Malaria diagnosis and hospitalization trends, Brazil.We focused on rates of malaria in the state of Amazonas and city of Manaus, Brazil. Plasmodium vivax Plasmodium vi·vax n. A protozoan that is the most common malarial parasite of humans, causing vivax malaria. accounted for an increased number and rate of hospital admissions, while P. falciparum cases decreased. Our observations on malaria epidemiology suggest that the increased hospitalization hospitalization /hos·pi·tal·iza·tion/ (hos?pi-t'l-i-za´shun) 1. the placing of a patient in a hospital for treatment. 2. the term of confinement in a hospital. rate could be due to increased severity of P. vivax vi·vax n. 1. The protozoan (Plasmodium vivax) that causes the most common form of malaria. 2. Vivax malaria. infections. ********** The study of malaria prevalence in the state of Amazonas and city of Manaus indicates an increase in the percentage of hospitalized Plasmodium vivax patients and an overall increase in malaria cases caused by this parasite parasite, plant or animal that at some stage of its existence obtains its nourishment from another living organism called the host. Parasites may or may not harm the host, but they never benefit it. . Our observations on malaria epidemiology and case treatment suggest that the increased hospital admissions are associated with a higher frequency of severe disease associated with P. vivax infections. Amazonas includes most of the Brazilian Amazon Region, where malaria has been controlled but never eradicated. Since the 1980s, there has been a reemergence of malaria, which appears to coincide with changing malaria control policies associated with the ending of the Malaria Eradication Campaign (1,2). From January through August 2003, the number of cases nationwide was reduced by 2.6%, when compared with the same period in 2002. However, this change did not represent a uniform reduction in the number of malaria infections within the country. The states of Amazonas, Rondonia, and Tocantins reported increases of 82.9%, 14.7%, and 10.3%, respectively (3). Perhaps the best indicator of what has been occurring with malaria control during the past 5 years is reflected in recent statistics for malaria in Amazonas and the city of Manaus. During 2002 and 2003, the number of malaria cases reported in Amazonas increased 103.3% (4). An observational study In statistics, the goal of an observational study is to draw inferences about the possible effect of a treatment on subjects, where the assignment of subjects into a treated group versus a control group is outside the control of the investigator. conducted in the reference center for diagnosis and treatment of malaria in Amazonas (Fundacao de Medicina Tropical do Amazonas [FMT-AM]) described severe disease, including thrombocytopenia Thrombocytopenia Definition Thrombocytopenia is an abnormal drop in the number of blood cells involved in forming blood clots. These cells are called platelets. with hemorrhagic Hemorrhagic A condition resulting in massive, difficult-to-control bleeding. Mentioned in: Hantavirus Infections hemorrhagic pertaining to or characterized by hemorrhage. manifestations during infection with P. vivax. In that series, 46 (61.3%) of 75 patients admitted to the hospital for treatment of P. vivax malaria vivax malaria n. Malaria in which the paroxysms recur every third day, counting inclusively, and are induced by the release of merozoites and their invasion of new red blood cells. Also called tertian malaria. were classified with severe disease using predetermined pre·de·ter·mine v. pre·de·ter·mined, pre·de·ter·min·ing, pre·de·ter·mines v.tr. 1. To determine, decide, or establish in advance: criteria (5). We considered increased case severity as the need to hospitalize hos·pi·tal·ize tr.v. hos·pi·tal·ized, hos·pi·tal·iz·ing, hos·pi·tal·iz·es To place in a hospital for treatment, care, or observation. patients for treatment. Our primary goals were to present the epidemiology of malaria in Amazonas and the city of Manaus from 1980 to 2006 and to describe the overall rates, prevalence, and admission rates of malaria caused by P. falciparum and P. vivax. The Study We extracted total yearly cases of malaria and population size in Amazonas from the database maintained by the Brazilian Ministry of Health (DATASUS, 2004), National Foundation of Health (6-8), and Secretary of Surveillance in Health (3,9). Data from FMT-AM were extracted from the malaria logbooks (for the years before the Foundation started publishing the reports) and from the Quarterly reports (for the years that the Foundation published the reports). All malaria cases diagnosed and referred for treatment are maintained (1989-1994) and quarterly reports are published by the FMT-AM (10). Quarterly reports published from 1995 to 2004 provided the total number of malaria diagnoses, case-patients admitted to the hospital, and number of deaths. Data from 2005 and 2006 were obtained by one of the authors (M.R.F. Costa) directly at FMT-AM (Subgerencia de Arquivos Medicos e Contas Hospitalares). The hospital protocol is to exclude mixed infections by additional testing. We collected and tabulated data from these sources by year, parasite species, admissions, and percent admissions (Table). Percent admission was calculated as the total number of case-patients admitted to the hospital due to the specified parasite, divided by the total number of malaria cases caused by that same parasite in FMT-AM during that year, multiplied by 100. Malaria cases from all causes in Amazonas, 1980-2006, are presented in Figure I. An irregular increase is noted since 1988, reaching a peak in 1999, followed by a decline in 2001, only to rise again in the following years. A decrease was observed in 2006, but the data are not final. Figure 1 also shows the total number of malaria cases diagnosed at FMT-AM; fluctuations observed are very similar in direction and relative magnitude to those found statewide. The number of infections due to P. falciparum and P. vivax diagnosed annually at FMT-AM are shown in Figure 2, panel A. The percentage of diagnosed case-patients admitted to the hospital, by parasite and year, is presented in Figure 2, panel B. In 1989, 264 (20%) of the patients with a diagnosis of P. falciparum infection were admitted to the hospital, while only 26 (0.85%) of those infected in·fect tr.v. in·fect·ed, in·fect·ing, in·fects 1. To contaminate with a pathogenic microorganism or agent. 2. To communicate a pathogen or disease to. 3. To invade and produce infection in. with P. vivax required admission. While P. falciparum remains the main cause of malaria admissions, we observed a significant increase in P. vivax admissions: the mean percent admissions from 1989 to 1996 was 0.59% (standard deviation In statistics, the average amount a number varies from the average number in a series of numbers. (statistics) standard deviation - (SD) A measure of the range of values in a set of numbers. [SD] 0.18), increasing to 1.91% (SD 0.74) from 1997 to 2006. This relative increase in P. vivax malaria requiring admission to the hospital for treatment was disproportionate to the change in numbers in numbered parts; as, a book published in numbers. See also: Number of cases and to the relative frequency of P. vivax cases over P. falciparum malaria fal·cip·a·rum malaria n. Malaria caused by Plasmodium falciparum and characterized by severe malarial paroxysms that recur about every 48 hours and often by acute cerebral, renal, or gastrointestinal manifestations. cases. Conclusions We presented the epidemiology of recent malaria cases in the State of Amazonas and city of Manaus, emphasizing the emergence of severe P. vivax malaria. Assuming that patients requiring hospital admission were sicker than those treated as outpatients, we observed that malaria transmission in this region was continuous and fluctuated in intensity. P. vivax was consistently the main cause of malaria, but the number of patients with P. vivax requiring hospital admission increased significantly in recent years. Changes in control operations were linked to the reestablishment of malaria in major urban areas of the Amazon basin “Amazonian” redirects here. For other uses, see Amazonian (disambiguation). The Amazon Basin is the part of South America drained by the Amazon River and its tributaries. , e.g., Belem (11). In Manaus, this could have had an impact on P. vivax disease manifestations and severity but did not seem to have affected the severity of disease caused by P. falciparum, perhaps because the current policy of early diagnosis and treatment has been reported to have a greater impact on disease caused by P. falciparum than P. vivax (12,13). In this study, we assumed that case definition and criteria for admission at FMT-AM, for both P. vivax and P. falciparum malaria, were relatively constant (http://www. fmt.am.gov.br/). Our data showed that the likelihood of hospital admissions for case-patients diagnosed with P. vivax malaria increased substantially after 1996, while the percentage of P. falciparum admissions declined. The decreasing rate of admission for P. falciparum malaria during the later years of our study supports the interpretation that the criteria for admission to FMT-AM were not loosened. It is possible that referrals to FMT-AM from elsewhere in the region increased during this period, but that would likely affect P. falciparum admissions too. Based on these considerations, we interpret the data as suggestive of suggestive of Decision making adjective Referring to a pattern by LM or imaging, that the interpreter associates with a particular–usually malignant lesion. See Aunt Millie approach, Defensive medicine. an increased illness associated with P. vivax infections in the region. [FIGURE 1 OMITTED] In this study we did not attempt to describe the specific disease manifestations that were the basis for admissions of individual patients. However, recent reports described a range of unusual manifestations of P. vivax infection elsewhere (14), consistent with the disease manifestations reported in Manaus (5). Biologic aspects of the human host, vector, and parasite and changes in the environment contribute to the epidemiology of malaria. Our data demonstrate that malaria is a growing health burden in the Amazon Region of Brazil and that disease caused by P. vivax is a substantial and increasing threat to the health of the population in Manaus. More studies are needed to understand the complex mechanisms of this disease and its impact on susceptible populations. [FIGURE 2 OMITTED] This research was supported in part by National Institutes of Health grants U01 AI054777 and R01 AI49726. References (1.) Brazil: Ministerio da Saude, Fundacao Nacional de Saude (FU-NASA). Vigilancia Epidemiologica: Programa Nacional de Prevencao e Controle da Malaria-PNCM. Brasilia-DF. Dec 2002. [cited 2007 Aug 29]. Available from http://www.funasa.gov.br (2.) Loiola CCP (Certified Computer Professional) The award for successful completion of a comprehensive examination on computers offered by the ICCP. See ICCP and certification. . 1. (language) CCP - Concurrent Constraint Programming. 2. , da Silva sil·va also syl·va n. pl. sil·vas or sil·vae 1. The trees or forests of a region. 2. A written work on the trees or forests of a region. CJM CJM Canadian Journal of Mathematics CJM Corporate Jet Management CJM Congregation of Jesus and Mary (religious order) CJM Contemporary Jewish Museum of San Francisco CJM Chantiers Jeunes Maroc , Tauil PL. Controle da malaria no Brasil: 1965-2001. Rev Panam Salud Publica. 2002;11:235-44. (3.) Brasil, Ministerio da Saude, Secretaria de Vigilancia em Saude (SVS SVS - OS/VS2 ). Boletim Epidemiologico da Malaria. No. 2. Dec 2003. [cited 2007 Aug 29]. Available from http://dtr2001.saude.gov.br/svs/epi/ malaria/pdfs/be_malaria_02_2003.pdf (4.) Fundacao de Medicina Tropical do Amazonas (FMT-AM), 2005. Informe Epidemiologico, No. 1. 2005. Malaria notificada no Amazonas no Periodo de 2003 a 2004. (5.) Alecrim MGC MGC Mammalian Gene Collection MGC Media Gateway Controller MGC Middle Georgia College MGC Museums and Galleries Commission (UK government) MGC Mississippi Gaming Commission MGC Manual Gain Control . Estudo Clinico, resistencia e polimorfismo parasitario na malaria pelo Plasmodium vivax, em Manaus. Brasilia-DF: 2000. Universidade de Brasilia; Faculdade de Medicina/Nucleo de Medicina Tropical, Tese de Doutorado. p. 177. (6.) Brazil: Fundacao Nacional de Saude (FUNASA). Vigilancia Epidemiologica: Situacao da Prevencao e Controle das Doencas Transmissiveis no Brasil. Brasilia-DF. Sep 2002:22-3. [cited 2007 Aug 29]. Available from http://www.funasa.gov.br (7.) Brazil: Fundacao Nacional de Saude (FUNASA). Vigilancia Epidemiologica. Brasilia-DF. 2004. [cited 2007 Aug 29]. Available from http://www.funasa.gov.br (8.) Brasil: Fundacao Nacional de Saude (FUNASA). Vigilancia Epidemiologica: Casos confirmados, segundo o periodo de diagnostico e local de residencia, por U.F. Brasil, 1980-2001. Brazil-DF. 2003. [cited 2007 Aug 29]. Available from http://www.funasa.gov.br (9.) Brasil: Secretaria de Vigilancia em Saude (SVS). Serie historica de casos de Doencas de Notificacao compulsoria-Amazonas, 1980-2001. Brasilia-DF. 2004. [cited 2007 Aug 29]. Available from http:// dtr2001.saude.gov.br/svs/epi/situacaodoencas/transmissiveis00.htm (10.) Fundacao de Medicina Tropical do Amazonas (FMT-AM). Boletim trimestral tri·mes·ter n. 1. A period or term of three months. 2. One of three terms into which an academic year is divided in some universities and colleges. , Numeros 1 a X. Manaus, Amazonas, Brasil: 1995 to 2004. (11.) Libonati RM, Dos Santos Santos (sän`t  s), city (1996 pop. 412,288), São Paulo state, SE Brazil, on the island of São Vicente in the Atlantic just off the mainland. MVN MVN Most Valuable Network (sports-related web site)MVN Mission Viejo Nadadores (swimming group) MVN Mount Vernon, IL, USA - Mount Vernon Outland Airport (Airport Code) MVN Mark L. , Pinto pinto Spotted horse, also called paint, piebald, skewbald, and other terms to describe variations in colour and markings. The American Indian ponies of the western U.S. were often pintos. Most pure-breed associations refuse to register horses with pinto colouring. AYN, Calvosa AM, Ventura PHM, Figueiredo JM, et al. Malaria autoctone na Grande Belem: panorama atual e prevalencia no ultimos seis anos. Rev Soc Bras Med Trop. 2000;33(Suppl 1):347. (12.) Mendis K, Sina BJ, Marchesini P, Carter R. The neglected burden of Plasmodium vivax malaria. Am J Trop Med Hyg. 2001;64:97-106. (13.) Pan American Health Organization The Pan American Health Organization (PAHO) is an international public health agency with 100 years of experience in working to improve health and living standards of the countries of the Americas. It serves as the specialized organization for health of the Inter-American System. . Situation of malaria programs in the Americas. Epidemiol Bull/PAHO. 2001;22:10-4. (14.) Kochar DK, Saxena V, Singh N, Kochar SK, Kumar SV, Das A. Plasmodium vivax malaria. Emerg Infect infect /in·fect/ (in-fekt´) 1. to invade and produce infection in. 2. to transmit a pathogen or disease to. in·fect v. 1. Dis. 2005;11:132-4. Patricia D. Santos-Ciminera, * ([dagger]) Donald R. Roberts, * Maria das Gracas C. Alecrim, ([dagger]) Monica R.F. Costa, ([dagger]) and Gerald V. Quinnan Jr * * Uniformed Services University of the Health Sciences The university currently has two mottos: "Learning to Care For Those In Harm's Way" and "Providing Good Medicine In Bad Places." USU School of Medicine With an enrollment of approximately 167 students per class, USU School of Medicine is located in Bethesda, Maryland on the , Bethesda, Maryland Bethesda is an urbanized, but unincorporated, area in southern Montgomery County, Maryland, just Northwest of Washington, D.C. It takes its name from a church located there, the Bethesda Presbyterian Church, built in 1820 and rebuilt in 1850, which in turn took its name from , USA; and ([dagger]) Fundacao de Medicina Tropical do Amazonas, Manaus, Brazil Address for correspondence: Patricia D. Santos-Ciminera, Department of Preventive Medicine preventive medicine, branch of medicine dealing with the prevention of disease and the maintenance of good health practices. Until recently preventive medicine was largely the domain of the U.S. and Biometrics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Room A3079, Bethesda, MD 20814, USA; email: patriciadantas@hotmail.com Dr Santos-Ciminera is originally from Brazil, where she worked at the Foundation of Tropical Medicine tropical medicine, study, diagnosis, treatment, and prevention of certain diseases prevalent in the tropics. The warmth and humidity of the tropics and the often unsanitary conditions under which so many people in those areas live contribute to the development and of Amazonas. She is currently an adjunct professor at Villa Julie College History Villa Julie College was founded in 1947 in Stevenson by the Sisters of Notre Dame de Namur as a one-year school training women to become medical secretaries. The College was named for Saint Julie Billiart, foundress of the Sisters of Notre Dame. in Maryland. Her primary research interests are malaria epidemiology (traditional and molecular) and pathogenic path·o·gen·ic or path·o·ge·net·ic adj. 1. Having the capability to cause disease. 2. Producing disease. 3. Relating to pathogenesis. mechanisms of infectious diseases infectious diseases: see communicable diseases. .
Table. Total malaria cases in the state of Amazonas, Brazil,
1980-2006, and malaria case-patients diagnosed and admitted
at FMT-AM by parasite, 1989-2006 *
FMT-AM
Plasmodium falciparum
Malaria, No.
Amazonas all No. case- admitted
Year ([dagger]) causes patients N
1980 4,447 -- -- --
1981 8,169 -- -- --
1982 13,142 -- -- --
1983 10,299 -- -- --
1984 8,528 -- -- --
1985 11,196 -- -- --
1986 15,319 -- -- --
1987 15,233 -- -- --
1988 19,392 -- -- --
1989 34,944 4,347 1,262 264 (20.92)
1990 28,479 3,037 839 175 (20.86)
1991 45,849 5,765 664 179 (26.96)
1992 37,885 5,083 670 118 (17.61)
1993 55,364 10,157 2,834 325 (11.47)
1994 68,287 7,469 1,433 199 (13.89)
1995 52,602 5,765 1,049 174 (15.08)
1996 70,044 6,206 1,333 201 (15.08)
1997 94,382 10,483 1,871 186 (9.78)
1998 114,748 10,854 1,751 217 (12.39)
1999 167,722 19,967 4,459 341 (7.65)
2000 96,026 12,266 2,541 177 (6.97)
2001 48,385 4,315 813 127 (15.62)
2002 70,223 88,711 992 106 (10.69)
2003 143,343 30,017 2,213 150 (6.78)
2004 152,440 27,169 5,727 257 (4.49)
2005 229,330 31,243 8,698 264 (3.52)
2006 190,378 16,182 3,363 175 (4.31)
FMT-AM
Other causes
([double
P. vivax dagger])
No.
No. case- admitted No. case-
Year patients N patients
1980 -- -- --
1981 -- -- --
1982 -- -- --
1983 -- -- --
1984 -- -- --
1985 -- -- --
1986 -- -- --
1987 -- -- --
1988 -- -- --
1989 3,043 26 (0.85) 42
1990 2,175 15 (0.69) 23
1991 5,076 23 (0.45) 25
1992 4,398 29 (0.66) 15
1993 7,284 24 (0.33) 39
1994 5,948 44 (0.74) 88
1995 4,518 30 (0.66) 198
1996 4,686 18 (0.38) 187
1997 8,506 175 (2.06) 106
1998 9,004 116 (1.29) 99
1999 15,238 155 (1.02) 270
2000 9,227 147 (1.59) 498
2001 3,443 95 (2.76) 59
2002 7,808 263 (3.37) 71
2003 27,679 677 (2.45) 125
2004 21,228 345 (1.63) 214
2005 22,174 378 (1.70) 371
2006 12,672 161 (1.27) 147
* 2005-2006 data obtained at the Malaria Laboratory and
Epidemiology Department of the FMT-AM by M.R.F.C. FMT-AM,
Fundacao de Medicina Tropical do Amazonas; --, data not
available.
([dagger]) Total malaria cases in the state of Amazonas.
([double dagger]) Includes P. malariae infections and mixed
infections (P. falciparum + P. vivax).
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