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Background: Post-artemisinin delayed hemolysis (PADH) is a serious complication in patients who recover from severe malaria after receiving artemisinin-based combined therapy (ACT), including artemether-lumefantrine. In Japan, among the antimalarial drugs recommended by the World Health Organization (WHO) guideline for severe malaria, intravenous quinine gluconate is available only in 29 designated hospitals, and intravenous artesunate is unavailable. Therefore, oral artemether-lumefantrine is occasionally administered as an alternative, even though it may be a suboptimal treatment. In non-endemic settings like Japan, a lack of knowledge of malaria and the side effects, such as post-artemisinin delayed hemolysis caused by the ACT, can have critical consequences. Like our patient, being a primigravida in the early stages of pregnancy is a serious risk factor for severe malaria and must be carefully monitored. Case presentation: This report describes a severe case of imported Plasmodium falciparum malaria complicated by fetal loss and prolonged anemia, requiring frequent blood transfusions. The patient was a previously healthy pregnant Japanese female in her 30 s. She developed a high fever 2 days after returning from Nigeria. The patient fulfilled the severe malaria criteria by WHO. On arrival, an abdominal ultrasound incidentally revealed a fetus of 5 week gestational age with a heartbeat in the uterus. Given her pregnancy and the severity of the disease, she was administered intravenous quinine 16 mg/kg as a loading dose. However, the second dose of quinine was not administered due to frequent vomiting and QTc prolongation. We initiated treatment with oral artemether-lumefantrine, and clearance of parasitemia was confirmed by microscopic observation on day 4. Miscarriage was noted on day 6 after admission. Moreover, the patient became feverish again up to 39 °C, and from days 14 to 22, the patient required multiple blood transfusions due to PADH. On day 40, follow-up was discontinued as the hemoglobin level exceeded 10 g/dL. Conclusions: In patients who recover from severe malaria after ACT treatment, monitoring the hemoglobin level for at least a month is strongly recommended for prompt identification of PADH. Travelers to malaria-endemic countries, especially primigravida women, should be provided with adequate information on the risk and prevention of infection. [ABSTRACT FROM AUTHOR]

Both sickle cell anemia (SCA) and glucose-6-phosphate dehydrogenase (G6PD) deficiency are common genetically transmitted disorders associated with hemolytic anemia, with a high prevalence in sub-Saharan Africa. Co-inheritance of both diseases has been reported in Nigeria where the prevalence of each disease is high. However, a high index of suspicion is needed to diagnose the co-existence of both disorders in the same individual. Here, we present an unusual case of a 32-year-old dentistry student who was known to have SCA since the age of one year. He presented with episodic exacerbation of jaundice and passage of dark-colored urine following skin and inhalational exposure to wax (polycyclic aromatic hydrocarbons) used for reconstructive dental practical sessions. After investigations, he was found to have G6PD deficiency. This report underscores the importance of screening for G6PD deficiency in male patients with SCA presenting with episodic symptoms of hemolysis. [ABSTRACT FROM AUTHOR]

Antibiotics have been utilized as both antibacterials and growth-promoting agents, although their residues have been reported to be hazardous to both animals and humans. This study aimed to determine the presence of drug resistant haemolytic Escherichia coli in cultured African catfish, detect chloramphenicol and furaltadone residues in fish-fillets, and assess knowledge, attitude and practice of fish farmers on antimicrobial usage. Liver and fillets samples (N=400) from 10 commercial fish farms (n=40) were examined. Isolates were identified after Grams' staining using conventional biochemical tests. Antimicrobial susceptibility was tested using Kirby-Bauer disc diffusion technique and results were interpreted using clinical laboratory standard institute(CLSI) guide. Detection of drug residues was done using high performance liquid chromatography (HPLC). Antimicrobial use (knowledge, attitude and practice) of fish farmers were assessed usingsemistructured questionnaire. Haemolytic E. coli (69.3) were isolated and 63 % were observed to be resistant to chloramphenicol, furaltadone, gentamicin, amoxicillin, erythromycin, tetracycline, penicillin, streptomycin, nitrofurantoin and doxycycline. Chloramphenicol and furaltadone residues were not detected in all the samples. Most fish farmers 18 (60%) lack knowledge of antimicrobial resistance and withdrawal period 22 (73.3 %). Their sources of information on antimicrobial usage are cofarmers, drug-vendors and internet. In this study from cultured Clarias gariepinus the occurrence of haemolytic E. coli was 69.3 % and that of chloramphenicol, furaltadone and their metabolites was zero. The E. coli isolated were resistant to at least 4 of the 10 antimicrobials tested. [ABSTRACT FROM AUTHOR]

BACKGROUND: Vitamin D supplementation has been shown to improve hemoglobin levels in patients with sickle cell anemia (SCA). However, very little is known about the prevalence of its deficiency, its role in hemolysis, and its effects on transfusion requirements in SCA, hence this study. PATIENTS AND METHODS: Serum level of vitamin D was determined in 50 SCA patients in steady state, 50 SCA patients in hemolytic crises, and 50 in normal HbAA individuals. All were 18 years or older and were age- and sex-matched. In addition, PCV and hemoglobin (Hb) concentration, absolute reticulocyte count, uric acid, total and conjugated bilirubin, creatinine, lactate dehydrogenase (LDH), and estimated glomerular filtration rate (eGFR) were also assessed in all subjects and controls. Baseline sociodemographic, clinical, and anthropometric data were also recorded. RESULTS: The prevalence of vitamin D insufficiency and deficiency was found to be 18% and 79%, respectively. The mean serum levels of vitamin D were 18.84 ± 6.86 ng/mL and 17.58 ± 6.23 ng/mL in the steady-state and the hemolytic crises SCA groups, respectively. Transfusion requirements were found to be higher in SCA patients with lower vitamin D levels. Unlike those in crisis who received one or more units of blood transfusion, 42% of those in the steady state did not receive blood transfusion over the same period of 12 months. Hemoglobin levels were, however, found to predict reduced vitamin D levels. CONCLUSION: Vitamin D deficiency (VDD) is highly prevalent among adults with SCA and those with lower vitamin D levels are more anemic and hence may require more blood transfusions. [ABSTRACT FROM AUTHOR]

Geographic variation in aridity determines environmental productivity patterns, including large-scale variability in pathogens, vectors and associated diseases. If disease risk decreases with increasing aridity and is matched by immune defense, we predict a decrease in innate immune function along a gradient of increasing aridity from the cool-wet forest to the hot-dry Sahel, from south to north in Nigeria. We sampled blood and measured five innate immune indices from 286 Common Bulbuls Pycnonotus barbatus between 6 and 13°N. We sampled in the dry season; we resampled the first location (Jos) also as the last sample location to test temporal change in immune function. Immune indices did not decrease with aridity. One immune index, nitric oxide concentration showed a weak quadratic pattern. In Jos, ovotransferrin concentration, haemagglutination and haemolysis titres increased 12 weeks into the dry season, contrary to expectations that immune indices should decrease with increased dryness. In this tropical system, innate immune function does not decrease with increasing aridity but temporal factors within a location may influence immune function more strongly than spatial variation in aridity, suggesting that immune variation does not follow a simple environmental productivity pattern. Consequently, caution should probably be exercised in predicting effects of climate variability on immune function or disease risk. [ABSTRACT FROM AUTHOR]

Background: In this study, the hematological and antioxidant potential as well as the osmotic fragility effects of a Nigerian polyherbal formulation were evaluated. Materials and methods: A total of 40 fats were divided into four groups of 10 rats each. Group 1 served as the control group, and the rest were assigned increasing daily oral administration of the extract for 28 days. At the end of treatment, blood was collected for hematological and osmotic fragility studies. The free radical scavenging effect of the extract was investigated via different in vitro models as well. Results: Results showed that the nitric oxide scavenging and 2,2-diphenyl-1-picrylhydrazyl (DPPH) activities of the extract were significant (p < 0.05) and compared favorably with that of vitamin C. At 200 and 400 μg/mL, the nitric oxide scavenging activities for Ajumbise Polyherbal Extract (APE) were 60.71 ± 0.25% and 59.49 ± 0.98%, respectively, whereas for the same concentrations of vitamin C, 74.60 ± 0.25% and 85.24 ± 0.14 scavenging activities were obtained. The (DPPH) activity at 100 μg/mL was 81.24 ± 0.02% for the extract and 96.22 ± 0.18% for vitamin C. However, at all concentrations, the extract had significantly lower Ferric Reducing Antioxidant Power (FRAP) activity than vitamin C. Red blood cell counts (RBCC), hemoglobin and packed cell volume values (PCV) were significantly lowered only in groups treated with 400 and 800 mg/kg of the extract (p < 0.05), whereas other RBCC parameters and white blood cell counts (WBCC) were not significantly affected (p < 0.05). Platelet (PLT) count was also significantly lowered in all extract-treated groups. The extract also significantly reduced RBCC percentage hemolysis (p < 0.05). Conclusions: Ajumbise polyherbal may be free of hematoxicity and may improve the integrity of the RBC membrane due to its appreciable antioxidant activity. [ABSTRACT FROM AUTHOR]

Introduction: Cerebral vasculopathy, elevated transcranial Doppler velocities and stroke are linked to excessive intravascular haemolysis in sickle cell anaemia. This study determined the prevalence and pattern of abnormal blood flow velocities in children with sickle cell anaemia from Northern Nigeria using transcranial Doppler and to correlate transcranial Doppler velocities with haematological and biochemical markers of haemolysis. Methods: Full blood count, reticulocyte count, fetal haemoglobin and some selected biochemical markers of haemolysis of 100 children with sickle cell anaemia were determined at steady state. The time-averaged mean of maximal velocities in four major intracranial blood vessels was measured using non-imaging transcranial Doppler, which were then classified according to the stroke prevention in sickle cell disease trial protocol. A simple linear correlation between time-averaged mean of maximal velocities in the four major intracranial vessels as the dependent variable and haematological and biochemical markers of haemolysis as independent variables was also determined at the significance level of 0.05. Results: Abnormal transcranial Doppler velocities, classified as high risk, were found in 3% of the studied patients; 11% had intermediate risk while 84% had standard risk. Most high velocities were detected in the middle cerebral artery. The time-averaged mean of maximal velocities of middle cerebral artery positively correlated with total white blood cell count, absolute neutrophil count, platelet count, reticulocyte count, serum lactate dehydrogenase and total bilirubin, while it was negatively correlated with haematocrit and fetal haemoglobin levels. Conclusion: Our study showed low prevalence of abnormal transcranial Doppler velocities and low prevalence is unrelated to low markers of haemolysis in our study population. [ABSTRACT FROM AUTHOR]

Asymptomatic malaria (ASM) has been implicated in the development of hemolytic crisis in infected sickle cell anemia (SCA) patients worldwide. This study surveyed steady state SCA Nigerian patients for ASM to investigate the influence of malaria prevention behaviors and age on parasitaemia and multiplicity of infection (MOI). A total of 78 steady SCA patients aged 5 - 27 years on routine care at three health facilities in Lagos were investigated for ASM by light microscopy and PCR with a multiplicity of infection determined by genotyping block 2 of merozoite surface protein 1 (msp1) gene of Plasmodium falciparum (P. falciparum). Use of malaria prevention measures was captured using a semi-structured questionnaire. The prevalence rates of ASM (due to Pf only) by microscopy and PCR were found to be 27.3% and 47.4% respectively (P < 0.05) with a Mean + SEM parasite density of 2238.4 + 464.3 parasites/uL. Five distinct msp1 genotypes [K1 (2), MAD20 (2), RO33 (1)] were detected and significant (P<0.05) disparity in allele frequencies (K1, 91.8%, MAD20, 32.4%; RO33, 18.9%) was found. The overall MOI was 1.43 and 37.8% of infections were polyclonal (P<0.05). ASM was associated with non-use of preventive measures and occurred in 62.1% of SCA patients aged < 10y with lower MOI of 1.3 compared to 38.1% in older patients with a higher MOI of 1.5 (P<0.05). We conclude that PCR improved the diagnosis of ASM among Nigerian SCA patients with infections being of low complexity and associated with non-use of preventive interventions and R033 msp1 allele selection. [ABSTRACT FROM AUTHOR]

Background: Haemoglobinuria is one of the manifestations of severe malaria and results from severe intravascular haemolysis. Glucose-6-phosphate dehydrogenase (G6PD) deficiency has been implicated in its aetiology. Haemoglobinuria may be associated with severe anaemia and, less frequently, acute renal failure. Methods: A prospective case-control study was carried out to determine the incidence of haemoglobinuria as confirmed by dipstick urinalysis, microscopy and spectrophotometric measurement, among children with severe malaria. A total of 251 children presenting at the Children's Emergency Ward with severe malaria were recruited over a period of 21 months. The G6PD status and the outcomes of severe malaria in children with and without haemoglobinuria was studied with respect to renal failure, the recurrence of haemoglobinuria and blood pressure changes over a three-month follow-up period. Results: It was found that the incidence of haemoglobinuria among children with severe malaria is 19.1%. Children <5 years constituted 76.8% of all the study patients. Patients with haemoglobinuria had median age of 52.5 months, which was significantly higher than 35 months in patients without haemoglobinuria (p=0.001). Although, haemaglobinuria was commoner among boys (54.2%) than girls (45.8%), the difference was not statistically significant. There were no significant differences between children with and without haemoglobinuria regarding their nutritional status or parasite densities. Among the clinical features of the study patients, only jaundice was significantly associated with haemoglobinuria (p=0.0001). Renal failure occurred in three out of 48 children with haemoglobinuria and in none of the 203 without. There was not recurrence of haemoglobinuria in the follow-up period. At discharge, blood pressure was elevated in six children (one previously haemoglobinuric), but all returned to normal within the follow-up period. Conclusions: Haemoglobinuria was a prominent feature of severe malaria and it was significantly associated with jaundice at presentation. Haemoglobinuria was commoner in older children than younger children but not related to sex. G6PD deficiency was not an independent predictor of the occurrence or outcome of haemoglobinuria. Blood pressure was not affected by haemoglobinuria on admission nor during follow-up. [ABSTRACT FROM AUTHOR]

Aim: Nigeria, where malaria is prevalent, has the largest sickle cell gene pool in the world. To this end, there is a need for increased understanding of the pathophysiology of HbSS patients in a malaria endemic zone to reduce mortality. Haematology Department, University College Hospital, Ibadan, Nigeria. Materials and methods: The levels of HbF, IgG, IgA, IgM, transferin (TRF), C-reactive protein (CRP), and haptoglobin (HPT) were determined in 14 Nigerians having HbAA genotype with malaria parasitaemia (HbAA +MP), 17 Nigerians having haemoglobin AA genotype without malaria parasitaemia (HbAA -MP), 15 Nigerians having haemoglobin SS genotype without malaria parasitaemia (HbSS -MP), and 14 Nigerians having HbSS with malaria parasitaemia (HbSS +MP). Results: The levels of Ig classes were statistically similar in all the groups. CRP was significantly increased in HbSS -MP compared with HbAA +MP or HbAA -MP. The levels of TRF and HPT were significantly reduced in HbSS -MP or HbSS +MP compared with HbAA -MP. Also TRF and HPT were significantly reduced in HbSS +MP compared with HbSS -MP. Conclusion: These observations may be related to RBC haemolysis especially in HbSS +MP. [ABSTRACT FROM AUTHOR]

Fresh, different meat types and offal were examined for the occurrence of Aeromonas species by the direct-plating and enrichment methods. The enrichment method (coefficient of variation = 15.1%) enhanced the recovery of Aeromonas species. The major Aeromonas species identified were A. sobria (67.3%) and A. hydrophila (21.2%). Other species occurred in minor proportions and were A. caviae , A. proteolytica and A. salmonicida . Out of the 52 isolates, 50 were motile species except two which were not motile and identified as the species A. proteolytica . Sixteen motile species occurred in cow, 18 in goat and 16 in lamb. The motile species and the two nonmotile species were hemolytic. They were all sensitive to chloramphenicol (30 mg) and resistant to ampicillin (10 mg). The nonmotile A. proteolytica were all resistant to tetracycline. Aeromonas caviae , A. salmonicida , A. hydrophila and A. sobria were killed after exposure to 50C (decimal reduction time, D 10 = 30 s). Aeromonads are unlikely to pose a public health problem in Nigeria where meat undergoes prolonged cooking. Meat is a possible factor in the epidemiology of Aeromonas -associated gastroenteritis in man. [ABSTRACT FROM AUTHOR]