries (Confalonieri et al., 2007). The dilemma with climate change is that it is different from many of the other types of environmental exposures: all countries in the world are affected; it is expected to become more acute over the next decades, even with greenhouse gas emissions stabilizing at year 2000 levels – and thus children will be those most affected; it plays an important role in the spatial and temporal distribution of infectious diseases and thus can affect health security; the effects are unequally distributed and are particularly severe in countries with already high disease burdens or in populations with low adaptive capacity; and the effects are highly complex and will involve a number of processes, developments, sectors and activities. Furthermore, recent events have demonstrated that populations and health systems may be unable to cope with increases in the frequency and intensity of extreme weather events. These events can reduce the resilience of communities, affect vulnerable regions and localities and overwhelm the coping capacities of most societies. This is a preliminary evaluation report, using international and national literature and with the help of expert advice. The aim was to assess the potential risks of climate change to human health in Italy, to see what preventive actions are available and to suggest what may be additionally needed.
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A field study on diversity and distribution of anophelines currently present in a past endemic malaria area of Spain was carried out in order to identify possible risk areas of local disease transmission. Multiple larval sites were sampled from June to October of 2011 in the Region of Somontano de Barbastro (Northeastern Spain). The sampling effort was fixed at 10 minutes which included the active search for larvae in each biotope visited. A total of 237 larval specimens belonging to four Anopheles species (Anopheles atroparvus, An. claviger, An. maculipennis and An. petragnani) were collected and identified. Malaria receptivity in the study area is high, especially in the area of Cinca river valley, due to the abundance of breeding sites of An. atroparvus very close to human settlements. Although current socio-economic conditions in Spain reduce possibilities of re-emergence of malaria transmission, it is evident that certain entomological and epidemiological vigilance must be maintained and even increased in the context of current processes of climate change and globalization.
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Since the two or three last decades, imported malaria increasing in Europe is linked to the growing use of transcontinental air transport and the surge of travel to tropical countries. However occurence of autochthonous vivax malaria cases in European countries is a recent phenomenon to which it is necessary to pay a special attention. The causes of this reemergence can be attributed to different factors such as climate changes and intercontinental population migrations. Such new event requires the higher vigilance from sanitary authorities and medical staff.
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Mosquitoes belonging to the Maculipennis Complex of Anopheles subgenus Anopheles were collected in 10 prefectures across Greece: Attiki, Evros, Florina, Fthiotida, Ioannina, Lakonia, Magnesia, Rodopi, Serres, and Xanthi. DNA was extracted from 276 specimens and sequences for the nuclear rDNA ITS2 region were obtained from 257 of these (93.1%). Four members of the An. maculipennis Meigen complex were identified: An. maculipennis, An. sacharovi Favre, An. melanoon Hackett, and An. messeae Falleroni. Species were identified based on correlation of their sequences with those available in GenBank. All four species have been incriminated as primary or secondary vectors of malaria. Species distributions in relation to potential threats of reintroduction of malaria in Greece are discussed. This study comprises the most complete study of the Maculipennis Complex in Greece to date, and contributes substantially to the current knowledge of the genetics and distributions of the four species.
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Epidemiologic data on imported Plasmodium falciparum malaria in France and chemoprophylaxis is issued by two national reference centers, one dealing with imported malaria and the other with chemoresistance in malaria. In 1997, the imported malaria incidence rate was estimated at 9.46 cases per 100,000 inhabitants, with 2.6% imported cases per year (return from Africa). P. falciparum was reported in 85% of the cases and 98% of these were African strains. Twenty-four cases of airport malaria have been recorded since 1977. The mean death rate has reached 16 per year since 1985. These data are comparable to those of other European countries. Concerning chemoresistance, chemoprophylaxis was used in 282 reported cases of imported malaria (but it is difficult to define these as failed chemoprophylaxes). There was a higher risk of double resistance in parasites isolated from patients without chemoprophylaxis since 1991 in group 3 countries than in group 2, and this resistance increased between 1991–1994 and 1995–1997, notably in Benin. The reevaluation of malaria risks for travelers in this country led to changes in French recommendations on chemoprophylaxis.
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Movements of people in a variety of forms and at a variety of scales play an important role in the malaria equation of parasites-vectors-people. They contribute to the transmission of malaria, spreading infection and exposing non-immune people to risk of infection, and they complicate measures for the control of malaria. The nature of malaria risk is outlined and then relationships between movements and risks are illustrated in regional examples (Southeast Asia, south India, Latin America and tropical Africa). Some consideration is given to cases of 'imported' malaria in the largely malaria-free temperate lands of Europe. While the significance of population movements is recognised, they and other human factors (e.g. distribution and composition of population, social organisation and economic activities) do not receive attention comparable to that given to malaria parasites and vectors. More interdisciplinary approaches by biomedical and social scientists are needed.
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We assessed the effect of surgery on survival from stage I non-small-cell lung cancer based on data collected in these screening programs. The majority of patients diagnosed in each program were treated by surgical resection, but 5 percent of the Sloan-Kettering group, 21 percent of the Hopkins group and 11 percent of the Mayo group failed to receive surgical treatment. Approximately 70 percent of the stage I patients in each program who were treated surgically survived more than five years, but there were only two five-year survivors among those who did not have surgery. We conclude that patients with lung cancers detected in stage I by chest x-ray film and treated surgically have a good chance of remaining free of disease for many years. Those stage I lung cancers which are not resected progress and lead to death within five years. Therefore, every effort should be made to detect and treat lung cancer early in high-risk populations.
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Based on the official reports received from local health laboratories, an epidemiological analysis of malaria cases reported in Italy from 1989 to 1992 is presented. A total of 1,941 cases were reported, 1,287 among Italians and 654 among foreigners. The incidence of cases was on average 500 per year with a maximum in 1990. A slight, but constant decrease of incidence of malaria cases was recorded in this period among Italian citizens (-21.5%), while the incidence among foreigners increased (+80%). Plasmodium falciparum accounted for 74.2% of total infections, followed by P. vivax (19%). The highest number of cases was imported from Africa (86.5%), followed by Asia, South America, and Oceania. 11 cases were contracted in Europe (transfusion, airport and cryptic malaria). 26 people died from malaria during the four years, with a fatality rate of 2.3% among Italians. Other epidemiological features concerning incidence in the different categories of travellers, countries of infection, clinical and therapeutic aspects of cases, are also discussed.
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In order to evaluate the efficacy of lung-cancer screening, a case-control study was conducted using the data from 50 areas where population-based lung-cancer screening programmes have been operated by local municipalities. In most areas, chest X-ray examinations for all participants and sputum cytology for high-risk participants were offered annually. Case series consisted of 273 deceased lung-cancer cases. For each case, 2 to 5 controls (a total of 1, 269 controls) were collected from those who were alive at the time of diagnosis of the corresponding case, matched by sex, age, smoking status and type of health insurance. Cases and controls were limited to a high-risk group for males and a non-high-risk group for females. Screening histories, which were obtained from the list of screenees, were compared between case and matched controls for the identical calendar period before the time of diagnosis of the case. The odds ratio of dying from lung cancer for those screened within 12 months vs. those not screened was 0.72 (95% confidence interval 0.50–1.03; p = 0.07). The odds ratios increased towards unity, as the length of time in which screening histories were compared increased. After adjusting for some other variables, which appeared to be associated with the opportunities of chest X-ray examination, the estimated odds ratio did not change. These results suggest some benefits from lung-cancer screening in terms of reduction of lung-cancer mortality and should be subject to further research.
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Experimental work has confirmed the refractoriness of Anopheles atroparvus to tropical strains of Plasmodium falciparum to which A. labranchiae may also be refractory. This indicates a lower receptivity to malaria in Europe than the existing vector densities and increasing number of parasite carriers would suggest.
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Preliminary experiments in Garki, Nigeria, with A. atroparvus from Italy have shown a refractoriness to infection with the local strain of P. falciparum. Comparative studies involving A. labranchiae and two strains of A. atroparvus, all from Italy, and one local strain of A. gambiae species B, were carried out at Kismu, Kenya. While oocysts developed in 77% of A. gambiae and, from day 14 onwards, 100% of the oocyst positive mosquitos had sporozoites in the salivary glands, oocysts were seen in only 4% of one of the A. atroparvus strains; the development of these oocysts appeared to be arrested at an early stage. A labranchiae and the other strain of A. atroparvus showed no oocysts. None of the Italian mosquito strains was positive for sporozoites. It is concluded that the importation of falciparum malaria cases from tropical Africa is unlikely to produce epidemics in those southern European areas where A. labranchiae and A. atroparvus used to be malaria vectors.
Article
The early lung cancer detection program in New York is described, and preliminary prevalence rate data are reported. Cigarette-smoking men over the age of 45, who are considered at high risk, are encouraged to enroll in the program and, to date, 6,612 have done so. These men receive PA and lateral chest x-rays annually, while a randomly selected sub-population of about half also have sputum cytology every four months. A controlled study of sputum cytology as an adjunct to the chest x-ray is now in progress. There were 15 cases of late lung cancer (pathologic stages II and III) detected at the initial examination, and 11 early cases (pathologic stages O and I). In the population of 3,387 men who had x-rays alone there were three early lung cancers detected; in the population of 3,225 men who had both examinations four early cancers were detected by x-ray and four by cytology. In addition, three cases of larynx cancer were detected by cytology. The early lung cancers detected by x-ray were peripheral and most were bronchiolar or adenocarcinoma; the early cancers detected by cytology were central epidermoid carcinoma of major bronchi. No early carcinomas were detected by both techniques. These findings suggest that a combination of chest x-rays and sputum cytology can be more effective than either one alone in detecting early lung cancer.
Article
The National Cancer Institute of the United States recently sponsored three large-scale, randomized controlled trials of screening for early lung cancer. The trials were conducted at the Johns Hopkins Medical Institutions, the Memorial Sloan-Kettering Cancer Center, and the Mayo Clinic. Participants were middle-aged and older men who were chronic heavy cigarette smokers and thus at high risk of developing lung cancer. Screening procedures were chest radiography and sputum cytology, the only screening tests of established value for detecting early stage, asymptomatic lung cancer. In the Hopkins and Memorial trials the study population was offered yearly chest radiography plus sputum cytology every 4 months. The control population was offered yearly chest radiography only. In these trials the addition of sputum cytology appeared to confer no lung cancer mortality rate advantage. The Mayo Clinic trial compared offering chest radiography and sputum cytology every 4 months to offering advice that the two tests be obtained once a year. This trial demonstrated significantly increased lung cancer detection, resectability, and survivorship in the group offered screening every 4 months compared with the control group. However, there was no significant difference in lung cancer mortality rate between the two groups. The statistical power of these trials was somewhat limited. Nevertheless, results do not justify recommending large-scale radiologic or cytologic screening for early lung cancer at this time.
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Cigarette-smoking males (6,364), aged 40-64, were randomized into an intervention group which received 6-monthly screening by chest X-ray and sputum cytology, and a control group which received no asymptomatic investigation. After 3 years, both groups entered a follow-up period during which they received annual chest X-rays. Lung cancer cases detected by screening were identified at an earlier stage, more often resectable, and had a significantly better survival than "interval" cases diagnosed mainly because of symptoms. Comparison of the 2 groups showed a higher incidence of lung cancer in the intervention group, despite the follow-up period when both groups received annual examinations. There was no significant difference in mortality between the 2 groups.
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Phenotypic heterogeneity in the repetitive portion of a human malaria circumsporozoite (CS) protein, a major target of candidate vaccines, has been found. Over 14% of clinical cases of uncomplicated Plasmodium vivax malaria at two sites in western Thailand produced sporozoites immunologically distinct from previously characterized examples of the species. Monoclonal antibodies to the CS protein of other P. vivax isolates and to other species of human and simian malarias did not bind to these nonreactive sporozoites, nor did antibodies from monkeys immunized with a candidate vaccine made from the repeat portion of a New World CS protein. The section of the CS protein gene between the conserved regions I and II of a nonreactive isolate contained a nonapeptide repeat, Ala-Asn-Gly-Ala-Gly-Asn-Gln-Pro-Gly, identical at only three amino acid positions with published nonapeptide sequences. This heterogeneity implies that a P. vivax vaccine based on the CS protein repeat of one isolate will not be universally protective.
Article
By means of a case-control study, a screening programme originally introduced to control tuberculosis and utilizing biennial chest X-rays (70 X 70 pa.) was evaluated for its effect on lung cancer mortality. The case group consisted of 130 population-based deaths from lung cancer (males below 70). One general population-based and one hospital-based control group were used, both consisting of 260 males matched for age and alive at the same time as the relevant case. The proportion of exposed persons, i.e. those having had at least one screening test within the 2 years preceding diagnosis, was similar in the case group and in the 2 control groups: 76, 78 and 75%, respectively. The relative risk of lung cancer death was 0.9 and 1.1 (95% confidence intervals 0.5 to 1.5 and 0.7 to 1.8). There was no trend in relative risks with regard to the number of tests performed and the interval since the last test.
The initial (prevalence) radiologic and cytologic screening for lung cancer in the Mayo Clinic study (Mayo Lung Project) involved 10,933 outpatients. All were men at high risk for lung cancer, but none were suspected of having it when they entered the Mayo Clinic. Screening identified 91 lung cancers (8.3 per 1,000 screened). Nearly two thirds of the prevalence lung cancers were detected by chest roentgenography alone. Half of these cancers were resected. Only a fifth of the cancers were detected by sputum cytologic examination alone; however, all but 1 of these were resected. Compared with a group of lung cancers encountered in contemporary clinical practice at the Mayo Clinic, the prevalence cancers were more than twice as likely to be (1) resectable, (2) postsurgical Stage I or II (AJCC), and (3) associated with survival 5 yr after treatment.
The Johns Hopkins Lung Project was designed to determine whether the addition of cytologic screening to the radiographic screening of high-risk volunteers could enhance the early detection of asymptomatic lung cancer and whether early therapeutic intervention in detected cases could significantly reduce the mortality from this disease. Male volunteers, 45 yr of age and older, who smoked at least 1 pack of cigarettes per day were recruited from the Baltimore metropolitan area. All of the 10,387 acceptable high-risk volunteers received annual chest radiographic screening. By random assignment, one half received cytologic examination of induced sputum in addition to the roentgenogram. This report describes the results of the initial screening. Compared with usual methods of clinical diagnosis, screening by both roentgenography and cytology identified a greater proportion of the lung cancer cases at an earlier stage. Screening by sputum cytology was found to improve the detection only of squamous cell carcinoma. In the dual-screen group, sputum cytology accounted for 28% of the detected cases, and resulted in 39% additional detection of lung cancer over that achieved by roentgenography. There was no corresponding decrease in prevalence. Lung cancers detected by cytology alone were found at very early stages. Although there has been an increase in average survival, much of this increase, if not all, may have resulted from lead-time and sampling bias.
Article
The Memorial Sloan-Kettering lung cancer screening program was begun in 1974 to evaluate sputum cytology as a supplement to the annual chest x-ray examination for early detection and diagnosis. The 10,040 adult, male cigarette smokers who enrolled were randomly assigned to receive annual chest x-ray examinations only or a dual screen with annual chest x-ray examination and four monthly sputum cytology evaluation. Over 40 percent of the 288 who developed lung cancer were diagnosed in stage I, and their survival was 76 percent at five years; overall survival was 35 percent. Nearly one third of the lung cancers detected on first examination on the dual screen, and 14 percent of those on subsequent examinations were found by cytologic examination. The same number of cancers developed in the x-ray screen only group, and were diagnosed at a later date. Despite the delay, survival and mortality were the same, suggesting that the squamous carcinomas detected by cytologic examination alone are very slow growing and tend to remain localized until detectable by x-ray examination.
Article
When normal people ingest 90 mEq/day of K+ in their diet, they absorb about 90% of intake (81 mEq) and excrete an equivalent amount of K+ in the urine. Normal fecal K+ excretion averages about 9 mEq/day. The vast majority of intestinal K+ absorption occurs in the small intestine; the contribution of the normal colon to net K+ absorption and secretion is trivial. K+ is absorbed or secreted mainly by passive mechanisms; the rectum and perhaps the sigmoid colon have the capacity to actively secrete K+, but the quantitative and physiological significance of this active secretion is uncertain. Hyperaldosteronism increases fecal K+ excretion by about 3 mEq/day in people with otherwise normal intestinal tracts. Cation exchange resin by mouth can increase fecal K+ excretion to 40 mEq/day. The absorptive mechanisms of K+ are not disturbed by diarrhea per se, but fecal K+ losses are increased in diarrheal diseases by unabsorbed anions (which obligate K+), by electrochemical gradients secondary to active chloride secretion, and probably by secondary hyperaldosteronism. In diarrhea, total body K+ can be reduced by two mechanisms: loss of muscle mass because of malnutrition and reduced net absorption of K+; only the latter causes hypokalemia. Balance studies in patients with diarrhea are exceedingly rare, but available data emphasize an important role for dietary K+ intake, renal K+ excretion, and fecal K+ losses in determining whether or not a patient develops hypokalemia. The paradoxical negative K+ balance induced by ureterosigmoid anastomosis is described. The concept that fecal K+ excretion is markedly elevated in patients with uremia as an intestinal adaptation to prevent hyperkalemia is analyzed; we conclude that the data do not convincingly show the existence of a major intestinal adaptive response to chronic renal failure.
Article
In the County of Uppsala, Sweden, a general health survey including a chest roentgenogram was operational from the late 1960s until the end of June, 1985. The screening was offered every 2 years and participation was about 70%. From the local cancer registry all cases of lung cancer during the period 1980-1990 aged 75 or less were obtained and their survival and mode of discovery investigated. Only WHO I-IV and undifferentiated cancers verified histologically were included. Twenty-eight cancers (11.5%) were discovered in the survey and these patients had a very good prognosis compared to those who presented with symptoms. During the health survey there were 35 of 244 (14.3%) who survived more than 4 years, and after the survey this figure was 34 out of 265 (12.8%), a nonsignificant difference. Survival for patients with squamous cell carcinoma or adenocarcinoma discovered in the health survey was much improved, and for these two groups combined the 4-year survival was 41.7% compared to 10.3% for those discovered by symptoms (P < 0.001). Thus, survival of patients with lung cancer of squamous cell or adenocarcinoma types can be improved by screening, but unfortunately, only few of the cancers will be discovered in this way, so the total impact of screening will be small.
Article
About 30 yr after malaria eradication, surveys to assess the presence and abundance of anopheline vectors were carried out in central and southern Italy and in the islands of Sardinia and Sicily from 1992 to 1994. Anopheles labranchiae Falleroni was present in scattered foci in all regions, except for Tuscany, where it breeds almost exclusively in rice fields (Grosseto Province). Most common breeding sites were rivers and streams, followed by ponds and ground pools. The highest adult density was found in Tuscany near rice fields and along the west coast of Calabria. Anophelines in Grosseto were abundant at human bait, with peaks of > 200 landings per human per night and vectorial capacity between 7.3 and 26 for Plasmodium falciparum and between 8.3 and 32.5 for Plasmodium vivax. Anopheles sacharovi Favre, a former malaria vector in Puglia and Sardinia, was not found in these regions. The other vector in southern Italy, Anopheles superpictus Grassi, was found at low densities on the western and eastern coasts of Calabria. All anopheline populations were fully susceptible to deltamethrin, malathion, and DDT but showed reduced susceptibility to permethrin and propoxur. These data are discussed in the light of a possible reintroduction of malaria into Italy.
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