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    30 June 2021, Volume 39 Issue 3
    INVITED REVIEW
    Development of malaria vaccines and the challenges
    CHEN Sui-lin, LIU Tai-ping, XU Wen-yue
    2021, 39(3):  283-295.  doi:10.12140/j.issn.1000-7423.2021.03.001
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    Historically, the ultimate control and elimination of infectious diseases were all attributed to the inoculation of vaccines. For more than 60 years, scientists have never stopped their efforts on developing effective malaria vaccines. Recently, clinical trials on subunit vaccine RTS,S and attenuated sporozoite vaccine have shedded light on production of a safe and effective malaria vaccines. However, there are still many technical and theoretical bottlenecks that hinder the final development of effective malaria vaccine. In this paper, we analyze the problems currently encountered in the malaria vaccine development process from the view point of biological and immunological characteristics ofPlasmodium spp., in the hope to provide clues and directions for the ultimate development of effective malaria vaccines.

    ORIGINAL ARTICLES
    Role of extracellular matrix protein 1 in the liver fibrosis induced by Echinococcus multilocularis infection in mice
    LI Wen-ding, WEN Hao, HOU Jiao, WANG Ming-kun, LI liang, LI Jing, ZHANG Chuan-shan, SUN Bing, WANG Hui
    2021, 39(3):  296-303.  doi:10.12140/j.issn.1000-7423.2021.03.002
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    Objective To investigate the role of extracellular matrix protein 1 (ECM1) in the liver fibrosis of mice infected with Echinococcus multilocularis (Em) by detecting the expression of ECM1 and the relationship with the liver fibrosis process. Methods Forty female C57BL/6 mice were randomly divided into the Em infection group (n = 20) and the control group (n = 20). For the Em infection group, 2 000 Em protoscoleces were collected under aseptic condition and inoculated through hepatic portal vein to establish the Em infection mouse model. Mice in the control group were injected with the same volume of saline in the same way. Liver tissues were collected at 1, 6, 12 and 24 weeks after Em infection. Histopathological changes were observed through hematoxylin eosin (HE) staining. The degree of liver fibrosis was evaluated through Sirius red staining and α-SMA staining. Immunohistochemical assay was performed to detect ECM1 expression in the mouse liver. The correlation between ECM1 expression and the degree of liver fibrosis was analyzed by Pearson post analysis. Results HE staining showed that lesions with obvious germinal layer structure were formed at 6 weeks after Em infection, showing obvious infiltration of inflammatory cells in surrounding tissues, accompanied by proliferation of fibrous tissue. Sirius red staining showed that the percentages of collagen deposition area in the mice liver tissue around the metacestodes lesion at week 1, 6 weeks, 12, and 24 after infection were (6.97 ± 0.07)%, (10.39 ± 0.02)%, (17.31 ± 1.78)%, and (22.24 ± 1.07)%, respectively, which were significantly higher than those in the control group ( P < 0.05). The α-SMA staining showed that the percentages of α-SMA-positive area around the lesion in the Em infection group were (5.31 ± 0.39)%, (9.97 ± 1.3)%, (16.16 ± 0.17)%, and (19.01 ± 0.49)%, respectively, at week 1, 6, 12, and 24 after infection, which were also significantly higher than that in the control group ( P < 0.05). These results indicated that the degree of liver fibrosis around the lesion gradually increased with the duration of Em infection. Immunohistochemical staining of ECM1 showed that ECM1 was mainly expressed in the inflammatory cell band around the lesion The percentages of ECM1-positive area in the Em infection group were (8.60 ± 0.44)%, (13.90 ± 0.57)%, (16.37 ± 0.77)%, and (19.50 ± 0.50)%, respectively, at week 1, 6, 12, and 24 after infection, which were significantly higher than those in the control group ( P < 0.05). Pearson correlation analysis showed that the expression level of ECM1 was positively correlated with the positive area with Sirius red staining ( r = 0.900, P < 0.01) and the percentage of α-SMA-positive area ( r = 0.941,P < 0.01). Conclusion ECM1 expression in the Em infected mouse liver at different time points post-infection was significantly higher than that in control group, and was positively correlated with the degree of liver fibrosis.

    Inhibitory effect of xanthohumol on the growth of Echinococcus multilocularis metacestode in the liver of mice
    TAN Xiao-wu, YU Xiao-fan, JIANG Hui-jiao, XING Zhi-kun, CHEN Xue-ling, WU Xiang-wei
    2021, 39(3):  304-310.  doi:10.12140/j.issn.1000-7423.2021.03.003
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    Objective To explore the inhibitory effect of xanthohumol on the growth of hepatic Echinococcus multilocularis metacestode in mice.Methods Thirty C57BL/6 mice with liver infection of E. multilocularis metacestode 30 d post infection were randomly assigned into the infection group, solvent group, and xanthohumol group (10 mice in each group); a health control group of 10 mice was also set. Mice in the xanthohumol group received weekly intraperitoneal injection of xanthohumol (10 mg/kg), while those in the solvent group were intraperitoneally injected with an equal volume of dimethyl sulfoxide (DMSO). The mice in the health control group and infection group received no any treatment. After 60 days of treatment, the mice of each group were euthanized. The wet weights of liver and the multilocular hydatid cysts in each group were recorded, and the inhibition rate of cyst wet weight was calculated. ELISA was performed to examine the serum content of vascular endothelial growth factor (VEGF) in the mice in each group. The histopathological changes of hepatic multilocular hydatid cysts were observed by HE staining. Immunohistochemistry and Western blotting were used to detect the protein levels of nuclear factor kappa-B P65 (NF-κB P65), VEGF and microvessel density-highly glycosylated type I transmembrane glycoprotein (MVD-CD34) in the hepatic multilocular metacestode tissues in mice, with the glyceraldehyde-3-phosphate dehydrogenase(GAPDH) as internal control.Results After 60 days of xanthohumol treatment, the cyst wet weight in the xanthohumol group was (0.458 ± 0.068) g, which was lower than in the infection group (1.088 ± 0.274) g and the solvent group (1.973 ± 0.213) g (bothP < 0.05); the cyst inhibition rate of the xanthohumol group was 57.7% (63/109), which was higher than 10.4% (11.5/109.8) in the solvent group and 0 in the infection group (both P < 0.05). ELISA results showed that the serum level of VEGF in the xanthohumol group was (45.24 ± 1.93) pg/ml, which was lower than (58.00 ± 5.56) pg/ml in the infection group and (57.85 ± 16.00) pg/ml in the solvent group, but higher than (40.20 ± 3.24) pg/ml in the health control group (all P < 0.05). The liver pathological examination of the infected mice liver tissues showed that the xanthohumol group had narrow inflammatory reaction bands and disordered germinal layers. The results of immunohistochemistry showed that the score of NF-κB P65 in the multilocular metacestode tissue in the xanthohumol group was (2.65 ± 1.14), which was lower than that of the infection group (9.46 ± 2.60) and the solvent group (9.20 ± 1.64) (both P < 0.05). The VEGF score in the xanthohumol group (1.80 ± 0.83) was significantly lower than that of the infection group (7.20 ± 1.30) and the solvent group (7.43 ± 2.96) (both P < 0.05). The MVD-CD34 score in the xanthohumol group was (16.40 ± 1.14), which was significantly lower than that of the infection group (40.60 ± 1.14) and the solvent group (40.83 ± 2.16) (both P < 0.05). Western blotting results showed that the VEGF/GAPDH ratio in the xanthohumol group was (0.76 ± 0.82), which was lower than that of the infection group (2.84 ± 0.33) and the solvent group (2.47 ± 0.12), but was higher than that of the health control group (0.63 ± 0.02) (all P < 0.05), but there was no significant difference between the infection group and the solvent group ( P > 0.05). The MVD-CD34/GAPDH ratio in the xanthohumol group was (0.40 ± 0.02), which was lower than that of the infection group (1.11 ± 0.07) and the solvent group (1.02 ± 0.14), but was higher than that of the health control group (0.14 ± 0.02) (all P < 0.05). There was no significant difference between the infection group and the solvent group ( P > 0.05). The NF-κB P65/GAPDH ratio in the xanthohumol group was (0.24 ± 0.03), which was lower than that of the infection group (0.61 ± 0.05) and the solvent group (0.66 ± 0.13), but was higher than that of the health control group (0.02 ± 0.01) (all P < 0.05). Conclusion The growth and angiogenesis of hepatic multilocular metacestode in mice were inhibited after treatment with xanthohumol for 60 days.

    Affects of Echinococcus multilocularis metacestode infection on the natural killer T cells and their subsets in mouse spleen
    LI Ling-hui, WANG Wei, HOU Xin-ling, SHI Yang, LI De-wei, LI Liang, WANG Hui, LI Jing, ZHANG Chuan-shan
    2021, 39(3):  311-317.  doi:10.12140/j.issn.1000-7423.2021.03.004
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    Objective To understand the affects of Echinococcus multilocularismetacestode infection to natural killer T (NKT) cells and their subsets in mouse spleen. Methods Twenty-four C57BL/6 mice were randomly assigned into low, medium, high infection groups and control group (6 mice in each). The mice in low, medium, high infection groups were infected with 50, 500, 2 000 protoscoleces, respectively, through hepatic portal vein, while the mice in the control group injected with the same amount of saline. Two weeks after infection, the mice liver and spleen were collected to prepare liver tissue slices. The slices were stained with Masson routine method to observe the metacestodes lesion and liver fibrosis. Spleen lymphocyte suspensions were prepared for examining different NKT subsets, and the secreted cytokines by using flow cytometry.Results Two weeks after infection, there was no significant change in the mice liver of the control group. In the low and medium infection groups, only a small amount of granulomas were seen in the liver, together with weak inflammatory response which showed a conversion toward fibrosis repair; however, in the high infection group, a small germinal layer structure was formed in the liver, surrounded by dense inflammatory cells. The absolute numbers of splenic NKT cells in the medium and high infection groups were (6.32 ± 0.53) × 10 5 and (7.37 ± 1.72) × 105, respectively, which were higher than those in the control group and the low infection group [(5.02 ± 1.08) × 10 5 and (4.90 ± 1.27) × 10 5, P < 0.01]. The proportions of splenic NKT1-type cells secreting IFN-γ in the medium and high infection groups were (13.93 ± 1.61)% and (10.9 ± 3.04)%, respectively, which were lower than those in the control group and the low infection group [(17.3 ± 3.18)% and (19.42 ± 2.82)%, P < 0.01)]; the proportions of splenic NKT2-type cells secreting IL-4 in the low, medium and high infection groups were (5.62 ± 0.58)%, (5.86 ± 1.43)% and (5.92 ± 0.94)%, respectively, which were higher than that in the control group [(4.37 ± 0.83) %, P < 0.05)]; the proportion of splenic NKT17-type cells secreting IL-17A in the low and medium infection groups were (7.02 ± 1.19)% and (6.62 ± 0.41)%, respectively, which were higher than those in the control group and the high infection group [(4.68 ± 0.73)% and (3.73 ± 1.04)%, P < 0.01]. The absolute numbers of splenic CD4 + NKT cells in the medium and high infection groups were (1.75 ± 0.36) × 10 5 and (1.82 ± 0.24) × 10 5, respectively, which were higher than those in the control group [(1.24 ± 0.26) × 10 5, P < 0.01]; the proportions of splenic CD4 + NKT1-type cells secreting IFN-γ in the low, medium- and high infection groups were (19.42 ± 2.82)%, (14.40 ± 1.81)%, and (12.5 ± 2.96)%, respectively, which were lower than those in the control group [(21.16 ± 2.83) %,P < 0.01]; the proportions of splenic CD4 + NKT17-type cells secreting IL-17A in the low, medium and high infection groups were (18.73 ± 1.99)%, (16.06 ± 1.42)% and (14.41 ± 3.55)%, respectively, which were higher than that in the control group [(10.27 ± 1.79)%,P < 0.01]. The proportions of splenic CD8 + NKT cells secreting IFN-γ in the low, medium and high infection groups were (10.04 ± 0.92)%, (13.43 ± 0.92)% and (9.24 ± 1.37)%, respectively, which were lower than those in the control group [(15.83 ± 1.59)%,P < 0.01]; the proportions of splenic CD8 + NKT cells secreting IL-10 in the medium and high infection groups were (4.07 ± 0.48)% and (3.92 ± 0.75)%, respectively, which were higher than that in the control group [(2.85 ± 0.64) %, P < 0.05]. The proportions of splenic DN NKT cells secreting IFN-γ in the medium and high infection groups were (17.48 ± 2.50)% and (14.06 ± 3.95)%, respectively, which were lower than that in the control group [(25.18 ± 5.78)%, P < 0.01]. Conclusion After infection of different numbers of E. multilocularismetacestode, the mice spleen NKT cells and their subsets changed significantly. The mice in the low and middle infection groups showed the immune response predominately with the CD4+ NKT17 type to kill and clear the parasites, while mice in the high infection group responded largely with the mixed subsets of CD4+ NKT17, NKT2 and NKT10 type cells, and NKT cells showed an inhibitory phenotype, leading to the decline of NKT1-type immune response, which is in favour of the parasite surviving.

    Analysis of medical cost of echinococcosis cases and influencing factors in Henan Province during 2017—2019
    ZHANG Ya-lan, DENG Yan, CHEN Wei-qi, ZHU Yan-kun, LIN Xi-meng, ZHANG Hong-wei
    2021, 39(3):  321-326.  doi:10.12140/j.issn.1000-7423.2021.03.005
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    Objective To analyze the medical cost of echinococcosis patients and the influencing factors in Henan Province from 2017 to 2019. Methods The general information of echinococcosis cases of Henan Province was collected through the Chinese National Infectious Diseases Reporting System during 2017—2019. The clinical information was collected by epidemiological investigation and telephone follow-up. The epidemiological characteristics of the reported cases were analyzed with SPSS 22.0, and the rank sum test for two or multi independent samples was used to analyze the influential factors for medical expenses of echinococcosis cases.Results From 2017 to 2019, 51 echinococcosis cases were reported in Henan, of which 34 cases were imported from Xinjiang. For area distribution, the cases were predominantly distributed in Zhoukou (25.5%, 13/51), followed by Nanyang (17.7%, 9/51), Shangqiu (11.8%, 6/51) and Zhumadian (9.8%, 5/51). The male-to-female ratio was 1.8 : 1, and the age of patients was mainly in the range of 40-60 years. By analyzing the medical expenses of 40 echinococcosis cases, the medical expense ranged 0-0.6 million, with a median of 60 000 yuan. Factors that were significantly associated with medical expenses were gender, type of echinococcosis, lesion number, the occurrence of relapse, the time from onset to confirmed diagnosis, level of hospital offering diagnosis, time of referring and time of operation ( P < 0.05). Conclusion The medical cost of echinococcosis patients was related to disease progression and hospital visits in Henan Province.

    Investigation on infection of Echinococcus multilocularis metacestode in small rodents in Chabchar County, Xinjiang
    GUO Bao-ping, GUO Gang, ZHANG Li, XIANG Jing-jing, WANG Xiao-ping, REN Yuan, QI Wen-jing, ZHANG Hui, LI Jun, ZHANG Wen-bao, WANG Hai-yan
    2021, 39(3):  327-332.  doi:10.12140/j.issn.1000-7423.2021.03.006
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    Objective To investigate the infection and distribution of Echinococcus multilocularis in small rodents, the intermediate hosts, in Chabuchaer County, Xinjiang, and to identify the intermediate host species of the parasite, providing scientific basis for formulating local control measures. Methods Small rodents were captured with plate clamps and bow clips in four selected investigation sites, including Jiagasitai town, Qiongbole town, Sishi and Dulata Port. Suspected infection in liver tissues was confirmed by HE staining and PCR amplification. The PCR products were sequenced. The species of small rodents were identified according to their physical appearance and skull morphology. Theχ2 test was used to compare the infection rate in different regions and in different rodent populations. Results A total of 595 small rodents were captured, which belonged to 7 species, including 464 Microtus spp., 84 Apodemus sylvaticus, 14 Meriones tamariscinus Pallas, 14 Rhombomys sopimus Pallas, 8 Ellobius trancrei, 6 Cricetulus migratorius Pallas and 5 Meriones erythrourus Pallas. In 67 liver samples of suspected infection, lesions of E. multilocularis metacestodes were observed. HE staining showed that the protoscoleces of E. multilocularis metacestodes were visible in the lesion tissues. PCR amplification and sequence alignment showed that all the 67 small rodents were infected with metacestodes of E. multilocularis, with a total infection rate of 11.3%. All the seven species of rodents were infected, with infection rates of 12.8% (57/464), 3.6% (3/84), 1/14, 2/14, 2/8, 1/5 and 1/6 for Microtus spp, A. sylvaticus, M. tamariscinus Pallas, R. sopimus Pallas, E. trancrei, M. serythrourus Pallas and C. migratorius Pallas, respectively. Chi-square analysis showed that there was a significant difference in the infection rate between Microtus spp. and A. sylvaticus (P < 0.05). The infection rate of Microtus spp. did not significantly differ from that of the other species (P > 0.05). Of the 4 investigation sites, the Qiongbole town showed the highest infection rate (12.3%, 49/398). Conclusion The small rodents captured in Chabuchaer County were mainly Microtus spp. and A. sylvaticus, with the former species showing the highest infection rate of metacestodes.

    Analysis of malaria detection capability of laboratories in the districts of Shanghai during 2017—2019
    ZHANG Yao-guang, JIANG Li, WANG Zhen-yu, ZHU Min, ZHU Qian, MA Xiao-jiang, WU Huan-yu
    2021, 39(3):  337-342.  doi:10.12140/j.issn.1000-7423.2021.03.007
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    Objective To recheck the blood samples of malaria cases sent by district-level centers for disease control and prevention (CDC), in Shanghai Municipal Center for Disease Control and Prevention (SCDC), and analyze the review results, in order to provide a basis for improving the malaria diagnostic capability of district CDCs.Methods Blood smears and whole blood samples submitted by the district CDC malaria laboratories were rechecked by SCDC using microscopic examination and nuclear acid detection (nested PCR) during 2017—2019. Using the examination by SCDC as the standard, the positive and negative coincidence rates of microscopic examination, and the sensitivity and specificity of malaria nucleic acid detection performed in district CDC malaria laboratories were analyzed. In 2019, blind assessment of malaria nucleic acid tests was conducted for all district CDCs of each district.Results A total of 232 malaria samples were submitted by district CDCs for rechecking in 2017—2019, among them 225 were complete samples (containing both blood smear and whole blood samples), with a completeness rate of 99.1% (225/227). Of the 225 complete samples, 99 samples were from Jinshan District (44.0%); 35 from Jing’an District (15.6%); 17 from Pudong New District (7.6%); 15 from Hongkou District (6.7%); Qingpu District and Chongming District submitted the least numbers of samples (0 and 1, respectively); while other districts provided less than 6.0% of the samples. The recheck of 225 complete samples showed an overall coincidence rate, positive coincidence rate and negative coincidence rate being 96.0% (216/225), 98.8% (170/172) and 86.8% (46/53), respectively, and the coincidence rate of nucleic acid detection 88.8% (103/116). The district CDCs used the quantitative real-time PCR (qPCR) method for nucleic acid detection, resulting in a sensitivity of 76.6% (85/111), which was significantly different from that of the nested PCR method used by SCDC (87.4%, 97/111) (P < 0.05). The specificity of the two nucleic acid detection methods was 100.0%. Comprehensive evaluation of the 225 samples by using the two detection methods showed that the coincidence rate of district CDCs was 96.9% (218/225), and the misjudgment rate was 3.1% (7/225), including 5 with qualitative errors and 2 with errors in species identification. In 2019, the overall correct detection rate of blind assessment of malaria nucleic acid by district CDCs was 97.5% (78/80). Specifically, the correct detection rate of P. falciparum sample was 94.1% (32/34), which was not significantly different from those of the other four types of samples (P. vivax, P.ovale, P. malariae and negative infection) (P > 0.05). Conclusion From 2017 to 2019, the malaria laboratories of district CDCs showed a strong capability of malaria microscopic examination, but the sensitivity of nuclear acid detection needs to be improved.

    Surveillance and analysis of parasitic infection in food on market in Shanghai during 2015—2019
    WANG Zhen-yu, WU Huan-yu, JIANG Li, MA Xiao-jiang, ZHANG Yao-guang, HE Yan-yan, ZHU Qian
    2021, 39(3):  347-351.  doi:10.12140/j.issn.1000-7423.2021.03.008
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    Objective To understand the status of parasitic infection in the food on market in Shanghai, in order to provide evidence for formulating strategies for food safety. Methods To carry out the surveillance,freshwater products, seawater products, pickled products, meat products and vegetables on farm product markets and supermarkets were sampled in Shanghai during 2015—2019, based on the combination of urban and suburb regions. The parasitic infection in the food samples were examined by using pressing method and digestion for detecting metacercariae in freshwater products and pickled products; using dissection microscopy forAnisakis larvae in seawater products; using pressing method for Taenia cysticercus and Trichinella encysted larvae in meat products; using fluorescent quantitative PCR for detectingToxoplasma gondii DNA in the meat products; using the saline floating method for Fasciolopsis buski metacercaria or parasite eggs in vegetables. Results A total of 1 125 samples of fresh water products were examined during 2015—2019, of which 9 were found of parasite metacercariae, with a positive rate of 0.8%. In the 585 freshwater fish samples, the positive rate of parasite metacercariae (Clonorchis sinensis) was 1.5% (9/585). The 540 samples of freshwater shrimps and crabs were not detected of Paragonimus metacercariae. Among freshwater fishes, the Pseudorasbora parve had the highest positive rate (5/8). The positive rates of parasite metacercaria in freshwater fishes were 0.7% (1/144), 3.3% (4/121), 1.7% (2/120), 0 (0/100) and 2.0% (2/100) during 2015—2019, respectively.Anisakis larvae were found in 31.1% (184/591) of 591 samples of 35 species of seawater products. The positive rates of Anisakis larvae in seawater fishes were 36.0% (50/139), 37.1% (49/132), 29.2% (35/120), 39.0% (39/100) and 11.0% (11/100) during 2015—2019, respectively. The positive rate ofAnisakis was higher in Pneumatophorus japonicas (72.5%, 37/51), Larimichthys polyactis (70.1%, 61/87) and Trichiurus lepturus (50.0%, 52/104) than in other seawater products (19.1%, 34/178) (χ2 = 33.9, 48.3, 13.2; P < 0.01). Among the 443 pickled products examined, 272 pickled bullacta exarata products were infected with Echinostoma metacercariae, showing a positive rate of 61.4%, and none was detected with Paragonimus metacercariae. Of the 253 meat product samples of pigs, cattle, sheep, chickens and ducks, none was detected with Taenia solium metacercariae,Taenia saginata metacercariae, Trichinella larva cysts, or Toxoplasma spp. The 30 samples of vegetables were not detected with Fasciolopsis buski metacercaria or other parasite eggs. Conclusion There are different degrees of parasitic infection in freshwater products, seawater products and pickled products on the market in Shanghai.

    Epidemiological characteristics of visceral leishmaniasis in Shanxi Province, 2010—2019
    ZHENG Yu-hua, BAI Yong-fei, TIE Ping, YAN Chang-fu, WANG Ting, WANG Jing-ying, WANG San-tao, CAI Jian
    2021, 39(3):  352-358.  doi:10.12140/j.issn.1000-7423.2021.03.009
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    Objective To understand the epidemic status and transmission trend of kala-azar in Shanxi Province, and to provide informative basis for formulating appropriate control strategy for kala-azar. Methods Information of kala-azar cases who were residents in Shanxi Province, reported from 2010 to 2019 from the National infectious Disease Surveillance Reporting and Management System, was collected for a descriptive epidemiological analysis. In addition, epidemiological investigation information of the reported cases was collected individually to analyze the change of epidemic situation of kala-azar in different counties.Results A total of 140 cases of kala-azar were reported in Shanxi from 2010 to 2019, with an annual average incidence of 0.04 per 100 000. Among them, 131 were local cases, 7 were imported cases, and the source of infection in 2 cases was unknown. No more than 4 kala-azar cases were reported each year in 2010—2014, but the reported yearly incidence showed a trend of increase from 2015 to 2019 (8 cases, 9 cases, 18 cases, 37 cases and 52 cases respectively). Furthermore, the epidemic area expanded year by year. More than 10 cases were reported in the two counties where the kala-azar endemicity was higher severe in 2019. The reported cases were mainly in cities of Yangquan, Changzhi and Linfen, accounting for 92.14% (129/140) of the total. The reported cases of kala-azar were significantly increased from 4 in 2016 to 33 in 2019 in Yangquan City, while the epidemic situation was relatively stable in Linfen and Changzhi. During 2010-2019 there were eight new epidemic counties located in four cities, which were Yangquan (3 cases), Changzhi (2 cases), Linfen (2 cases) and Yuncheng (1 case), and 6 epidemic reemerging counties located in four cities, which were Changzhi (1 case), Jinzhong (1 case), Yangquan (1 case) and Linfen (3 cases). Of all cases, 98 were males and 42 were females, with a male-to-female ratio of 2.33 ∶ 1. The age distribution showed that 39.29% (55/140) of the cases were infants under 3 years, with peak age of disease onset under 1. Children and famers were at a high risk of kala-azar, accounting for 41.13% (58/140) and 28.37% (40/140), respectively. The majority of cases were residents in villages (85.00%, 119/140).Conclusion The epidemic of kala-azar in Shanxi Province shows a noticeable increasing trend, is rising with the affected areas being expanded year by year; new endemic areas continuously occurred, and reemergence appeared in some areas. The incidence shows an obvious regional distribution pattern.

    Effects of Zanthoxylum bungeanum ethanol extracts against Giardia lamblia
    LI Ming, LUO Qing-qing, FANG Hui, CAO Xiao-qin
    2021, 39(3):  359-364.  doi:10.12140/j.issn.1000-7423.2021.03.010
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    Objective To investigate the effect of Zanthoxylum bungeanum against Giardia duodenalis by observing inhibitory effect and structural changes on the parasite in vitro cultures by Z. bungeanum ethanol extracts. Methods Giardia strophozoites at the concentration of 7.5×105-2.5×106/ml in culture was treated with different concentrations of Z. bungeanum Maxim solution (0.05, 0.500, 5.00, 50.00, 250.00 mg/ml) and albendazole solution at final concentrations of 0.04, 0.40, 4.00, 40.00, and 200.00 mg/ml, respectively. A blank treatment group served as control. After anaerobic culture at 37 ℃ for 24 h using modified TYI-S-33 medium, the inhibitory effects of the two testing reagents on the growth of G. duodenalis were observed and counted. Each concentration was tested in triplicates. The half maximal inhibitory concentration (IC50) values of Z. bungeanum extracts and albendazole were calculated using the SPSS 22.0 software. Then, the trophozoites of G. duodenalis were treated in vitro with the Z. bungeanum extracts at the IC50 concentration for 1, 3, 7, 15 and 24 h at 37 ℃. Blank control group was set for the study. The vitality, morphological and structural changes were observed, and fatality rate of the trophozoites was calculated (repeated 3 times at each time point), and the morphological changes were observed by scanning electron microscopy.Results G. duodenalis in the blank control group showed normal growth, fullness appearance with increased number, while the Z. bungeanum Maxim at different concentrations and albendazole solution suppressed the growth of parasites. Compared with the blank control group, tthe trophozoites treated with Z. bungeanum extracts (5-250 mg/ml) and albendazole solution (0.04-200 mg/ml) showed significant morphological changes (P < 0.05). The IC 50 values of Z. bungeanum extracts and albendazole were 4.57 mg/ml and 0.07 mg/ml, respectively. At the IC50 concentrations, suppressive effect on the parasites was increased with longer exposure time. Exposed to the reagents for 7 h, the parasite fatality was higher than 50%, and the exposure for 15 h resulted in a fatality rate higher than 70%. The fatality reached (80.03 ± 3.62)% and (91.70 ± 4.91)% after 24 h treatment with Z. bungeanum extracts and albendazole, respectively (P < 0.05 compared with the control group). Electron microscopy found after treatment with Z. bungeanum extract for 7 h, the parasite deformed with irregular surface, but the flagella remained clearly visible; upon treatment for > 12 h, the growth of the trophozoites ceased, flagella were obviously damaged, surface cytomembrane of ventral acetabula were broken, cell content spilled, cells flattened due to losing skeleton brace; after treatment for 24, worm surface were seriously damaged, worm epithelial membrane shrank, leading to changes in worm stereo structure, and eventually leaving only the worm outer form due to depleted cytoplasm. Conclusion The Z. bungeanum extract has certain suppressive effect on the growth of G. duodenalis, and the suppressive effect on the worms was enhanced with the increasing concentration of the testing extracts.

    INFORMATION REPORTS
    The impact of COVID-19 epidemic on the control of important parasitic diseases
    ZHU Hui-hui, ZHU Ting-jun, CHEN Ying-dan, DENG Zhuo-hui, XU Jing, ZHOU Chang-hai, QIAN Men-bao, QIN Zhi-qiang, HUANG Ji-lei, LV Chao, ZHANG Mi-zhen, LI Shi-zhu
    2021, 39(3):  365-369.  doi:10.12140/j.issn.1000-7423.2021.03.011
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    The spread of COVID-19 has increased the risk of contact transmission between people, and imposes challenges and opportunities for the prevention and control of important parasitic diseases. There may be risks of COVID-19 infection during the implementation of the virus control, including in field investigation and intervention, contacting with fecal samples, or with asymptomatic infected people. Therefore, corresponding prevention and control measures should be taken before and during field investigation, and in sample transportation and detection to prevent the risks effectively. In this paper, the risks and corresponding countermeasures in the above processes are discussed in detail, and the opportunities that COVID-19 brought to the disease control system are also analyzed.

    International cooperation on malaria research in China: bibliometric analysis based on the WoS core database
    DU Yan-qiu, ZHAO Su-ning, HUANG Jia-yan, CAO Jun
    2021, 39(3):  370-374.  doi:10.12140/j.issn.1000-7423.2021.03.012
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    To analyze the characteristics and trends of international cooperation in malaria-related scientific research in China from 1980 to 2019, and provide a reference for the next step of international cooperation. Academic articles published by Chinese authors from 1980 to 2019 were searched in the Web of Science core database, and the publication years and journal distribution were analyzed. The method of bibliometric analysis was used for the academic articles published from 2000 to 2019 to analyze cooperative countries, funding sources, and cooperative institutions, and meantime software Citespace was used to construct a network map of state co-occurrence, and institution co-occurrence. This study searched a total of 1 500 malaria related academic articles with Chinese co-authorship. TheMalaria Journalhas published the totally most articles(161 articles), followed by PLoS One (60 articles). The publication of papers began to increase exponentially from 2006, and the average annual increase from 2006 to 2018 reached 31.9%. The five-years funding increased rapidly from 176 in 2005—2009 to 2 098 in 2015—2019. According to the analysis of state co-occurrence, more than 25 countries’ scientists published research papers jointly with Chinese authors in 2015—2019, among them the top 5 countries were the United States, the United Kingdom, Australia, Thailand, and Japan. According to the analysis of institutional co-occurrence, the Chinese Center for Disease Control and Prevention was the domestic institution with the highest intermediary centrality, and the University of Oxford was the highest foreign institution. In summary, since 2000, China’s international cooperation in malaria scientific research has grown significantly, the sources of funding have been continuously increasing, and the cooperating countries shows a diversified trend. The establishment of cooperative relations has been concentrated in a few key institutions at home and abroad.

    TEACHING RESEARCH
    Development and application of online-offline mixed teaching mode for medical parasitology
    YAN Bao-long, LIANG Shao-hui
    2021, 39(3):  376-379.  doi:10.12140/j.issn.1000-7423.2021.03.013
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    The online-offline mixed teaching mode for medical parasitology aims to achieve the goal of mastering core knowledge in medical parasitology by integrating the modern teaching concept of "putting learning in the center" with information technology, enabling personalized online-learning at any time in any place. This teaching mode, accompanied by case-based offline discussion in small classes and laboratory courses, enables internalization of core knowledge, application of knowledge and deep learning. The integration of political education during class results in formative evaluation throughout the learning process. The courses are guided for medical students' competency on their working positions, in the aim to improve the abilities of knowledge application, lifelong learning, interpersonal communication and team cooperation of medical students.

    REVIEWS
    Progress on the intervention of inflammatory conditions by helminthes and their derived molecules
    CHEN Yu-ying, WANG Xiao-ting, DAI Yang, CAO Jun
    2021, 39(3):  380-385.  doi:10.12140/j.issn.1000-7423.2021.03.014
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    Inflammation is a complex protective response to pathogen invasion or tissue damage. Inflammation-related diseases include cardiovascular diseases, diabetes, asthma, obesity, etc. In recent years, accumulating evidence has shown that helminthes and their derived molecules can effectively interfere with inflammatory diseases, which leads to the ‘worm therapy’ concept. As administering with live worms is challenged with serious ethical and safety concerns, current research is focusing on the screening and structural analysis of worm-derived anti-inflammatory molecules, and identification and verification of anti-inflammatory effects. This article reviews the latest advances in worm-derived anti-inflammatory active molecules and the mechanisms underlying their intervention of inflammatory diseases.

    Solid organ transplantation and toxoplasmosis
    HUANG Zi-yun, LV Fang-li
    2021, 39(3):  386-392.  doi:10.12140/j.issn.1000-7423.2021.03.015
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    Toxoplasma gondii infection in immunocompetent people is often asymptomatic, but may lead to severe clinical symptoms in immunocompromised patients, even with fatal consequences. Due to the diversity of solid organ transplants, the degrees of immunosuppression, and the relatively low incidence of toxoplasmosis among organ transplant recipients, the clinical risk of T. gondii infection in organ transplant patients remains poorly understood. Therefore, this paper reviews the clinical manifestations, pathogenesis, diagnosis, prevention, and treatment of toxoplasmosis in solid organ transplant recipients, in order to provide reference for clinical diagnosis and treatment of toxoplasmosis after solid organ transplantation.

    Research progress on the treatment of malaria with artemisinin and its derivatives
    YANG Bo, SUN Yi-fan, LEI Yao, CHENG Yang
    2021, 39(3):  393-402.  doi:10.12140/j.issn.1000-7423.2021.03.016
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    Artemisinin is a safe antimalarial drug. Artemisinin-based drug combinations have been recommended by the World Health Organization as the first-line treatment for falciparum malaria. However, artemisinin resistance is emerging in the treatment of malaria, and has gradually become a major threat to malaria control. Artemisinin drugs have attracted much attention due to the quick effect and low toxicity. In recent years, research and clinical application of artemisinin and its derivatives have been continuously carried out in depth. This paper reviews the antimalarial mechanism, drug resistance phenomenon and mechanism and clinical application of artemisinin drugs, in order to provide valuable reference of further research and application of artemisinin and its derivatives.

    SHORT COMMUNICATIONS
    Analysis of malaria situation in Nanchang from 2014 to 2018
    QIAN Ke, HU Zhu-hua, PENG Guo-hua, LIU Yue, FENG Xiao-wu
    2021, 39(3):  317-320.  doi:10.12140/j.issn.1000-7423.2021.03.017
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    To analyze malaria situation and epidemiological characteristics in Nanchang from 2014 to 2018, and to provide scientific reference for formulation of a rational malaria control strategy in the city, the information of malaria cases and associated epidemiological data of Nanchang City from 2014 to 2018 were collected from the National Infectious Disease Report Information Management System and the Nanchang Malaria Epidemic Information Sheet and Epidemic Case Survey Form. The ArcGIS 10.1 software was used to analyze the spatial distribution of malaria cases. From 2014 to 2018, a total of 114 malaria cases were reported in Nanchang, all of them were imported cases from countries outside of China. Among them, 110 cases (96.49%) were imported from African countries, 3 cases (2.63%) from Asian countries, and 1 case (0.88%) from an Oceania country.Plasmodium infection was predominated by P. falciparum (65 cases, 57.02%) and P. vivax (30 cases, 26.32%); the cases were reported throughout the months, with no obvious seasonal changes. The malaria cases comprised 107 males (93.86%) and 7 females (6.14%), with male-to-female ratio of 15.3: 1; and the average age of the disease occurrence was 39.81 years. In addition, 111 of the cases (97.37%) were distributed in the age groups of 20-39 and 40-59. The occupation distribution were predominated by workers (44, 38.59%) and farmers (37, 32.46%). The median time from onset to etiological diagnosis was 3 days. No recurrence, re-ignition, death, and imported secondary cases occurred. Jinxian County, Qingshan Lake District, and Xinjian District were the top three counties in Nanchang City in terms of reported malaria cases. ArcGIS10.1 hotspot map showed that Nanchang urban area and Jinxian County were two concentrated spots. These results suggest that prevention and control of imported malaria is the key point of future work in Nanchang City, with Jinxian County as a particular key site.

    Analysis of characteristics of echinococcosis patients in Shiqu County at different time periods
    LIAO Sha, YU Wen-jie, ZHANG Guang-jia, HE Wei, WANG Qi, LI Tiao-ying, CHEN Xing-wang, WANG Qian
    2021, 39(3):  332-336.  doi:10.12140/j.issn.1000-7423.2021.03.018
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    Mass screening for echinococcosis was conducted in the administrative villages in 7 and 8 towns in Shiqu county using the random cluster sampling method from 2000 to 2002 and from 2014 to 2017. Ultrasonographic imaging and serological tests were applied to diagnose echinococcosis. The sex, age, lesion size and classification of patients were compared between the two time periods. A total of 416 and 2 090 echinococcosis patients were investigated during 2000—2002 and 2014—2017, respectively. The proportion of cystic echinococcosis (CE) patients in Shiqu county decreased from 51.9% (216/416) in 2000—2002 to 39.8% (832/2 090) in 2014—2017, while the proportion of alveolar echinococcosis (AE) patients increased from 48.1% (200/416) in 2000—2002 to 57.4% (1 200/2 090) in 2014—2017 (P < 0.05). The proportions of CL, CE1 and CE2 type patients decreased from 2.4% (10/416), 18.0% (75/416) and 13.0% (54/416) in 2000—2002 to 0.7% (14/2 090), 4.6% (96/2 090) and 6.0% (125/2 090) in 2014—2017 ( P < 0.05). The proportions of CE3, CE4 and CE5 patients increased from 5.5% (23/416), 11.5% (48/416) and 1.4% (6/416) in 2000—2002 to 11.1% (232/2 090), 14.1% (294/2 090) and 3.4% (71/2 090) in 2014—2017, respectively ( P < 0.05). The proportion of AE patients with calcification and nodular increased from 10.3% (43/416) in 2000—2002 to 21.2% (444/2 090) in 2014—2017, while the proportion of AE patients with central necrosis lesion decreased from 18.3% (76/416) in 2000—2002 to 13.6% (284/2 090) in 2014—2017 ( P < 0.05); meanwhile, the proportion of AE patients with lesion diameter < 5 cm increased from 15.1% (63/416) in 2000—2002 to 25.7% (523/2 032) in 2014—2017 ( P < 0.05). The proportion of CE patients aged 21 to 30 years decreased from 2000—2002 (10.6%, 44/416) to 2014—2017 (4.5%, 92/2 032)( P < 0.05), and the proportion of CE patients aged 41-50 years and over 60 years increased from 2000—2002(8.7%, 36/416; 5.3%, 22/416) to 2014—2017(9.8%, 199/2 032; 6.9%, 141/2 032), respectively ( P < 0.05). After more than 10 years’ comprehensive prevention and control for echinococcosis in Shiqu county, the proportion of the patients showed changes with the CE type decreased and AE type increased, and correspondently, changes were seen in the composition of patients with different lesion classifications and sizes, and ages.

    Surveillance of key parasitic diseases in populations of Baise City in Guangxi from 2016 to 2019
    DENG Ji-guang, YU Shui-lan, NONG Zhi, JIANG Zhi-hua
    2021, 39(3):  342-346.  doi:10.12140/j.issn.1000-7423.2021.03.019
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    In accordance with the Implementation Plan for Surveillance and Investigation of Key Human Parasitic Diseases in Guangxi, a survey on human soil-borne nematodiasis (including hookworm disease, ascariasis, whipworm disease, pinworm disease) and clonorchiasis was performed in Baise City, Guanxi, from 2016 to 2019. Stool samples were collected from 200 residents over 3 years old at each site, and examined with modified Kato-Katz thick smear method for the eggs of soil-borne nematodes and Clonorchis sinensis and counted. Hookworm species were identified using larva test-tube filter paper culture method for Ancylostoma duodenale and Ancylostoma americana; Enterobius eggs were examined with cellophane anal swab for children aged 3-12 years. The survey of human parasitic diseases were carried out for 14 524 person-times in the city in 2016—2019. The results showed that a total of 1 464 persons were found infected, with a infection rate of 10.08%. The infection rate was highest in 2018 (16.72%, 508/3 039), and lowest in 2016 (6.79%, 283/4 168). The infection rate was highest ofC. sinensis (4.96%, 721/14 524) followed by hookworms (3.48%, 80/14 524). The infection rate was 6.94% (452/14 524) in males and 12.63% (1 012/14 524) in females (P < 0.01). The infection rate was high in populations aged 13-20 years, residing in rural areas, with an occupation of farmers, and having an education level of illiteracy, and in Tianyang District, which were 21.46% (362/1 268), 29.58% (1 039/3 512), 13.39% (641/4 787), 19.96% (641/3 211) and 13.50% (561/4 155), respectively. A total of 2 485 children were examined during the 4 years, of them 166 were infected with Enterobius vermicularis (6.68%, 166), and the highest rate was found in 7-year-old children (10.45%, 23/220). The infection rate was 5.83% (69/1 184) in boys and 7.46% (97/1 301) in girls. The results indicate that the infection rate of human parasites in Baise showed a trend of increase followed by a decrease during 2016—2019. The infection rate ofC. sinensis was relatively high, but the infection of soil-borne nematode was predominated by hookworm infection. It is necessary to strengthen the treatment, and health education in the key populations aged 13-20 years, residing in rural areas, with an occupation of farmers, and having an education level of illiteracy, and in Tianyang District.

    Establishment of a Giardia lamblia detection method based on the LAMP microfluidic chip
    YU Ming-chuan, YANG Zhong-wei, WANG Hua-ran, SHI Dan-yang, ZHOU Shu-qing, YIN Jing, SUN Shu-min
    2021, 39(3):  402-405.  doi:10.12140/j.issn.1000-7423.2021.03.020
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    The triose phosphate isomerase (TPI) gene of Giardia lamblia was selected as the target gene, for which primers were designed, and the synthetic plasmid containing TPI gene sequence was used as the template to establish a LAMP microfluidic chip detection method for detection ofG. lamblia. The specificity, sensitivity, repeatability and stability of the method were evaluated. The results showed that the established LAMP microfluidic chip detection method for G. lamblia could complete nucleic acid amplification within 30 min, and the detection sensitivity reached 4.0 × 10 copies/μl and 0.01 ng nucleic acid/μl. In addition, this method showed high specificity for G. lamblia, while not being able to amplify the nucleic acids of Cryptosporidium, Trichinella spiralis, Eimeria, hepatitis E virus or Enterococcus faecalis. The stability and repeatability of the method were tested using different dilutions of recombinant plasmids. The results showed that the nucleic acid concentration was highly correlated with the reaction time, and positive fecal samples presented amplifying signals. The results demonstrate the establishment of a lamp microfluidic chip-based nucleic acid detection method forG. lamblia. The method is simple and highly specific.

    Analysis of laboratory detection capabilities for imported Plasmodium ovale in Hubei Province
    WU Dong-ni, SUN Ling-cong, ZHANG Hua-xun, WAN Lun, ZHANG Juan, CAO Mu-min, XIA Jing
    2021, 39(3):  406-409.  doi:10.12140/j.issn.1000-7423.2021.03.021
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    To assess the laboratory capabilities in two genetic types of imported Plasmodium ovale in Hubei Province. Blood samples were collected from imported malaria cases in the province during 2015—2018. All cases were rechecked and genotyped by the Hubei Provincial Diagnostic Reference Laboratory (Hubei DRL) using microscopy and nested polymerase chain reaction (nested PCR). The detection accuracy of importedP. ovale by microscopy and malaria rapid diagnostic test (RDT) were compared with the nested PCR, which was used as positive reference. During 2015—2018, a total of 494 malaria cases were confirmed in Hubei Province, of them 76 cases (15.38%) were identified ofP. ovale infection by nested PCR, including 50 (65.79%) P. ovale curtisi, a subspecies,and 26 (34.21%) P. ovale wallikeri, a mutated subspecies. In examining the P. ovale curtisi, the Hubei DRL detected 48 cases by microscopy with a coincidence rate of microscopy and RDT was 96.00% and 64.00%, respectively. In examining the P. ovale wallikeri, the Hubei DRL detected 23 cases by microscopy with coincidence rate of microscopy and RDT was 88.46% and 80.77%, respectively. The microscopic examination in the city-level Center for Disease Control and Prevention (CDC) detected 37 cases ofP. ovale, with an accuracy of only 48.68%. Overall, 97.36% (74/76) of the P. ovale cases were from Africa. The results suggested that microscope operation training should be strengthened in city-level CDCs to improve the identification capability for P. ovale identification, and that the combined use of microscopy and RDT should be promoted for diagnosis of imported P. ovale malaria cases.

    Epidemiological investigation on a new local case of visceral leishmaniasis in Luoyang City, Henan Province
    LI Yun-xia, CHENG Rui, ZHOU Rui-min, YANG Cheng-yun, ZHANG Hong-wei, TIAN Li-guang, AI Lin
    2021, 39(3):  410-413.  doi:10.12140/j.issn.1000-7423.2021.03.022
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    Epidemiological investigation was performed for a new case of child visceral leishmaniasis occurred in Luoyang City in 2020, to analyze the course of the disease and the possible source of infection, and monitor the residents of and dogs of dubious infection. rK39 antibody detection and PCR assay were conducted in the suspected subjects; sandflies in the village environment were investigated and monitored. The transmission risk was assessed according to the source of infection, sandfly breeding environment and vector distribution. The results of investigation and monitoring showed that the positive rate of rK39 antibody was 27.27% (9/33) in 7 groups of dogs examined in the child’s residency area, Yinjiagou of High Tech District of Luoyang City, and the positive rate of rK39 antibody was 7.60% (13/171) in the residents of the village. Sandflies were found in the village where the patient lived. The PCR assay of blood samples indicated the amplified sequences from thepatient and infected dogs showed 99% similarity to that ofLeishmania infantis. This case was the first local visceral leishmanian case in Luoyang City over the past 60 years. It was highly likely that the patient was infected from infected dog. These results suggest that there is a high risk of local of visceral leishmaniasis in the area. It is imperative to scale-up the surveillance and strengthen prevention and control measures in the areas of surrounding counties to prevent further spread of visceral leishmaniasis.