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    30 December 2018, Volume 36 Issue 6
    Orginal Article
    Prevalent history and discovery of schistosomiasis in Jiangxi Province--At the 60th anniversary of the publication of Chairman MAO Ze-dong’s poem Farewell to the God of Plague
    Jun GE, Dan-dan LIN
    2018, 36(6):  545-551. 
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    Jiangxi Province used to be one of the heavily endemic provinces with schistosomiasis in China. The disease has been prevailing in Jiangxi for a long history and was a serious burden to public health and the social-economic development in endemic areas. In recent years, more attention has been paid to the prevalence and control of schistosomiasis from the perspective of disease history research. In this paper, the discovery endemic history of schistosomiasis in the Province was systematically reviewed through searching historical literatures and modern medicine references, providing the evidence for further research on the history of schistosomiasis in Jiangxi Province.

    Treatment of complicated hepatic alveolar echinococcosis: our experience of 98 cases
    Xiao-lei XU, Zhi-xin WANG, Zhan WANG, Hai-wen YE, Ming-quan PANG, Ying ZHOU, Hai-jiu WANG, Hai-ning FAN
    2018, 36(6):  552-559. 
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    ObjectiveTo explore the clinical treatment strategies for complicated hepatic alveolar echinococcosis and summarize treatment experiences. Methods A retrospective analysis was made on patients with complicated hepatic alveolar echinococcosis admitted to the Affiliated Hospital of Qinghai University from October 2015 to October 2017. According to the distribution of lesions, patients with advanced or mid-stage echinococcosis.were included in the study. Patients with hepatic cystic echinococcosis, early hepatic alveolar echinococcosis, and those treated with albendazole alone were excluded. According to the treatment design, they were divided into the quasi-radical surgical resection group (61 cases), the palliative surgical resection group(29 cases), and the liver transplantation group(8 cases). The operation duration, intraoperative blood loss, postoperative complications, and recurrence during follow-up were analyzed. Data were analyzed with SPSS 20.0. Results Ninety-eight patients were included in the study, including 40 males and 58 females (male to female ratio of 1 : 1.45). The patients aged 5 to 72 years, with an average age of 38 years. The incidence of postoperative complications in the quasi-radical resection group was 55.7% (34/61), including 18 cases of hypoproteinemia accompanied by pleural effusion, 9 with lung infection, 3 with incision infection, and 4 with bile leakage; the recurrence rate was 14.8% (9/61), and 3 died during follow-up. The incidence of postoperative complications in the palliative surgical resection group was 41.4%(12/29), including 5 with bile leakage complicated by residual cavity infection, 3 with pulmonary infection with pleural effusion, 2 with obstructive jaundice, 1 with incision infection, and 1 with bile duct-bronchial leak; the postoperative recurrence rate was 17.2% (9/29), and 3 died during follow-up. There was no significant difference in the postoperative complication incidence or recurrence rate between the quasi-radical resection group and the palliative resection group (P > 0.05), but a significant difference was found in the operation duration and blood loss (P < 0.05). Among the 8 patients who received liver transplantation, 4 died with 1 due to multiple organ failure after acute rejection, 2 gastrointestinal bleeding due to coagulopathy, and 1 hepatorenal syndrome, and the remaining 4 patients had long-term survival. Conclusion The treatment protocol for complicated hepatic alveolar echinococcosis needs to be individualized, in combination with multidisciplinary and highlighting damage control during surgery, in order to maximize patients' benefits.

    Endemic status of echinococcosis in Inner Mongolia Autonomous Region from 2011 to 2017
    Jian SONG, Ying-xin PEI, Wei-dong GUO, Xiao-feng JIANG, Li-ying WANG
    2018, 36(6):  560-564. 
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    Objective To understand the endemic status and characteristics of echinococcosis in Inner Mongolia Autonomous Region from 2011 to 2017 so as to provide evidence-based information for formulating control strategies and measures. Methods Data of echinococcosis endemic in Inner Mongolia from 2011 to 2017 were collected from the China Infectious Disease Reporting Information Management System of China CDC and analyzed by using SPSS 20.0. The map of case distribution was drawn using QGIS 3.4.2. Results Totally 543 cases of echinococcosis were reported in the Region from 2011 to 2017 with 117, 89, 69, 81, 62, 62 and 63 cases reported for each year, respectively. The reported incidence decreased yearly from 0.48/100 000 in 2011 to 0.25/100 000 in 2017. A total of 25 endemic counties of echinococcosis were identified in the Region. 397 of 543 reported cases were indigenous cases in these endemic counties, accounting for 73.11%. The reported cases covered 74 counties of 12 prefectures (cities) in the whole region. The highest case incidence was reported in Xilingol and Alxa Leagues with 5.14/100 000 and 2.42/100 000, respectively. Among the 543 cases reported 255 were males and 288 females with average annual incidence of 1.97/100 000 and 2.41/100 000, respectively. The difference of incidence between males and females was statistically significant (P < 0.05). The average age of reported cases was 48 years old with highest cases reported in the 40s age group (128, 31.50%). Most cases fell into the age group from 30-59 years old, accounting for 74.03% of the total reported cases (402/543). Among the reported cases, 192 were herdsmen, 131 peasants and 111 housewives and unemployment, accounting for 35.36%, 24.13% and 20.44%, respectively. Conclusion The distribution of echinococcosis cases in Inner Mongolia Autonomous Region is sporadic, mainly in pastoral, semi-pastoral and semi-agricultural areas. Women, young and middle-aged people and herdsmen are the high-risk groups of the disease.

    Prevalence of echinococcosis in Tacheng Prefecture, Xinjiang Uygur Autonomous Region, China
    Adalaiti·Tuoliuhan, Mangeguli·Hatimulati, Ahelijiang·Kayiduola, Halinuer·Rexiti, Ajiguli·Rehemutu, Qin-yan WANG, Xi-ling DANG, Abulaiti·Abudoukailimu
    2018, 36(6):  565-570. 
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    Objective To determine the endemic status and prevalence of Echinococcus granulosus in Tacheng endemic area. Methods Residents with age of 6 years old and above were randomly selected from 6 cities or counties (Tacheng, Wusu, Emin, Shawan, Tuoli, Yumin and Hefeng) in Tacheng Prefecture, Xinjiang Uygur Autonomous Region, for the epidemiological investigation of echinococcosis during 2015-2017. The participants were examined with abdominal ultrasound, sera were collected for detecting anti-E. granulosus IgG by ELISA. The fecal samples of dog were collected to detect E. granulosus antigen using double antibody ELISA. The infection of E. granulosus in livestock was determined by examining cystic hydatid in the viscera of slaughtered livestock sheep. The prevalence of E. granulosus in human, dog and livestock in these areas was statistically analyzed. Results The general prevalence of hydatid disease in Tacheng residents was 0.25% (912/277 615) during 2015-2017, with an increasing trend year by year [0.15% (131/84 882) in 2015, 0.23% (238/101 509) in 2016 and 0.34% (314/91 224) in 2017] with statistical difference by year (P < 0.05). All 7 investigated cities or counties were endemic with E. granulosus, with highest prevalence in Hefeng (0.56%, 65/11 606) with statistical difference compared to other endemic areas(P < 0.01). There was no statistical difference on the prevalence of E. granulosus between males (0.24%, 345/141 584) and females (0.25%, 338/136 031)(P > 0.05). Participants of 50-59 years-old showed the highest infection rate of 0.35%(113/31 843) with statistical difference to other age groups (P < 0.01). Farmers had the highest infection rate (0.41%, 365/88 411) with statistic difference to other occupations (P < 0.01). Totally 18 560 serum samples were collected from children for antibody test and 190 were positive for anti-E. granulosus IgG with a positive rate of 1.02%, and showing an increasing trend yearly [0.60% (49/8 167) in 2015, 0.71% (43/6 034) in 2016 and 2.24% (98/4 359) in 2017] (P < 0.01). Children in Hefeng had the highest serological IgG positive rate of 3.16%(60/1 900)compared to other areas(P < 0.01). Total 34 343 dog fecal samples were examined for E. granulosus antigen with a positive rate of 1.04% (356/34 343). The highest rate of fecal antigen was identified in 2016 (1.71%, 206/11 824) compared to other years (P < 0.01). The dog fecal antigen was identified in all areas with highest rate in Hefeng (3.16%, 98/3 100)(P < 0.01). 4 008 sheep were examined for cystic hydatid with an average positive rate of 1.05% (42/4 008), with the highest rate in 2015 (1.67%, 30/1 800)(P < 0.01). Conclusion The infection of E. granulosus remains low prevalent in Tacheng Prefecture, but shows an increasing trend from 2015 to 2017 based on the infection rate in residents, antibody positive rate in children and the antigen positive rate in dog fecal sample.

    Modified culture of germinal cells released from the digested cyst walls debris of Echinococcus granulosus hydatids from mice
    Kai LI, Hong-ye WU, Jun-jie FAN, Fen WANG, Xu-nuo LIU, jing ZHANG, Bin YE
    2018, 36(6):  571-577. 
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    Objective To establish a more effective and economical method for primary culture of germinal cells released from Echinococcus granulosus hydatid cyst walls. Methods The cyst walls of E. granulosus hydatids isolated from the abdominal cavities of infected mice were digested with 0.25% trypsin-EDTA solution for 10, 20 and 30 minutes, respectively, the digested cyst walls debris were then primarily cultured using the regular debris-adherent culture method. The undigested cyst walls were cultured using the same adherent method as control. The growth of germinal cells was observed under an inverted microscope for their dynamic features of cell morphology and growth curve. The germinal cells were recognized by the serum from a patient with hydatidosis using immunofluorescence assay. To confirm the successful generation of E. gramulous germinal cells, the cultured cells were used to inoculate naive mice to observe the generation of hydatids 4 months after inoculation. Results The germinal cells in the cyst wall debris digested for 10 minutes were intact and full of cytoplasm. Plenty of germinal cells were grown and outreached from the edges of debris 2-4 days after being cultured and the colony-like growth of germinal cells was found 9 days post culture. However, the germinal cells in the cyst wall debris digested for 20 minutes or 30 minutes were mostly broken with naked nuclei observed. The success rate for the generation of germinal cells from the digestion-adherent culture method with digestion for 10 minutes (6/10) was higher than that generated from the direct adherent culture method (3/10). The growth curves of both methods were similar, with a “S” growth pattern. The average culture period for the generation of germinal cells from the hydatid cyst walls using the digestion culture method was 18 days. The proliferation level of germinal cells released from the digested cyst walls debris was higher than that released from the direct adherent culture (P < 0.01). The generated germinal cells from the digested culture for 18 days could be recognized by the serum from a patient with hydatidosis. The germinal cells collected from the digested culture were able to infect normal mice with cystic vesicles generated in the abdominal cavities of the mice inoculated with the culture cells in 4 months. HE staining of the cyst sections showed that the generated cysts contained the developing laminated layer and the germinal layer observed under microscope. Conclusion The modified adherent culture method of cyst wall with 0.25% trypsin-EDTA digestion for 10 minutes generated higher rate of germinal cells with ability to infect mouse.

    Dynamic changes of lymphocyte differentiation and programmed cell death protein ligand 1 expression in mice infected with Schistosoma japonicum
    Xiao-ling WANG, Yuan HU, Yu-xin XU, Hua LIU, Jian-ping CAO
    2018, 36(6):  579-585. 
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    Objective To evaluate the effect of Schistosoma japonicum infection on the lymphocyte differentiation and the programmed cell death protein ligand 1 (PD-L1) expression in infected mice. Methods Thirty BALB/c mice were randomly divided into infected group and uninfected groups. Mice in infected group were each infected with 20 ± 2 cercariae through abdominal skin. Three mice from each group were euthanized before infection and 2, 4, 6, 8, 10 weeks after infection and the lymphocytes were isolated from livers and spleens. The dynamic changes of the lymphocyte proportions for CD3+ T cells (CD3+CD19-), CD19+ B cells (CD3-CD19+), CD4+ T cells (CD3+CD19-CD4+CD8-) and CD8+ T cells(CD3+CD19-CD4-CD8+) and PD-L1 expression on these subset cells were detected by flow cytometry. The differences between groups were statistically analyzed by ANOVA test. Results Both in liver and spleen, the lymphocyte populations of CD3+ T cells, CD19+ B cells and CD4+ T subsets, decreased significantly in mice infected with S. japonicum for 4-8 weeks compared to the populations before infection (P < 0.05, 0.01 or P > 0.05). However, in livers of mice infected with S. japonicum, the population of CD8+ T cell subset at 6 week [(38.03 ± 7.41)%] after infection was significantly higher than uninfected group [(23.37 ± 3.98)%](P < 0.01), but no significant change in spleen. More interestingly, the expression of PD-L1 on CD19+ B cells at 6 week [(7.25 ± 3.47)%] after infection with S. japonicum was significantly inhibited compared with the uninfected group [(22.77 ± 8.90)%] (P < 0.01) while the changes in spleen was later than that in liver, at 8 week[(22.37±4.01)%] after infection was significantly inhibited compared with the uninfected group[(51.97 ± 1.62)%] (P < 0.01) and remained at low level thereafter, in both liver and spleen. The expression of PD-L1 on CD3+ T and CD4+ T cells in liver during 2 to 10 weeks (P < 0.05, 0.01 or P > 0.05) and in spleen during 4 to 8 weeks after infection was lower than that of the uninfected group (P <0.05). The expression of PD-L1 on CD8+ T cells in both liver and spleen was not changed at the early infection stage, but increased significantly at 10 weeks [(34.80 ± 3.68)%, (31.90 ± 2.53)%] after infection compared to the level before infection [(25.5 ± 0.80)%, (29.91 ± 3.55)%] (P < 0.01). Conclusion The lymphocyte proportion of CD19+ B, CD3+ T and CD4+ T cells were induced to decrease significantly in livers and spleens of mice infected with S. japonicum, however, the change in CD8+ T cell proportion was not significant in comparison to the level before infection. Similar trend was observed in PD-L1 expression on these lymphocyte subsets with significant decrease on CD19+ B, CD3+ T and CD4+ T lymphocytes, but significant increase on CD8+ T cells at later infection stage. These changes of lymphocytes in liver occur earlier than that in spleen.

    Epidemiological analysis on the imported cases of schistosomiasis in Zhejiang Province during 1996-2017
    Jian-feng ZHANG, Xiao-lan YAN, Li-yong WEN, Xiao ZHANG, Li-ling YU, Hai-juan DU, Ming-jin YANG
    2018, 36(6):  586-592. 
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    Objective To analyze the dynamic change and the factors that effect on the imported schistosomiasis case since the disease transmission blocking criteria have been met in Zhejiang Province in 1995. Methods Data for the imported case of schistosomiasis and snail investigation in Zhejiang Province from 1996 to 2017 were collected and analyzed retrospectively for the case distribution, diagnosis, treatment and for snail ridden area. Results Totally 245 cases of imported schistosomiasis were reported in 30 counties in Zhejiang Province from 1996-2017, including 41 cases of acute Schistosoma japonicum infection. Among them, 241 cases were imported from other provinces in China, mainly from neighboring Jiangxi (37.3%, 90/241) and Anhui (29.9%, 72/241). Four of them were imported from Nigeria in Africa including 3 cases of S. haematobium and 1 case of S. mansoni infections. The number of imported cases was increased in the years before 2005 with up to 40 cases in 2005, and then gardually to decreased. More cases were reported in the second half of each year (80.8%, 198/245). The imported cases were reported in total 30 counties (cities, district) in the province, most of them (230) were reported in 25 counties in the 8 historially endemic cities, and Ningbo had the largest number of imported cases (55.9%, 137/245) followed by Hangzhou (18.4%, 45/245) and Quzhou (6.9%, 17/245). Among the total 245 cases, 180 were males and 65 females. More cases were found in those with low education (29.8% with primary school and 49.4% with junior high school) and with blue collar occupations (farmers 42.0%, workers 23.3%) and in students (14.7%). Of the 241 cases imported from other provinces, 85.1% (205/241) cases were infected from uncontrolled or re-emerging endemic areas. Most cases were infected by the contact with contaminated water during swimming (37.1%) or agricultural practices (36.3%). More cases were identified by active monitor of local disease control authorities (51.4%, 126/245) than in clinics (48.6%, 119/245). 59.6% of the cases seeked for medication at the first time at the local county hospitals and 49.6% of them(59/119)was misdiagnosed. Snail was found in 30 formally endemic counties with a total area of 1 739.0 hm2. Conclusion The total 245 cases of imported schistosomiasis have been reported in Zhejiang Province through active monitoring and passive reporting system from 1996 to 2017. The number of cases has decreased since 2005. The main sources of the imported cases are from the uncontrolled or re-emerging areas of schistosomiasis in the country.

    Infection of Spirometra mansoni plerocercoid in snakes from Shanghai Zoo
    Yan LU, Jia-xu CHEN, Hao LI, Yu-chun CAI, Lin AI, Yan-hong CHU, Peng SONG, Shao-hong CHEN
    2018, 36(6):  593-596. 
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    Objective To investigate the infection status of plerocercoid in snakes from Shanghai Zoo in order to provide information for the prevention and treatment of sparganosis. Methods Thirty snakes were provided from Shanghai Zoo and dissected in 2017. The plerocercoids were collected from the snakes, the number of plerocercoids and their location were recorded. The structure of plerocercoid was examined under microscope after being Carmine stained. The total DNA was extracted from the plerocercoids and the DNA fragments for cytochrome c oxidase subunit 1 (cox1) and cytochrome b (cytb) genes were amplified by PCR. The amplified PCR products were sequenced and analyzed. Results The infection rate of plerocercoid in the snakes was 86.7% (26/30) with total 626 plerocercoids found, with an average intensity of infection of 24.1 plerocercoids per snake. The infection rate in snake Elaphe carinata and Zaocys dhumnades was 50.0% (3/6) and 95.8% (23/24), with the average intensity of infection of 1.3 and 27.0 plerocercoids per snake, respectively. Muscular tissue was the most common parasitizing location for the plerocercoids, accounting for 52.9% (331/626). The isolated worms were in accordance with Spirometra mansoni plerocercoids in morphology. The PCR amplified product of cox1 gene was about 470 bp and cytb gene was about 1 400 bp, respectively, sharing 96.4%~100% (cox1) and 97.8%~100% (cytb) sequence identity among the 26 samples. In comparison with the different tapeworm sequences in GenBank, it was found that the amplified cox1 and cytb gene sequences in the plerocercoids were highly homologous to those of S. erinaceieuropaei (99.8%~100%, GenBank Accession No. KP738288, AB374543) and less homologous to other species of tapeworm. Conclusion The snakes collected from Shanghai Zoo are widely infected with S. mansoni plerocercoids, indicating that they can be the infection source of human sparganosis.

    Contamination of Cryptosporidium and Giardia lamblia in water from Binyang County and Lingshan County in Guangxi
    Sheng-kui CAO, Yan-yan JIANG, Zhong-ying YUAN, Meng XU, Jian-ping CAO, Yi-chao YANG, Yu-juan SHEN
    2018, 36(6):  597-601. 
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    ObjectiveTo investigate the contamination of Cryptosporidium and Giardia in water from Binyang County and Lingshan County in Guangxi Zhuang Autonomous Region. Methods Standard quality-control samples were used to compare the recovery rate of Cryptosporidium oocyst and Giardia cyst by calcium carbonate flocculation method and that by membrane filtration, with reference to the National Standard Method. In addition, water samples from 10 tap water suppliers in Binyang (suppliers A, B, C, D and E) and Lingshan (suppliers F, G, H, I and J) counties were collected in 2016 and 2017, including water flowing into and out from the suppliers. Calcium carbonate flocculation method was used to concentrate Cryptosporidium oocysts and Giardia cysts in water flowing into the suppliers, while membrane filtration was used to concentrate Cryptosporidium oocysts and Giardia cysts in water flowing out from the suppliers. Immunomagnetic separation and immunofluorescence staining were then performed to detect the two types of parasites in water, and their densities were calculated. Results The recovery rates of Cryptosporidium oocyst and Giardia cyst in standard quality control samples using calcium carbonate flocculation were 48.5% and 52.0%, respectively, and those by membrane filtration were 35.0% and 36.5%, both performed better than the National Standard Method(15.0% and 16.0%) (calcium carbonate flocculation vs. Standard Method:χ2 = 26.007, 28.877, P < 0.01; membrane filtration vs. Standard Method:χ2 = 8.167, 11.019, P < 0.01). In addition, 10 tap water suppliers were selected, from each of which 2 water samples flowing into and 2 water samples flowing out were collected. The densities of Cryptosporidium oocysts in the water sample flowing into supplier A, water samples flowing into and out from supplier B, and water samples flowing out from suppliers C and F were 4.0/10 L, 10.0/10 L, 0.6/10 L, 2.9/10 L and 5.1/10 L, respectively. The density of Giardia cysts in water sample flowing out from suppliers F was 9.3/10 L. No Cryptosporidium or Giardia was detected in other water samples. Conclusion There are certain contaminations of Cryptosporidium and Giardia in water flowing into or out from water suppliers in Binyang and Lingshan counties. Monitoring on the contamination in rural areas should be strengthened.

    Epidemiological characteristics of malaria in Xinzhou District of Wuhan City from 2001 to 2016
    Yong-feng HU, Li-ping LIU, Min LI, Shuang XIA, Lu-juan QIU
    2018, 36(6):  601-604. 
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    A total of 90 confirmed cases of malaria were reported in Xinzhou District of Wuhan City during 2001-2016. There were no second-generation cases or deaths. Among them, 85 were males (94.4%) and 5 were females (5.6%). Most of the cases (87/90, 96.7%) aged 18 to 59 years. The cases consisted of 61 (67.8%) with falciparum malaria, 23 with vivax malaria (25.6%), 3 with ovarian malaria (3.3%), 2 with quartan malaria (2.2%), and 1 unclassified case (1.1%). There were 17 indigenous cases (18.9%), 2 imported cases from other provinces (2.2%), and 71 imported cases from other countries (78.9%). No indigenous case was found since 2009. Thirty-three cases were of the initial onset (36.7%) and 57 cases had a malaria history (63.3%). Fourteen cases had severe clinical symptoms (15.6%), 42(46.7%) with moderate symptoms, and 34 (37.8%) with mild symptoms.

    Morphological characteristics of Triatoma rubrofasciata at different developmental stages
    Li-zhen XIAO, Zhu-yun CHEN, Rong OUYANG, Xian-liang XIE, Han-guo XIE
    2018, 36(6):  605-610. 
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    Objective To describe and compare the morphological characteristics of Triatoma rubrofasciata at different developmental stages. Methods Adult T. rubrofasciata were captured and fed to obtain eggs and nymphs, which were then observed under a dissecting microscope to measure egg length, egg middle width, egg lid width, and egg lid middle height. For nymph and adult T. rubrofasciata, the following were measured: body length, head length, head width, length of anteocular part, length of postocular part, distance between ommateums, distance between ocelli, length of antennal joints, length of rostral segments, length of pronotum, length of anterior lobe of pronotum, length of posterior lobe of pronotum, maximum width of throax, maximum width of abdomen and length of forewing bud/hemelytron. Morphological comparisons were made between the adult T. rubrofasciata observed in this study and those of Panstrongylus, Rhodnius, and Triatoma sinica recorded in Medical Entomology and Chinese Bug Identification Manual. Results The life history of T. rubrofasciata includes egg, nymphⅠ-Ⅴ and adult stages. The eggs had a long oval shape, sized 1.838 mm × 0.976 mm on average, with an egg lid. The eyespot emerged in the late development stage. The body length increased from nymph to adult stage, being 2.546 mm, 4.834 mm, 7.127 mm, 10.258 mm, 17.062 mm and 21.787 mm at nymphⅠ-Ⅴ and adult stages, respectively. The wing buds grew out at nymph Ⅲ and then elongated gradually, which finally developed into wings at the adult stage. The average lengths of forewing bud/hemelytron from nymphⅢ to adult were 0.584 mm, 1.261 mm, 3.832 mm and 13.359 mm, respectively. The ocelli did not develop from nymphⅠ to nymphⅣ, showed a trace at nymphⅤ and finally developed into ocellus pair at adult. T. rubrofasciata could be differentiated from the genera of Panstrongylus and Rhodnius based on the shape of the head and the location of the antennae. The T. rubrofasciata had a moderate head length, and antennas between eyes and the clypeus. In contrast, the Panstrongylus had a thick and short head, and antennas located rightly ahead of the eyes. The Rhodnius had a narrow and long head and antennas located at the anterior region of the head, close to the clypeus. T. rubrofasciata could be differentiated from T. sinica based on the presence of particles on the head and the pronotum, and the morphological characteristics of the front angles of the pronotum and the angulus parielis of the scutel. For T. rubrofasciata, there were many particles on the head and the pronotum. The front angles of the pronotum were long and the angulus parielis of the scutel was needle-like. For T. sinica, there were no particles but wrinkles on the head and the pronotum. The front angles of the pronotum were short and the angulus parielis of the scutel did not appear needle-like. Conclusion The T. rubrofasciata had distinct morphological characteristics at different developmental stages. The morphological characteristics of adult T. rubrofasciata can be differentiated from those of Panstrongylus and Rhodnius genera as well as T. sinica.

    Epidemiological survey of soil-transmitted helminth infections in Fujian Province in 2015
    Chen-xin LIN, Han-guo XIE, Rong-yan ZHANG, Dian-wei JIANG, Xian-liang XIE
    2018, 36(6):  611-615. 
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    Objective To understand the endemic status of soil-transmitted helminth (STH) infections in Fujian Province so as to provide evidence-based information for the better prevention and control. Methods An epidemiological survey was performed in pilot sites selected by stratified cluster random sampling method based on the ecological zone, economic level and geographic location in Fujian Province from 2014 to 2015. The modified Kato-Katz thick smear method was used to examine fecal samples in duplicate to detect eggs of STH. The Enterobius vermicularis infection in children under 12 years old was examined using an anal tape test. The chi-square test was used to determine the statistical difference in infection rates between different population and areas. Results The fecal examination was performed in total 17 090 people from 63 pilot study sites in 25 counties, Fujian Province. Among them 560 people were found to be infected with STH’ with average infection rate of 3.28%. The prevalence of STH has been reduced by 95.76% compared with the infection rate of 77.30% (41 290/53 416) in the first province-wide survey in 1992 and by 90.89% compared to the second survey performed in 2003 (36.01%, 7 300/20 195). Among the three STH, hookworm had the highest infection rate in the investigated population (3.03%, 518/17 090), followed by infections of Trichuris trichiura (0.20%, 34/17 090) and Ascaris lumbricoides (0.05%, 8/17 090). Regarding the infection location, the infection rate of STH in Sanming area was among the highest (9.21%, 154/1 673), and Ningde was among the lowest (0.20%, 3/1 514). The prevalence in female people was 3.72% (325/8 728), which was higher than 2.81% (235/8 362) in males with statistical difference (χ2 = 11.24, P < 0.01). The prevalence of STH infection in the areas of Zhejiang/Fujian Mountain Ecological Zone was 3.52% (271/7 701), which was not statistically different (χ2 = 2.60, P > 0.05) compared to the prevalence in the areas of Yunnan/Guangxi/Guangdong/Fujian Mountain Ecological Zone. Generally, the prevalence of STH infections in different age groups increased with age, with the lowest infection rate in children of 3-9 years old (0.43%, 9/2 076) and the highest infection rate in old people of 60-69 years old (7.34%, 180/2 453) (χ2 = 314.64, P < 0.01). The farmers had the highest infection rate of 4.33% (524/12 095) compared with other occupations with statistical significance (χ2 = 151.02, P < 0.01). The prevalence of STH was higher in people with primary school education only (4.09%, 322/7 875) compared with people with higher education level (χ2 = 48.00, P < 0.01). A total of 3 472 children under the age of 12 were examined for E. vermicularis infection and 205 people were found to be positive with a infection rate of 5.90%. Conclusion The infection rate of soil-transmitted helminthes in Fujian Province has continuously declined since the first survey in 1992, and it is at a low prevalence level. However, farmers and the elderly are the key groups of people that need more attention to pay for the prevention and control of STH. Hookworm is the major STH that infects people in the Province and children is still vulnerable to the infection of E. vermicularis.

    Epidemiological characteristics of imported malaria in Jinhua City during 2015-2017
    Zhi-feng PANG, Han-ying GONG, Xiao-jun LUO, Guang-ming ZHANG, Meng-an CHEN, Hui-ling TANG
    2018, 36(6):  615-618. 
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    A total of 179 imported malaria cases were reported in Jinhua City during 2015-2017, comprising 149 falciparum malaria cases, 13 vivax malaria cases, 11 ovale malaria cases, 3 quartan malaria cases and 3 mixed infections. The place of infection source was predominated by Sub-Saharan African countries. Cases distributed in all the 9 counties/districts of the city, of which Yiwu ranked top in the number of cases (105, 58.7%). The cases were mostly young males, working mainly in commercial services and as migrant workers. About half of the cases had been infected by malaria during their stay abroad, but only one third of them received standard treatments. Clinically, most of the cases were stable, only 10 showed severe conditions. All recovered after standard treatment. The initial misdiagnosis rate was 32.40% (58/179), which was higher in township health centers (61.5%, 8/13) and private clinics (97.1%, 34/35). The median intervals from onset to primary diagnosis, primary diagnosis to confirmation, onset to confirmation, and confirmation to medication were 1, 1, 3 and 0 days, respectively.

    In vitro effects of Fasciola gigantica excretory-secretory products on human LO2 hepatocytes
    Wen-ping ZHAO, Xue-fang MEI, Wei SHI, Bin ZHU, Lin-jing HOU, Wei-yi HUANG
    2018, 36(6):  619-624. 
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    Objective To investigate the effect of Fasciola gigantica excretory-secretory products (FgESP) on the proliferation of LO2 hepatocytes and biochemical components related to hepatocyte injury in vitro. Methods LO2 cells were plated in a 96-well plate at 5 densities(1 000, 3 000, 5 000, 7 000 and 10 000 cells/well) while the blank control group was only added with culture medium. The growth curve was plotted to determine the optimal density for plating. FgESP was added to the wells at concentrations of 0.02, 0.10, 0.20, 0.40, and 1.00 mg/ml and incubated for 4, 8, 12, 24, 48 and 72 h followed by MTT assay. Each group had 4 replicates, and PBS was used as the negative control. Absorbance A490 was measured in a microplate reader. In a 24-well plate, FgESP was added to the wells at concentrations of 0.02, 0.10, 0.20, 0.40, and 1.00 mg/ml and incubated for 4, 8, 12, 24, 48 and 72 h, the supernatant was then collected to assess the levels of phosphomonoesterase (ALP), alanine transaminase (ALT), glutamic oxalacetic transaminase (AST) and albumin (ALB). Each group had 3 replicates, and PBS was used as the negative control. Data were analyzed using GraphPad Prism 6.0 software. Results The optimal cell density was 5 000 cells/well based on the growth curve. After FgESP treatment for 72 h, the A490 values for the five groups with FgESP concentrations of 0.02, 0.10, 0.20, 0.40 and 1.00 mg/ml were 1.29 ± 0.01, 1.28 ± 0.06, 1.13 ± 0.08, 0.97 ± 0.06 and 0.25 ± 0.01, respectively, which were all lower than the control group (1.45 ± 0.05) (P < 0.01). This suggested that FgESP significantly impaired the proliferation of LO2 cells in vitro, in a concentration- and time-dependent manner(P < 0.01). In addition, the contents of ALT in the 0.40 and 1.00 mg/ml FgESP group after 72 h were 2.00 ± 0.00, 3.67 ± 0.58, respectively, and the AST contents were 5.33 ± 0.58, 7.76 ± 0.58, respectively, which were higher than the control group (P < 0.01). The contents of ALT and AST in the 1.00 mg/ml FgESP group after 48 h were 2.00 ± 0.00 and 7.00 ± 0.00, significantly higher than that of control (0.33 ± 0.58, 3.67 ± 0.58 respectively) (P < 0.01). The ALP content significantly increased in comparison with the control within 12-72 hours of FgESP treatment at 0.10, 0.20, 0.40 and 1.00 mg/ml, while at 0.02 mg/ml, FgESP only increased at 72 h(P < 0.01). There was no significant difference in ALB content between the groups (P > 0.05). Conclusion FgESP could inhibit the proliferation of LO2 hepatocytes in vitro, and the extent of inhibition is positively correlated with the concentration of FgESP.

    Epidemiological investigation on Metorchis orientalis infection in endemic villages in Pucheng County, Fujian Province
    Chang-huang CAI, Ming-ying ZUO, Zhi-ping ZHANG, Hui ZHANG, Jian-ping LIAO, Wen-wu YU, Bao-jian CHEN
    2018, 36(6):  624-626. 
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    In order to investigate the endemic status of Metorchis orientalis infection in human, mammals, poultries and fishes, an epidemiological survey was performed in randomly selected 5 endemic villages in Pucheng County during 2016-2017. The modified Kato-Katz thick smear method was applied to examine eggs in fecal samples of villagers with over 3-years old. Fresh water fishes were collected from two ponds around villages of Shuidong and Guanjiu and metacercariae were examined in their muscle. The gallbladders were collected from ducks purchased from local market or from dumped wastes and the adult worms were collected and counted. Fecal samples were also collected from cats and dogs and eggs were examined by precipitation concentration and microscopy. Two ducks were each fed with 15 fish (Pseudorasbora parva). The adult worms were collected from gallbladders of the infected ducks and stained with carmine red. Seven people were found infected with M. orientalis from 1 168 subjects examined. The human infection rate in these villagers was 0.6%, 4 of them are males and 3 females with age ranged from 24-83. 190 metacercariae were identified in 340 collected fishes which belonged to 5 species. The infection rate in fish was 60.1% and the P. parva had the highest infection rate of 90.3% (177/196) with average 62 metacercariae infected. 4 out of 15 home-raised ducks were infected and adult worms were identified in their gallbladders. No infection was identified in total examined 50 gallbladders from ducks sold in the market. One each from 14 cat fecal samples and 30 dog fecal samples were infected with M. orientalis. Ten adult worms were collected from two ducks experimentally infected with metacercariae-infested P. parva. The epidemiological survey demonstrated that M. orientalis is endemic in Pucheng County, which infects human, mammals, ducks and fresh water fishes.

    Cloning and expression of house dust mite allergen Der p 3 and its antigenicity
    Xia GU, Chun-yan OUYANG, Ru-yi YUAN, Xie-fang YUAN, Guo-ping LI, Zhi-gang LIU
    2018, 36(6):  627-631. 
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    Objective To clone and express Der p 3, an allergen from house dust mite Dermatophagoides pteronyssinus, as a recombinant protein for its antigenicity test. Methods The total RNA was extracted from collected D. pteronyssinus and used for reverse transcription into cDNA. The coding DNA for Der p 3 was amplified from the total cDNA by PCR. The PCR products were sequenced and cloned into E. coli expression vector pET-32a by EcoRⅠand XhoⅠsites. The recombinant Der p 3 protein with His-tag was expressed in E. coli Rosetta under induction of 1 mmol/L IPTG and purified with nickel column. The antigenicity of recombinant Der p 3 was tested by Western blotting with sera from patients of asthma allergic to dust mites. The bioinformatics and structure of Der p 3 was analyzed by using BLAST ProtParam PSIPRED SWISS-MODEL and MEGA toolkit. IEBD and DNA Star was used to predict the epitopes of Der p 3 protein. Results The coding DNA for Der p 3 was amplified from D. pteronyssinus total cDNA by RT-PCR. The open reading frame of Der p 3 was 786 bp, encoding 261 amino acids. The recombinant Der p 3 protein was expressed as insoluble inclusion body in E. coli Rosetta under induction of IPTG, with size of Mr 30 000. The inclusion body was solubilized with urea and purified by nickel column chromatography. Western blotting demonstrated that the recombinant Der p 3 was strongly recognized by IgE in sera from dust mite allergic asthma patients, indicating a potential allergen for asthma. Homology analysis revealed that it shared 80% sequence identity with of Der f 3 from D. farina. Structure of Der p 3 protein was stable containing helix, extension chain and random coil. Six immunogenic epitopes were predicted. Conclusion Der p 3 is cloned from house dust mite D. pteronyssinus and expressed as recombinant protein. The expressed recombinant Der p 3 protein can strongly be recognized by IgE in sera from dust mite allergic asthma patients, indicating its potential as an allergen for asthma.

    Application and evaluation of integrative case study in Human Parasitology teaching
    Zhen-sheng WANG, Ying-hong MAO, Chun-yan WEI, Heng WANG
    2018, 36(6):  632-635. 
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    The integrative case study model was established by designing the clinical content related to parasitology teaching and integrating morphology content specified in the syllabus in order to improve the teaching quality of human parasitology. This newly designed integrative case study was applied to the teaching of human parasitology in class of grade 2013 of clinical medicine at Peking Union Medical College. The effectiveness of this teaching model was evaluated by questionnaire. Twenty-two parasitic infection case studies were prepared, covering 50 parasite specimens specified in the syllabus of human parasitology. After using Fasciolopsis buski infection as a teaching demonstration, according to the evaluation results of students’ feedback, the integrative case study teaching mode better integrates the basic medicine and clinical knowledge, boosts students’ interest and motivative in parasitology study and improves their ability to analyze and solve related problems.

    Exploration of molecular mechanisms of artemisinin resistance in malaria parasites
    Yun-shan MOU, Lu-jie LI, Yin-juan WU, Xue-rong LI
    2018, 36(6):  636-642. 
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    Malaria is one of the main infectious diseases threatening human health worldwide. Despite the effective control of malaria spread and reduction of mortality by artemisinin-based combination therapy (ACT), Plasmodium falciparum resistance to artemisinin and ACT is increasingly found in recent years. The present review summarizes the molecular mechanisms of artemisinin resistance in P. falciparum including the roles of genes P. falciparum multidrug resistance 1(Pfmdr1), P. falciparum chloroquine resistance transporter (Pfcrt), P. falciparum calcium ATPase 6(Pfatp6), and Pfkelch13, in order to advance our understanding of molecular mechanisms of artemisinin resistance and provide reference for the control and surveillance of spread of artemisinin-resistant malaria parasites.

    Anti-Plasmodium activity and mechanisms of antimicrobial peptides
    Wen-qi ZHENG, Xiu-lan SU
    2018, 36(6):  643-647. 
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    Antimicrobial peptides (AMPs) consist of a diverse group of small molecular polypeptides that widely exist in organisms and act as an important part of the innate immune system. AMPs can not only effectively kill bacteria, but also kill fungi, viruses, parasites and even tumor cells. It has been proved that antimicrobial peptides can inhibit the growth of different stages of Plasmodium protozoan and no drug tolerance has been identified so far, making it valuable as a novel anti-malaria agent. Currently, a variety of AMPs with anti-malarial activities have been successively isolated and identified. It includes the AMPs that target Plasmodium within erythrocytes such as dermaseptins and their derivatives dermaseptin S3 and dermaseptin S4, cecropin B and its derivatives SB-37 and Shiva-1, Defensin DefMT2, DefMT3 and DefMT5, etc. Those AMPs targeting the sexual stage of Plasmodium mainly include duramycin, melittin, TP10 and Vida1-Vida3. In this paper, the inhibition effects of AMPs on different developmental stages of Plasmodium and the possible mechanisms are reviewed.

    Research progress on extracellular vesicles of helminthes
    Xiao-fan ZHANG, Wen-ci GONG, Yu-juan SHEN
    2018, 36(6):  648-654. 
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    Extracellular vesicles are vesicular bodies secreted by a variety of cells and contain large amounts of biologically active substances such as proteins, lipids and nucleic acids. They are widely involved in intercellular substance exchange and information transmission. Studies have shown that parasites can conduct intercellular communications and transfer a series of biologically active molecules to host cells through extracellular vesicles to regulate the host immune system. This review summarizes the research progress on extracellular vesicles in parasitic helminthes, in order to provide new ideas for the study of extracellular vesicles in the field of parasites.

    Alveolar echinococcosis and immune evasion
    Han-dong LIU, Hong-bing WANG, Hai-ning FAN, Hai-feng NIU, Zhi-xin WANG
    2018, 36(6):  655-660. 
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    Alveolar echinococcosis (AE) is a zoonotic parasitic disease that has a worldwide distribution and seriously threatens human health and husbandry. In recent years, the immune escape mechanism of AE has become a research hotspot. This review is focused on the immune escape mechanisms from perspectives of self-antigen alteration, cytotoxicity, negative immune regulation, alteration of types of immune response, induction of immune cell apoptosis, immunosuppression, and innate immunity and genetic background of the host, in order to provide novel insights into echinococcosis.

    Advances in molecular epidemiology of Cryptosporidium and Giardia lamblia
    Ning XU, Jian-hai YIN, Yu-juan SHEN, Hua LIU, Jian-ping CAO
    2018, 36(6):  661-666. 
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    The infections of Cryptosporidium and Giardia lamblia cause diarrhea mainly and even death in severe cases. Cryptosporidiosis and giardiasis are emerging infectious diseases and the important public health problems that have been neglected and the disease burden is often underestimated. Recently developed molecular biology techniques have played important roles in the detection, genotyping and traceability of these parasitic protozoans. In this paper, the molecular epidemiology of Cryptosporidium and Giardia lamblia is reviewed in order to provide information for the better prevention and control of these infections.

    Research progress on genes related to ecological adaptability of Pomacea canaliculata
    Guang-yao MAO, Yun-hai GUO, Yi ZHANG, Ning XIAO
    2018, 36(6):  666-672. 
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    Pomacea canaliculata is one of the 100 worst invasive alien species disclosed by the International Union for Conservation of Nature and Natural Resources (IUCN), which impairs food agriculture and the stability of aquatic ecosystem of the invaded areas, and acts as an intermediate host of Angiostrongylus cantonensis for disease transmission. This species is difficult to prevent and control once a stable colony is formed, due to the high ecological adaptability and the lack of natural enemy. Research on the mechanisms of the ecological adaptability of P. canaliculata is of great significance for the prevention and control. Compared to other species, research on the functional genes of P. canaliculata is still in the preliminary stage, and the molecular mechanisms of the ecological adaptability are far less studied. In this article we review recent findings on the genes closely related to the mechanisms of the ecological adaptability of P. canaliculata, including heat shock proteins, trehalose synthase, multi-functional enzyme gene, perivitellin-2, and cytochrome P450. These results advance our understanding of the adaptability tendency of P. canaliculata under various environmental conditions such as temperature, food, predator, and molluscicides. Further insightful studies are still needed to reveal the regulatoty mechanisms.

    A case report of Taenia saginata infection in Ninghai County: diagnosis and treatment
    Yi-jiang YU, Jing-jing ZHENG, Bin WANG, Cong-han REN, Min-xia GU, Hai-hong XU
    2018, 36(6):  673-675. 
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    Epidemiological information on the first case of taenia infection in Ninghai County was collected and analyzed. Eggs in the patient feces were founded using saline smear method. The patient was dewormed with areca and pumpkin seeds and the expelled worm was collected for morphological identification. The cytochrome c oxidase 1(cox1) gene was amplified from the worm using PCR. The epidemiological results showed that the patient had no history of travelling out of the living area, but once experienced eating undercooked beef in a hot pot in September, 2017. The patient started to have manifestation of diarrheal and hunger on November 10, 2017. A white, flat and noodle-like segment of worm with 30 cm in length was first observed in the feces 2-weeks later. One more segment with 2 cm long was then seen in feces. The patient went to see a doctor and was diagnosed as taeniasis. The eggs were observed in the fecal sample with an oncosphere inside without membrane. The expelled worm was total 5.32 m in length, with a slim and long anterior part and gradually wide body connected with segments. The scolex was not observed. The gravid proglottids contained 24-28 uterus branches on each side. The morphological examination showed consistency with that of Taenia saginata. A DNA fragment with 832 bp of cox1 were amplified by PCR and the sequence results showed 99%, 96% and 88% identity to cox1 of Taenia saginata, Taenia asiatica and Taenia solium respectively (GenBank accession number: AB107239.1, AB107235.1, AB066485.1). The results confirm that this is a case of Taenia saginata infection.

    Epidemiology of Ascaris infection in rural primary and middle school students in Qingxin District, Qingyuan City
    Wei-qiang LUO, Xue-liang ZHANG, Zhi-shan ZHOU, Jing-hua LI, Xing-ru LI
    2018, 36(6):  676-678. 
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    An epidemiological investigation was performed to understand the prevalence and relevant factors of ascaris infection in primary and middle school students in rural areas of Qingyuan. Thirty rural schools in 8 towns of Qingxin District, Qingyuan City, were selected using stratified cluster random sampling method from 2015 to 2017. The fecal samples were collected from students and examined for Ascaris eggs under microscope using modified Kato-Katz thick smear method. In addition, a survey was conducted on the selected students, parents and teachers for their health habits and behaviors, school environment and parents’ education level by issuing a questionnaire and data were analyzed using a multivariate unconditional logistic regression. Results showed that a total of 116 case with ascaris infection were detected among 3 792 students with an average infection rate of 3.06%. The prevalence of ascaris infection was decreasing over the years with 3.68% (46/1 251) in 2015 to 2.28% (29/1 272) in 2017 with statistical significance(P < 0.05). However, the infection difference between the males (3.11%, 67/2 153) and females(3.24%, 59/1 819) was not statistically significant (P > 0.05). The infection rate in students living in mountain rural area (4.04%, 81/2 005) was higher than those living in suburb rural area (1.78%, 35/1 967) with statistical difference(P < 0.01). Ascaris infection was detected in all age groups with the highest infection rate among students aged 7 to 9 (5.50%, 66/1 201). The infection rate in primary school students (4.28%, 97/2 264) was higher than that in middle school students (1.11%, 19/1 708). The questionnairing demonstrated that the infection rate among students was associated to the factors such as living area, age, personal hygiene habit, home hygiene condition, parents’ education level, school hygiene condition, health education. The investigation reveals a low ascaris infection rate among students in the District, with higher infection rate in students with age of 7-9 and those living in mountainous areas than those living in suburban areas.

    Clinical application of colloidal-gold detection reagent for Plasmodium falciparum in Gabon of Africa
    Chun LIU, ALFRED Ndoumadiamba, Gou GNONDA Mounzie
    2018, 36(6):  679-680. 
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    Peripheral blood was collected from suspected malaria patients in the China-Gabonas Hospital of Libreville in Gabon, from February 2017 to February 2018. The blood samples were examined by the Colloidal-Gold Detection Kit for Plasmodium falciparum antigen. Meanwhile, microscopy was performed as the gold standard to evaluate the sensitivity and specificity of the kit. A total of 120 suspected patients participated in this study, including 50 Chinese cases and 70 local residents. The colloidal-gold method revealed a positive rate for P. falciparum of 50.8% (61/120), while microscopy revealed a positive rate for malaria parasite of 46.7% (56/120), including 52 with P. falciparum, 3 with P. vivax, and 1 with P. ovale. There was no significant difference between the two methods (P > 0.05). The sensitivity and the specificity of the Colloidal Gold Detection Kit were 98.4% and 100%, respectively, indicating a good performance for P. falciparum.