Comparative incidence and clinical spectrum of Plasmodium knowlesi malaria, a longitudinal study in Sabah, Malaysia

马来西亚沙巴的一项纵向研究诺氏疟原虫疟疾的发病率和临床谱比较

• 批准号: 8852206
• 负责人: Timothy William
• 金额: $ 13.67万
• 依托单位: INFECTIOUS DISEASE SOCIETY KOTA KINABALU
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-04-10 至 2020-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8852206
• 关键词: American; Applications Grants; Area; Blood specimen; Borneo; Child; Clinical; Collaborations; Country; Culicidae; Data; Diagnosis; Disease; District Hospitals; Enrollment; Epidemiology; Falciparum Malaria; Far East; Frequencies; Funding; Future; Gene Mutation; Hour; Human; Hygiene; Incidence; Infection; Investigation; Journals; Knowledge; Laboratories; Lead; Longitudinal Studies; Malaria; Malaysia; Malaysian; Methods; Microscopic; Microscopy; Molecular; Monkeys; Mutation; Notification; Outcome; Parasitemia; Parasites; Patients; Plasmodium; Plasmodium falciparum; Plasmodium knowlesi; Plasmodium vivax; Population; Pregnancy; Pregnant Women; Prevalence; Prospective Studies; Public Health; Reporting; Research; Risk; Risk Factors; Sabah; Scheme; Severities; Severity of illness; Southeastern Asia; Testing; Time; Treatment outcome; Tropical Medicine; Vivax Malaria; Work; World Health Organization; base; clinical epidemiology; comparative; design; man; neglected tropical diseases; programs; prospective; public health relevance; transmission process; treatment response; trend; vector mosquito

 DESCRIPTION (provided by applicant): Comparative incidence and clinical spectrum of Plasmodium knowlesi malaria, a longitudinal study in Sabah, Malaysia has one of the most successful malaria control programs in Southeast Asia, with marked reductions in the incidence of Plasmodium falciparum and P. vivax over recent decades and an aim to eliminate these species by 2020. However, the simian parasite P. knowlesi has emerged as a major cause of human malaria, and we recently reported that in Sabah, east Malaysia, combined notifications of P. knowlesi and the microscopically near-identical P. malariae increased >10-fold between 2004 - 2011. However, microscopic diagnosis of P. knowlesi is known to be problematic, and definitive diagnosis requires molecular methods. Hence, whether the apparent increase in P. knowlesi is due to increased recognition of the species remains uncertain, and the true incidence and trend of knowlesi malaria in Sabah, in comparison to the other human malaria species, has not been determined. P. knowlesi has a 24-hour replication cycle and can result in high parasitemias with consequent complications. Risk of severe disease appears higher than that of falciparum malaria, and fatal cases have been reported. However, many knowledge gaps remain with regards to the epidemiology and clinical features of knowlesi malaria. Large prospective longitudinal studies have not been conducted, and no prospective study has evaluated the clinical features of knowlesi malaria in children, or the occurrence and consequences of knowlesi malaria in pregnancy. In our proposed study we aim to determine the true incidence and trend of knowlesi malaria in Sabah, in comparison to the other human malaria species. This will be achieved through collaboration with the Sabah Public Health Laboratory, and will involve the implementation of state-wide molecular testing of every case of microscopy-diagnosed malaria in Sabah during the 5-year study period. Basic demographic details including pregnancy status will be recorded for all cases. Our second aim is to determine the epidemiology and clinical spectrum of knowlesi malaria at two district hospitals, including changes over time. This will be achieved through the enrolment of every patient admitted with malaria at two district hospitals in northeast Sabah, with detailed epidemiological and clinical details recorded. Our proposed research will provide for the first time accurate information regarding the true incidence of knowlesi malaria in Sabah, and the trend of this species over time in comparison to the other human malaria species. This will inform malaria control programs in Sabah, in addition to informing other countries in Southeast Asia about the potential emergence of knowlesi malaria as P. falciparum and P. vivax are brought under control. In addition, our prospective district-hospital studies will provide crucial information regarding the clinical features of knowlesi malaria in populations that have not been previously well-studied, including children and pregnant women.

 描述（由申请方提供）：诺氏疟原虫疟疾的发病率和临床谱比较，在马来西亚沙巴进行的一项纵向研究，该研究是东南亚最成功的疟疾控制项目之一，近几十年来恶性疟原虫和间日疟原虫的发病率显著降低，目标是到2020年消除这些物种。然而，猿类寄生虫诺氏疟原虫已成为人类疟疾的主要原因，我们最近报道，在马来西亚东部的沙巴，诺氏疟原虫和显微镜下几乎相同的三日疟原虫的合并报告在2004 - 2011年间增加了10倍以上。然而，已知诺氏疟原虫的显微镜诊断是有问题的，并且确定性诊断需要分子方法。因此，诺氏疟原虫的明显增加是否是由于对该物种的认识增加仍然不确定，与其他人类疟疾物种相比，沙巴诺氏疟疾的真实发病率和趋势尚未确定。诺氏疟原虫有24小时的复制周期，可导致高寄生虫血症并随之而来的并发症。严重疾病的风险似乎高于恶性疟疾，并已报告了致命病例。然而，在诺氏疟疾的流行病学和临床特征方面仍存在许多知识空白。尚未进行大规模的前瞻性纵向研究，也没有前瞻性研究评估儿童诺氏疟疾的临床特征或妊娠期诺氏疟疾的发生和后果。在我们提出的研究中，我们的目标是确定真正的发病率和趋势诺氏疟疾在沙巴，在比较其他人类疟疾物种。这将通过与沙巴公共卫生实验室的合作来实现，并将涉及在5年研究期间对沙巴的每一个显微镜诊断的疟疾病例进行全州范围的分子检测。将记录所有病例的基本人口统计学详细信息，包括妊娠状态。我们的第二个目标是确定诺氏疟疾在两个地区医院的流行病学和临床谱，包括随时间的变化。这将通过在沙巴东北部的两个地区医院登记每一个疟疾病人来实现，并记录详细的流行病学和临床细节。我们提议的研究将首次提供关于沙巴诺氏疟疾真实发病率的准确信息，以及与其他人类疟疾物种相比，该物种随时间的趋势。这将为沙巴的疟疾控制计划提供信息，此外还将向东南亚其他国家通报恶性疟原虫和间日疟原虫得到控制后可能出现的诺氏疟疾。此外，我们的前瞻性地区医院研究将提供关于诺氏疟疾在以前没有得到充分研究的人群（包括儿童和孕妇）中的临床特征的重要信息。