High polymorphism of parasites isolates is associated with Cerebral Malaria in Dakar. Bob NS, Diop BM, Marrama L, MT Ekala, Tall A, Ka B, Hovette Ph, Seck SY, O Mercereau-Puijalon, Jambou R 1 Institut Pasteur de Dakar, 2 Clinique des maladies infectieuses CHN Fann, 3 Institut Pasteur Paris, 4 Hôpital Principal de Dakar
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Polymorphisme parasitaire et accès graves en zone périurbaine
Polymorphisme parasitaire et accès graves en zone périurbaine - Conférence de la 5e édition du Cours international « Atelier Paludisme » - Ronan JAMBOU - Institut Pasteur de Dakar - [email protected]
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High polymorphism of parasites isolates is associated with Cerebral Malaria in Dakar.
Bob NS, Diop BM, Marrama L, MT Ekala, Tall A, Ka B, HovettePh, Seck SY, O Mercereau-Puijalon, Jambou R
1 Institut Pasteur de Dakar, 2 Clinique des maladies infectieuses CHN Fann, 3 Institut Pasteur Paris, 4 Hôpital Principal de Dakar
Severe Malaria
Newborn
fever
dehydratation
convulsion
Metabolic disorders
= impaired consciousness
Child
Severe anemia +++
High parasiteamia +++
Cerebral attack
Adult
Respiratory distress
cerebral malaria
low parasiteamia
= delay in treatment
mechanic hypothesis
Van der heyde 2006
Activation des endothéliums = expression d’ICAM
Adhesion RBC
Adhesion leukocytes
Disruption tigh junction = leakage
hemorrhage
Apoptose EC
Adhesion platelets
Blockage capillaries
1
3
22
3
2
4
3
mechanic + immune
4
4InflammationLocal / general
Do isolates differ
MILD / CEREBRAL malaria
Which mechanism the most important ?
RATIONALE
�low transmission
�Low immunity
�Drug resistance
�Travel
�Highly virulent strains ?
� treatment retardation
Malaria in Urban area
15°
14°
13°
16°N
Dakar
17°W 16° 15° 14° 13° 12°
SENEGAL
Area of Study
Seasonal transmission
3 M inhabitants
An arabiensis
Prevalence of malaria in consultations
0
0,05
0,1
0,15
0,2
0,25
0,3
septembre octobre novembre decembre
0-1 y
1- 4 y
5-14 y
15- 49 y
> 50 y
0
0,1
0,2
0,3
0,4
0,5
0,6
septembre octobre novembre decembre
0
0,05
0,1
0,15
0,2
0,25
0,3
0,35
0,4
septembre octobre novembre decembre
part of class of age in the malaria cases
prevalence of severe malaria.
0
200
400
600
800
1000
1200
1400
M F M F M F M F M F
0-1 an 1- 4ans 5-14 ans 15- 49 ans 50ans &+
consultations by age
MALARIA AT CHN FANN
Number of cases / 2004
0 100 200 300 400 500 600
CHOLERA
HIV
malaria
Tetanos
infections
Meningitides
Tuberculosis
Others
In emergency unit, malaria = only 10% of the patients
� Number of severe malaria : 170
� Geographic origin of the patients : Dakar 92%
(urban population in Africa : 2030 = 50%)
� Seasonality of the cases
Severe Malaria at CHN Fann , 2004
MALARIA AT CHN FANN – 2004 -
Rainy season
0
5
10
15
20
25
30
35
40
No
mb
re d
e
J F M A M J J A S O N D
Mois
� Age : 15-34 ans = 64% of patients
� Sex-ratio = 1,46 (male +++)
� Delay before hospitalization > 48 hours for 68% patients
� Evolution
- Duration of hospitalization : mean 5 days [0 to 40 d]