Karim Asad Mustafa, Hussain Irfan, Malik Sumera Kausar, Lee Jung Hun, Cho Ill Hwan, Kim Young Bae, Lee Sang Hee
National Leading Research Laboratory, Department of Biological Sciences, Myongji University, Yongin, Gyeonggido, Republic of Korea.
Department of Zoology, Kohat University of Science and Technology, Kohat, Pakistan.
PLoS Negl Trop Dis. 2016 Jan 25;10(1):e0004399. doi: 10.1371/journal.pntd.0004399. eCollection 2016 Jan.
Military conflict has been a major challenge in the detection and control of emerging infectious diseases such as malaria. It poses issues associated with enhancing emergence and transmission of infectious diseases by destroying infrastructure and collapsing healthcare systems. The Orakzai agency in Pakistan has witnessed a series of intense violence and destruction. Military conflicts and instability in Afghanistan have resulted in the migration of refugees into the area and possible introduction of many infectious disease epidemics. Due to the ongoing violence and Talibanization, it has been a challenge to conduct an epidemiological study.
METHODOLOGY/PRINCIPAL FINDINGS: All patients were sampled within the transmission season. After a detailed clinical investigation of patients, data were recorded. Baseline venous blood samples were taken for microscopy and nested polymerase chain reaction (nPCR) analysis. Plasmodium species were detected using nested PCR (nPCR) and amplification of the small subunit ribosomal ribonucleic acid (ssrRNA) genes using the primer pairs. We report a clinical assessment of the epidemic situation of malaria caused by Plasmodium vivax (86.5%) and Plasmodium falciparum (11.79%) infections with analysis of complications in patients such as decompensated shock (41%), anemia (8.98%), hypoglycaemia (7.3%), multiple convulsions (6.7%), hyperpyrexia (6.17%), jaundice (5%), and hyperparasitaemia (4.49%).
CONCLUSIONS/SIGNIFICANCE: This overlooked distribution of P. vivax should be considered by malaria control strategy makers in the world and by the Government of Pakistan. In our study, children were the most susceptible population to malaria infection while they were the least expected to use satisfactory prevention strategies in such a war-torn deprived region. Local health authorities should initiate malaria awareness programs in schools and malaria-related education should be further promoted at the local level reaching out to both children and parents.
军事冲突一直是疟疾等新发传染病检测与防控的重大挑战。它引发了一系列问题，比如因破坏基础设施和瓦解医疗体系而加剧传染病的出现与传播。巴基斯坦的奥拉兹艾机构经历了一系列激烈的暴力和破坏事件。阿富汗的军事冲突和动荡导致难民涌入该地区，可能引发多种传染病的流行。由于持续的暴力和塔利班化，开展流行病学研究面临挑战。
方法/主要发现：所有患者均在传播季节进行采样。在对患者进行详细的临床检查后，记录相关数据。采集基线静脉血样本用于显微镜检查和巢式聚合酶链反应（nPCR）分析。使用巢式PCR（nPCR）检测疟原虫种类，并使用引物对扩增小亚基核糖体核糖核酸（ssrRNA）基因。我们报告了对间日疟原虫（86.5%）和恶性疟原虫（11.79%）感染所致疟疾疫情的临床评估，并分析了患者的并发症，如失代偿性休克（41%）、贫血（8.98%）、低血糖（7.3%）、多次惊厥（6.7%）、高热（6.17%）、黄疸（5%）和高疟原虫血症（4.49%）。
结论/意义：全球疟疾防控策略制定者以及巴基斯坦政府应考虑间日疟原虫这种被忽视的分布情况。在我们的研究中，儿童是最易感染疟疾的人群，而在这样一个饱受战争蹂躏的贫困地区，他们最不可能采用令人满意的预防策略。当地卫生当局应在学校启动疟疾宣传项目，并在地方层面进一步推广与疟疾相关的教育，覆盖儿童和家长。
