Case Study Analysis Report Of Malaria Patient

Introduction - Case Study Analysis Report Of Malaria Patient

Malaria is a serious disease produced by parasites of the genus Plasmodium in humans through the bites of Female Anopheles mosquitoes. That is why it is one of the highest priorities for the world’s health systems, especially for tropical and subtropical zones including sub-Saharan Africa, Southeast Asia, and Latin America. Even though new attempts at the prevention and cure for malaria have been developed, this disease still results in several hundred thousand deaths every year, and the biggest suffering falls on children and pregnant women. Patients normally present with features such as fever, chills, sweating, headache, nausea, and vomiting but may develop life-threatening complications like anemia, renal failure, liver failure, or even death when not managed early. Malaria transmission is rather associated with environmental and climatic prerequisites preferred by the Anopheles mosquitoes easily distinguishing between regional episodes in non-endemic countries like Australia. However, outbreaks of only one case of malaria can be contracted atypically, for example, through “airport malaria” when infected mosquitoes are transported through airplanes from endemic areas or by other forms of contact. The identification and management of such rare cases raise a lot of problems for clinicians, especially as the diagnosis of the species of malaria requires the use of molecular methods like sequencing or polymerase chain reaction. Malaria is endemic in the world with occasional sporadic transmission in the US, therefore, the public health systems of the world must remain watchful at all times.

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Case presentation

This case study represents John Jeewhiz, who is a 41-year-old man and accessible with clinical features indicative of probable malaria, and this case is an unfamiliar one. Malaria mostly affects the tropical world and is caused by Anopheles mosquito bites with the most affected areas being sub-Saharan Africa, Southeast Asia, and South America (Kotepui et al. 2020). However, what seems to set him apart in this case is that he has never traveled outside the country, thus criteria that explain why many people contract malaria. The last time was a domestic trip within Australia, where he went from Sydney to Brisbane and then finally to Cairns. None of these places is categorized as a malaria endemic area and this in turn raises questions concerning the transmission pattern.

Background

Another peculiarity of this case is John’s profession; basically, he is a representative of a sub-field of marine biology, as he deals with marine vertebrates, penguins, and pinnipeds in particular, every day. This is rather strange because the leading cause of malaria, the mosquitoes, is not associated with these animals. However, his uncommon case increases the opportunity of the improper form of transmission or having an altogether different disease that looks like malaria, which necessitates further diagnosis. Because of the complicated and uncommon nature of the case, DNA sequencing has been advised as being the best way to figure out precisely what sort of malaria or any other pathogen is involved. One more advantage is that the species of Plasmodium was not identified and, as a rule, the species identification in malaria-endemic countries is unproblematic (Wilairatana et al. 2021). The patient also displayed typical malaria symptoms such as fever, chills, abdominal pain, and anemia despite the geographical incoherence of muffin-chain malaria.

Although local transmission of malaria, such as “airport malaria” or “baggage malaria,” has been substantiated, they are exceedingly rare and are usually traceable to airports in countries with malaria-importing airports. However, John’s case cannot be put in this bracket because the study did not reveal any direct contact with such areas. The proper presentation of the case study with the action plan is also represented in this report to represent the case scenario with proper details.

Action Plan

Initial assessment for collecting sample

The first procedure in diagnosing a possible infection is an examination of the patient’s status as well as sample procurement. Blood specimens are taken for microscopically examination with blood smears always necessary for the detection of blood-borne pathogens. Collection of the comprehensive history of the patient’s illness, such as the past medical history, substance use, and exposure history helps reach the diagnosis (Kotepui et al. 2020). Other information that should be elicited includes travel history within the last two weeks or is likely to come into contact with infectious risks such as the workplace.

Primary testing to diagnose

After sample collection, the basic diagnostic process is the microscopic examination of the blood samples prepared in the slides. This requires some staining techniques for instance the Giemsa stain to identify possible pathogens as the Plasmodium parasite in malaria. In light of the above-observed findings, the pathogen is then compared with reference standards and other related materials (Mousa et al. 2020). If microscopy fails to give a clear diagnosis, other samples of blood may be taken for further molecular tests. This leads to identifying the pathogen and gives direction on the patient’s infection.

Molecular analysis

Further, for a more accurate diagnosis, molecular analysis examination is done on DNA extraction from these samples shall be made. The spin column kit method is usual for isolation of high pure DNA. To determine the exact species of the suspected pathogen, PCR is then done to magnify specific genes of that pathogen (Elven et al. 2020). Post-PCR, the products undergo gel electrophoresis for vision enabling confirmation regarding the presence of pathogens. There are positive and negative controls to confirm the responsiveness and exactness of the reaction line. This step is a nice addition to the diagnostics process since it aims at the pathogens that are unique to the patient at their genetic level.

Advanced procedures for diagnosis

In the situations where preliminary tests were used and no clear identification of the pathogen was made or more detailed identification of the pathogen is needed, the specific identification tests are done. The focus results in the identification of specific strains of pathogens. The evolutionary history of strains may also be determined to diagnose phylogenetic relationships between the different strains. Comprehensive pathogen profiling through next-generation sequencing avail the detail of the infection nature as per the requirement.

Environmental Investigation

For this reason, environmental investigations are performed with the aim of identifying potential source(s) of transmission. All the samples from the patient’s workplace or residence are collected and tested using the same molecular methods (Phyo et al. 2020). This affords an opportunity to identify possible sources of infection or modes of transmission within the environment. In this way, the potential of having a localized contagion or exposure to the specific environment can be ascertained by evaluating these sources, according to the investigators.

Additional Testing

In case of gastrointestinal symptoms fecal diagnostics could be done to look for even more pathogens. Individual pathogen tests are conducted depending on preliminary results obtained. It is also important that PCR inhibitors are also tested to prevent affecting the molecular analysis investigation (Achan et al. 2022). To exclude PCR interference and confirm negative results further, Universal PCR can be used to determine DNA quality. This final step supports the completeness of the diagnosing procedure and assists the entire study by strengthening all possible sources and reinforcing probabilities.

Outcomes of the action plan

Figure 1: Gel-electrophoresis outcomes of the PCR products

(Source: Lab-work)

The above representation of the gel electrophoresis has supported an understanding of the proper visualization. The bright bands in the lanes suggest that the samples went through Polymerase Chain Reaction and yielded DNA fragments. Each of the bands is isolated from the DNA of interest, which on BLAST analysis is identified to be Plasmodium. The ladder of positive control proves that suitable bands were produced in the PCR setup procedure and the lack of bands in the negative control indicates that the sample did not succumb to contamination during the PCR stage. The outcome therefore indicates that there was a high quality of DNA extracted from the samples, regarding the results, which amplified successfully. As regards PCR outcomes, the samples analyzed by gel electrophoresis present clear and well-defined bands, so there are no indications of problems in the primer annealing or DNA polymerization. However, it is of note that a slight degree of lane-to-lane variability might arise due to variations in sample loading of PCR efficiency (Yimam et al. 2021). During the process of PCR, the gel had distinct bands that correspond to the expected molecular weights for Plasmodium. The presence of Plasmodium in the sample, therefore aligns with the diagnostic hypothesis that has been made in this study.

The outcomes of the BLAST analysis and the gel electrophoresis also reflect signals about the existence of the Plasmodium pathogen. Thus, using the criteria based on the BLAST search an identity of the pathogen is confirmed to be Plasmodium species due to a series of similarities of the nucleotide sequences (Cairns et al. 2021). The query also constructed a high degree of homology with Plasmodium species including Plasmodium malaria and Plasmodium vivax displaying a high Percent identity of 100% and low E values further endorsing the validity of the diagnostic approach. Considering such information about the patient’s clinical signs and symptoms, the analysis leaves clues implicating that this patient has an infection associated with Plasmodium, which is transmissible through mosquito bite hence making it malaria.

Interpretation of the findings

However, certain changes can be made in future PCR operation that warrants a better outcome. For example, making sure sample loading is much more precise across all wells in the gel electrophoresis would improve the result visibility and consistency. In some lanes, the experiment shows faint or less defined bands are present, which may be caused by slight pipetting errors, or low concentrations of DNA template (LaVerriere et al. 2022). The other aspect that it can be sensitive next time is the volume and density of samples loaded into the wells to enhance homogeneity. Another suggested enhancement could be to revisit the annealing temperature used in the PCR procedure because those extra bands may have arisen from low specificity in the primers.

Conclusion

The case has yielded a definitive malaria diagnosis since the patient was seen to harbor Plasmodium species through BLAST analysis and PCR amplification. The results suggest that the symptoms of this patient suggest exposure to this pathogen probably through traveling or through contact with the vector, the mosquito. Due to the molecular diagnostic methods, the pathogen was isolated, and specific treatment was provided. For some issues, the answers to such questions as what specific type of Plasmodium has affected the patient and whether the patient may simultaneously be infected with other pathogens or has become immune to some antimalarial preparations. This case is valuable because it stresses the need for concomitant microscopy and molecular analysis for pathogen identification. Post-treatment evaluation is important especially to assess the patient's response to antimalarial chemotherapy and confirm the clearance of the malaria parasite. Besides, any resistance to a drug should be studied further in order to modify the treatment regimen if needed.

Recommendations

The further procedures in this case include localization of specific Plasmodium strains by employing more sensitive molecular biology methods, such as polymerase chain reaction. This would also assist in determining any dormant drug resistance which is so vital for the formulation of the treatment plan. Further, the patient should have regular blood test checkups in order to monitor the success of elimination of the parasites and to avoid relapse of the disease. The follow-up should also involve enquiring about places the patient might have been in order to establish whether there are infectious sources such as mosquito-infested areas that may require control and or whether the patient needs chemoprophylaxis. When there is suspected resistance, drug sensitivity should be carried out for the adjustment of the treatment regimens. Thorough documentation of the case would also prove useful in augmenting the body of knowledge and future controlling strategies concerning malaria.

Reference List

Journals

• Achan, J., Serwanga, A., Wanzira, H., Kyagulanyi, T., Nuwa, A., Magumba, G., Kusasira, S., Sewanyana, I., Tetteh, K., Drakeley, C. and Nakwagala, F., 2022. Current malaria infection, previous malaria exposure, and clinical profiles and outcomes of COVID-19 in a setting of high malaria transmission: an exploratory cohort study in Uganda. The Lancet Microbe, 3(1), pp.e62-e71.
• Cairns, M., Ceesay, S.J., Sagara, I., Zongo, I., Kessely, H., Gamougam, K., Diallo, A., Ogboi, J.S., Moroso, D., Van Hulle, S. and Eloike, T., 2021. Effectiveness of seasonal malaria chemoprevention (SMC) treatments when SMC is implemented at scale: case–control studies in 5 countries. PLoS medicine, 18(9), p.e1003727.
• Cairns, M.E., Sagara, I., Zongo, I., Kuepfer, I., Thera, I., Nikiema, F., Diarra, M., Yerbanga, S.R., Barry, A., Tapily, A. and Coumare, S., 2020. Evaluation of seasonal malaria chemoprevention in two areas of intense seasonal malaria transmission: secondary analysis of a household-randomised, placebo-controlled trial in Houndé District, Burkina Faso and Bougouni District, Mali. PLoS medicine, 17(8), p.e1003214.
• Elven, J., Dahal, P., Ashley, E.A., Thomas, N.V., Shrestha, P., Stepniewska, K., Crump, J.A., Newton, P.N., Bell, D., Reyburn, H. and Hopkins, H., 2020. Non-malarial febrile illness: a systematic review of published aetiological studies and case reports from Africa, 1980–2015. BMC medicine, 18, pp.1-17.
• Kotepui, M., Kotepui, K.U., De Jesus Milanez, G. and Masangkay, F.R., 2020. Plasmodium spp. mixed infection leading to severe malaria: a systematic review and meta-analysis. Scientific Reports, 10(1), p.11068.
• Kotepui, M., Kotepui, K.U., Milanez, G.D.J. and Masangkay, F.R., 2020. Prevalence and risk factors related to poor outcome of patients with severe Plasmodium vivax infection: A systematic review, meta-analysis, and analysis of case reports. BMC Infectious Diseases, 20, pp.1-14.
• LaVerriere, E., Schwabl, P., Carrasquilla, M., Taylor, A.R., Johnson, Z.M., Shieh, M., Panchal, R., Straub, T.J., Kuzma, R., Watson, S. and Buckee, C.O., 2022. Design and implementation of multiplexed amplicon sequencing panels to serve genomic epidemiology of infectious disease: a malaria case study. Molecular Ecology Resources, 22(6), pp.2285-2303.
• Mousa, A., Al-Taiar, A., Anstey, N.M., Badaut, C., Barber, B.E., Bassat, Q., Challenger, J.D., Cunnington, A.J., Datta, D., Drakeley, C. and Ghani, A.C., 2020. The impact of delayed treatment of uncomplicated P. falciparum malaria on progression to severe malaria: a systematic review and a pooled multicentre individual-patient meta-analysis. PLoS medicine, 17(10), p.e1003359.
• Phyo, A.P., Dahal, P., Mayxay, M. and Ashley, E.A., 2022. Clinical impact of vivax malaria: A collection review. PLoS Medicine, 19(1), p.e1003890.
• Wilairatana, P., Masangkay, F.R., Kotepui, K.U., Milanez, G.D.J. and Kotepui, M., 2021. Prevalence and characteristics of malaria among COVID-19 individuals: A systematic review, meta-analysis, and analysis of case reports. PLoS neglected tropical diseases, 15(10), p.e0009766.
• Yimam, Y., Nateghpour, M., Mohebali, M. and Abbaszadeh Afshar, M.J., 2021. A systematic review and meta-analysis of asymptomatic malaria infection in pregnant women in Sub-Saharan Africa: a challenge for malaria elimination efforts. PLoS One, 16(4), p.e0248245.

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