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Watson JA, Uyoga S, Wanjiku P, Makale J, Nyutu GM, Mturi N, George EC, Woodrow CJ, Day NPJ, Bejon P, Opoka RO, Dondorp AM, John CC, Maitland K, Williams TN, White NJ. Improving the diagnosis of severe malaria in African children using platelet counts and plasma PfHRP2 concentrations. Sci Transl Med 2022; 14:eabn5040. [PMID: 35857826 PMCID: PMC7613613 DOI: 10.1126/scitranslmed.abn5040] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Severe malaria caused by Plasmodium falciparum is difficult to diagnose accurately in children in high-transmission settings. Using data from 2649 pediatric and adult patients enrolled in four studies of severe illness in three countries (Bangladesh, Kenya, and Uganda), we fitted Bayesian latent class models using two diagnostic markers: the platelet count and the plasma concentration of P. falciparum histidine-rich protein 2 (PfHRP2). In severely ill patients with clinical features consistent with severe malaria, the combination of a platelet count of ≤150,000/μl and a plasma PfHRP2 concentration of ≥1000 ng/ml had an estimated sensitivity of 74% and specificity of 93% in identifying severe falciparum malaria. Compared with misdiagnosed children, pediatric patients with true severe malaria had higher parasite densities, lower hematocrits, lower rates of invasive bacterial disease, and a lower prevalence of both sickle cell trait and sickle cell anemia. We estimate that one-third of the children enrolled into clinical studies of severe malaria in high-transmission settings in Africa had another cause of their severe illness.
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Affiliation(s)
- James A. Watson
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK,Corresponding author.
| | - Sophie Uyoga
- KEMRI Wellcome Trust Research Programme, Centre for Geographic Medicine Research, Coast, Kilifi 80108, Kenya
| | - Perpetual Wanjiku
- KEMRI Wellcome Trust Research Programme, Centre for Geographic Medicine Research, Coast, Kilifi 80108, Kenya
| | - Johnstone Makale
- KEMRI Wellcome Trust Research Programme, Centre for Geographic Medicine Research, Coast, Kilifi 80108, Kenya
| | - Gideon M. Nyutu
- KEMRI Wellcome Trust Research Programme, Centre for Geographic Medicine Research, Coast, Kilifi 80108, Kenya
| | - Neema Mturi
- KEMRI Wellcome Trust Research Programme, Centre for Geographic Medicine Research, Coast, Kilifi 80108, Kenya
| | - Elizabeth C. George
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - Charles J. Woodrow
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Nicholas P. J. Day
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Philip Bejon
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK,KEMRI Wellcome Trust Research Programme, Centre for Geographic Medicine Research, Coast, Kilifi 80108, Kenya
| | - Robert O. Opoka
- Makerere University, Department of Paediatrics and Child Health, Kampala, Uganda
| | - Arjen M. Dondorp
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Chandy C. John
- Department of Pediatrics, Indiana University, Indiana, IN, USA
| | - Kathryn Maitland
- KEMRI Wellcome Trust Research Programme, Centre for Geographic Medicine Research, Coast, Kilifi 80108, Kenya,Institute of Global Health Innovation, Department of Surgery and Cancer, Imperial College, London, UK
| | - Thomas N. Williams
- KEMRI Wellcome Trust Research Programme, Centre for Geographic Medicine Research, Coast, Kilifi 80108, Kenya,Institute of Global Health Innovation, Department of Surgery and Cancer, Imperial College, London, UK
| | - Nicholas J. White
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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Watson JA, Ndila CM, Uyoga S, Macharia A, Nyutu G, Mohammed S, Ngetsa C, Mturi N, Peshu N, Tsofa B, Rockett K, Leopold S, Kingston H, George EC, Maitland K, Day NPJ, Dondorp AM, Bejon P, Williams TN, Holmes CC, White NJ. Improving statistical power in severe malaria genetic association studies by augmenting phenotypic precision. eLife 2021; 10:e69698. [PMID: 34225842 PMCID: PMC8315799 DOI: 10.7554/elife.69698] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 06/22/2021] [Indexed: 12/14/2022] Open
Abstract
Severe falciparum malaria has substantially affected human evolution. Genetic association studies of patients with clinically defined severe malaria and matched population controls have helped characterise human genetic susceptibility to severe malaria, but phenotypic imprecision compromises discovered associations. In areas of high malaria transmission, the diagnosis of severe malaria in young children and, in particular, the distinction from bacterial sepsis are imprecise. We developed a probabilistic diagnostic model of severe malaria using platelet and white count data. Under this model, we re-analysed clinical and genetic data from 2220 Kenyan children with clinically defined severe malaria and 3940 population controls, adjusting for phenotype mis-labelling. Our model, validated by the distribution of sickle trait, estimated that approximately one-third of cases did not have severe malaria. We propose a data-tilting approach for case-control studies with phenotype mis-labelling and show that this reduces false discovery rates and improves statistical power in genome-wide association studies.
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Affiliation(s)
- James A Watson
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol UniversityBangkokThailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom
| | - Carolyne M Ndila
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol UniversityBangkokThailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom
| | - Sophie Uyoga
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research-CoastKilifiKenya
| | - Alexander Macharia
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research-CoastKilifiKenya
| | - Gideon Nyutu
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research-CoastKilifiKenya
| | - Shebe Mohammed
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research-CoastKilifiKenya
| | - Caroline Ngetsa
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research-CoastKilifiKenya
| | - Neema Mturi
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research-CoastKilifiKenya
| | - Norbert Peshu
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research-CoastKilifiKenya
| | - Benjamin Tsofa
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research-CoastKilifiKenya
| | - Kirk Rockett
- The Wellcome Sanger InstituteCambridgeUnited Kingdom
- Wellcome Trust Centre for Human Genetics, University of OxfordOxfordUnited Kingdom
| | - Stije Leopold
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol UniversityBangkokThailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom
| | - Hugh Kingston
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol UniversityBangkokThailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom
| | - Elizabeth C George
- Medical Research Council Clinical Trials Unit, University College LondonLondonUnited Kingdom
| | - Kathryn Maitland
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research-CoastKilifiKenya
- Institute of Global Health Innovation, Imperial College, LondonLondonUnited Kingdom
| | - Nicholas PJ Day
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol UniversityBangkokThailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom
| | - Arjen M Dondorp
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol UniversityBangkokThailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom
| | - Philip Bejon
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research-CoastKilifiKenya
| | - Thomas N Williams
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research-CoastKilifiKenya
- Institute of Global Health Innovation, Imperial College, LondonLondonUnited Kingdom
| | - Chris C Holmes
- Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom
- Department of Statistics, University of OxfordOxfordUnited Kingdom
| | - Nicholas J White
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol UniversityBangkokThailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom
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3
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Guedes KS, Sanchez BAM, Gomes LT, Fontes CJF. Aspartate aminotransferase-to-platelet ratio index (APRI): A potential marker for diagnosis in patients at risk of severe malaria caused by Plasmodium vivax. PLoS One 2019; 14:e0224877. [PMID: 31765438 PMCID: PMC6876935 DOI: 10.1371/journal.pone.0224877] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 10/23/2019] [Indexed: 02/07/2023] Open
Abstract
Acute infection with Plasmodium vivax, classically associated with benign disease, has been presenting as serious and even fatal disease in recent years. Severe disease is mainly due to biochemical and hematological alterations during the acute phase of infection. In the present cross-sectional study, the aspartate aminotransferase-to-platelet ratio index (APRI) was evaluated as a method for identifying patients at risk of severe vivax malaria. This retrospective study included 130 patients with confirmed P. vivax infection between June 2006 and January 2018. Clinical-epidemiological data were obtained from medical records. Hematological and biochemical parameters were determined using automated equipment. The criteria of severity for infection by Plasmodium falciparum, established by the World Health Organization (WHO), were adapted to classify patients with danger signs of severe vivax malaria. Of the 130 patient’s records evaluated, 19 (14.6%) had one or more signs and symptoms of severe malaria. The mean APRI values among patients with and without severe malaria were 2.11 and 1.09, respectively (p = 0.044). Among those with severe disease, the proportion with an APRI value above 1.50 was 30% compared to the 10% among those without severe disease (p = 0.007). The area under the receiver operating characteristic curve (95% CI), calculated to assess the accuracy of the APRI in discriminating between patients with and without severe disease, was 0.645 (0.494; 0.795). An APRI cutoff of 0.74 resulted in sensitivity of 74.0%, specificity of 56.0%, and accuracy of 65.0%. This study shows that the APRI is elevated in patients with evidence of infection by P. vivax. Based on the good sensitivity found in this study, we conclude that this simple index can serve as a diagnostic biomarker to identify patients at risk of severe disease during the acute phase of P. vivax infection.
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Affiliation(s)
- Karla Sena Guedes
- Institute of Health Sciences, Federal University of Mato Grosso, Sinop, Brazil
| | | | | | - Cor Jesus Fernandes Fontes
- Institute of Health Sciences, Federal University of Mato Grosso, Sinop, Brazil.,Júlio Müller University Hospital, Federal University of Mato Grosso, Cuiabá, Brazil
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4
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Chery L, Maki JN, Mascarenhas A, Walke JT, Gawas P, Almeida A, Fernandes M, Vaz M, Ramanan R, Shirodkar D, Bernabeu M, Manoharan SK, Pereira L, Dash R, Sharma A, Shaik RB, Chakrabarti R, Babar P, White J, Mudeppa DG, Kumar S, Zuo W, Skillman KM, Kanjee U, Lim C, Shaw-Saliba K, Kumar A, Valecha N, Jindal VN, Khandeparkar A, Naik P, Amonkar S, Duraisingh MT, Tuljapurkar S, Smith JD, Dubhashi N, Pinto RGW, Silveria M, Gomes E, Rathod PK. Demographic and clinical profiles of Plasmodium falciparum and Plasmodium vivax patients at a tertiary care centre in southwestern India. Malar J 2016; 15:569. [PMID: 27884146 PMCID: PMC5123287 DOI: 10.1186/s12936-016-1619-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 11/15/2016] [Indexed: 01/11/2023] Open
Abstract
Background Malaria remains an important cause of morbidity and mortality in India. Though many comprehensive studies have been carried out in Africa and Southeast Asia to characterize and examine determinants of Plasmodium falciparum and Plasmodium vivax malaria pathogenesis, fewer have been conducted in India. Methods A prospective study of malaria-positive individuals was conducted at Goa Medical College and Hospital (GMC) from 2012 to 2015 to identify demographic, diagnostic and clinical indicators associated with P. falciparum and P. vivax infection on univariate analysis. Results Between 2012 and 2015, 74,571 febrile individuals, 6287 (8.4%) of whom were malaria positive, presented to GMC. The total number of malaria cases at GMC increased more than two-fold over four years, with both P. vivax and P. falciparum cases present year-round. Some 1116 malaria-positive individuals (mean age = 27, 91% male), 88.2% of whom were born outside of Goa and 51% of whom were construction workers, were enroled in the study. Of 1088 confirmed malaria-positive patients, 77.0% had P. vivax, 21.0% had P. falciparum and 2.0% had mixed malaria. Patients over 40 years of age and with P. falciparum infection were significantly (p < 0.001) more likely to be hospitalised than younger and P. vivax patients, respectively. While approximately equal percentages of hospitalised P. falciparum (76.6%) and P. vivax (78.9%) cases presented with at least one WHO severity indicator, a greater percentage of P. falciparum inpatients presented with at least two (43.9%, p < 0.05) and at least three (29.9%, p < 0.01) severity features. There were six deaths among the 182 hospitalised malaria positive patients, all of whom had P. falciparum. Conclusion During the four year study period at GMC, the number of malaria cases increased substantially and the greatest burden of severe disease was contributed by P. falciparum.
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Affiliation(s)
- Laura Chery
- Departments of Chemistry and Global Health, University of Washington, Seattle, WA, 98195, USA
| | - Jennifer N Maki
- Departments of Chemistry and Global Health, University of Washington, Seattle, WA, 98195, USA
| | - Anjali Mascarenhas
- Departments of Chemistry and Global Health, University of Washington, Seattle, WA, 98195, USA.,Goa Medical College and Hospital, Bambolim, Goa, 403202, India
| | - Jayashri T Walke
- Departments of Chemistry and Global Health, University of Washington, Seattle, WA, 98195, USA.,Goa Medical College and Hospital, Bambolim, Goa, 403202, India
| | - Pooja Gawas
- Departments of Chemistry and Global Health, University of Washington, Seattle, WA, 98195, USA.,Goa Medical College and Hospital, Bambolim, Goa, 403202, India
| | - Anvily Almeida
- Departments of Chemistry and Global Health, University of Washington, Seattle, WA, 98195, USA.,Goa Medical College and Hospital, Bambolim, Goa, 403202, India
| | - Mezia Fernandes
- Departments of Chemistry and Global Health, University of Washington, Seattle, WA, 98195, USA.,Goa Medical College and Hospital, Bambolim, Goa, 403202, India
| | - Marina Vaz
- Goa Medical College and Hospital, Bambolim, Goa, 403202, India
| | - Rakesh Ramanan
- Goa Medical College and Hospital, Bambolim, Goa, 403202, India
| | | | - Maria Bernabeu
- Center for Infectious Disease Research (CIDR), Seattle, WA, 98109, USA
| | - Suresh Kumar Manoharan
- Departments of Chemistry and Global Health, University of Washington, Seattle, WA, 98195, USA.,Goa Medical College and Hospital, Bambolim, Goa, 403202, India
| | - Ligia Pereira
- Departments of Chemistry and Global Health, University of Washington, Seattle, WA, 98195, USA.,Goa Medical College and Hospital, Bambolim, Goa, 403202, India
| | - Rashmi Dash
- Departments of Chemistry and Global Health, University of Washington, Seattle, WA, 98195, USA.,Goa Medical College and Hospital, Bambolim, Goa, 403202, India
| | - Ambika Sharma
- Departments of Chemistry and Global Health, University of Washington, Seattle, WA, 98195, USA.,Goa Medical College and Hospital, Bambolim, Goa, 403202, India
| | - Riaz Basha Shaik
- Departments of Chemistry and Global Health, University of Washington, Seattle, WA, 98195, USA.,Goa Medical College and Hospital, Bambolim, Goa, 403202, India
| | - Rimi Chakrabarti
- Departments of Chemistry and Global Health, University of Washington, Seattle, WA, 98195, USA.,Goa Medical College and Hospital, Bambolim, Goa, 403202, India
| | - Prasad Babar
- Departments of Chemistry and Global Health, University of Washington, Seattle, WA, 98195, USA.,Goa Medical College and Hospital, Bambolim, Goa, 403202, India
| | - John White
- Departments of Chemistry and Global Health, University of Washington, Seattle, WA, 98195, USA
| | - Devaraja G Mudeppa
- Departments of Chemistry and Global Health, University of Washington, Seattle, WA, 98195, USA
| | - Shiva Kumar
- Departments of Chemistry and Global Health, University of Washington, Seattle, WA, 98195, USA
| | - Wenyun Zuo
- Department of Biology, Stanford University, Stanford, CA, 94305, USA
| | - Kristen M Skillman
- Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, MA, 02115, USA
| | - Usheer Kanjee
- Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, MA, 02115, USA
| | - Caeul Lim
- Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, MA, 02115, USA
| | - Kathryn Shaw-Saliba
- Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, MA, 02115, USA
| | - Ashwani Kumar
- National Institute of Malaria Research, Field Unit, Campal, Goa, 403001, India
| | - Neena Valecha
- National Institute of Malaria Research (ICMR), Sector 8, Dwarka, New Delhi, 110077, India
| | - V N Jindal
- Goa Medical College and Hospital, Bambolim, Goa, 403202, India
| | | | - Pradeep Naik
- Goa Medical College and Hospital, Bambolim, Goa, 403202, India
| | - Sunanda Amonkar
- Goa Medical College and Hospital, Bambolim, Goa, 403202, India
| | - Manoj T Duraisingh
- Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, MA, 02115, USA
| | | | - Joseph D Smith
- Center for Infectious Disease Research (CIDR), Seattle, WA, 98109, USA
| | - Nagesh Dubhashi
- Goa Medical College and Hospital, Bambolim, Goa, 403202, India
| | - Roque G W Pinto
- Goa Medical College and Hospital, Bambolim, Goa, 403202, India
| | - Maria Silveria
- Goa Medical College and Hospital, Bambolim, Goa, 403202, India
| | - Edwin Gomes
- Goa Medical College and Hospital, Bambolim, Goa, 403202, India
| | - Pradipsinh K Rathod
- Departments of Chemistry and Global Health, University of Washington, Seattle, WA, 98195, USA.
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5
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Aung NM, Kaung M, Kyi TT, Kyaw MP, Min M, Htet ZW, Anstey NM, Kyi MM, Hanson J. The Safety of a Conservative Fluid Replacement Strategy in Adults Hospitalised with Malaria. PLoS One 2015; 10:e0143062. [PMID: 26581060 PMCID: PMC4651424 DOI: 10.1371/journal.pone.0143062] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 10/22/2015] [Indexed: 12/29/2022] Open
Abstract
Background A conservative approach to fluid resuscitation improves survival in children with severe malaria; however, this strategy has not been formally evaluated in adults with the disease. Methods Adults hospitalised with malaria at two tertiary referral hospitals in Myanmar received intravenous fluid replacement with isotonic saline, administered at a maintenance rate using a simple weight-based algorithm. Clinical and biochemical indices were followed sequentially. Results Of 61 adults enrolled, 34 (56%) had Plasmodium falciparum mono-infection, 17 (28%) Plasmodium vivax mono-infection and 10 (16%) mixed infection; 27 (44%) patients were at high risk of death (P. falciparum infection and RCAM score ≥ 2). In the first six hours of hospitalisation patients received a mean 1.7 ml/kg/hour (range: 1.3–2.2) of intravenous fluid and were able to drink a mean of 0.8 ml/kg/hour (range: 0–3). Intravenous fluid administration and oral intake were similar for the remainder of the first 48 hours of hospitalisation. All 61 patients survived to discharge. No patient developed Adult Respiratory Distress Syndrome, a requirement for renal replacement therapy or hypotension (mean arterial pressure < 60mmHg). Plasma lactate was elevated (> 2 mmol/L) on enrolment in 26 (43%) patients but had declined by 6 hours in 25 (96%) and was declining at 24 hours in the other patient. Plasma creatinine was elevated (> 120 μmol/L) on enrolment in 17 (28%) patients, but was normal or falling in 16 (94%) at 48 hours and declining in the other patient by 72 hours. There was no clinically meaningful increase in plasma lactate or creatinine in any patient with a normal value on enrolment. Patients receiving fluid replacement with the conservative fluid replacement algorithm were more likely to survive than historical controls in the same hospitals who had received fluid replacement guided by clinical judgement in the year prior to the study (p = 0.03), despite having more severe disease (p < 0.001). Conclusions A conservative fluid resuscitation strategy appears safe in adults hospitalised with malaria.
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Affiliation(s)
| | - Myat Kaung
- Hpa-an Hospital, Hpa-an, Kayin State, Myanmar
| | | | - Myat Phone Kyaw
- Department of Medical Research (Lower Myanmar), Yangon, Myanmar
| | - Myo Min
- Myanmar Medical Association, Yangon, Myanmar
| | | | - Nicholas M. Anstey
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | | | - Josh Hanson
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
- * E-mail:
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Kinung'hi SM, Magnussen P, Kishamawe C, Todd J, Vennervald BJ. The impact of anthelmintic treatment intervention on malaria infection and anaemia in school and preschool children in Magu district, Tanzania: an open label randomised intervention trial. BMC Infect Dis 2015; 15:136. [PMID: 25887977 PMCID: PMC4391149 DOI: 10.1186/s12879-015-0864-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 03/02/2015] [Indexed: 01/12/2023] Open
Abstract
Background Some studies have suggested that helminth infections increase the risk of malaria infection and are associated with increased number of malaria attacks and anaemia. Thus interventions to control helminth infections may have an impact on incidence of clinical malaria and anaemia. The current study assessed the impact of two anthelmintic treatment approaches on malaria infection and on anaemia in school and pre-school children in Magu district, Tanzania. Methods A total of 765 children were enrolled into a prospective randomized anthelmintic intervention trial following a baseline study of 1546 children. Enrolled children were randomized to receive either repeated treatment with praziquantel and albendazole four times a year (intervention group, 394 children) or single dose treatment with praziquantel and albendazole once a year (control group, 371 children). Follow up examinations were conducted at 12 and 24 months after baseline to assess the impact of the intervention. Stool and urine samples were collected and examined for schistosome and soil transmitted helminth infections. Blood samples were also collected and examined for malaria parasites and haemoglobin concentrations. Monitoring of clinical malaria attacks was performed at each school during the two years of the intervention. Results Out of 1546 children screened for P. falciparum, S. mansoni, S. haematobium, hookworm and T. Trichiura at baseline, 1079 (69.8%) were infected with at least one of the four parasites. There was no significant difference in malaria infection (prevalence, parasite density and frequency of malaria attacks) and in the prevalence of anaemia between the repeated and single dose anthelmintic treatment groups at 12 and 24 months follow up (p > 0.05). However, overall, there was significant improvement in mean haemoglobin concentrations (p < 0.001) from baseline levels of 122.0g/L and 123.0g/L to 136.0g/L and 136.8g/L for the repeated and single dose treatment groups, respectively, at 24 months follow-up which resulted in significant reduction in prevalence of anaemia. Conclusions These results suggest that repeated anthelmintic treatment did not have an impact on malaria infection compared to single dose treatment. However, both treatment approaches had overall impact in terms of improvements of haemoglobin levels and hence reductions in prevalence of anaemia.
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Affiliation(s)
- Safari M Kinung'hi
- National Institute for Medical Research (NIMR), Mwanza Centre, Isamilo Road, PO Box 1462, Mwanza, Tanzania.
| | - Pascal Magnussen
- Department of Veterinary Disease Biology, Faculty of Health and Medical Sciences, University of Copenhagen, Grønnegårdsvej 15 DK-1870 Frederiksberg C, Copenhagen, Denmark.
| | - Coleman Kishamawe
- National Institute for Medical Research (NIMR), Mwanza Centre, Isamilo Road, PO Box 1462, Mwanza, Tanzania.
| | - Jim Todd
- Depatment of Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, WC1E, 7HT, London, UK.
| | - Birgitte J Vennervald
- Department of Veterinary Disease Biology, Faculty of Health and Medical Sciences, University of Copenhagen, Grønnegårdsvej 15 DK-1870 Frederiksberg C, Copenhagen, Denmark.
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7
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Zha Y, Zhou M, Hari A, Jacobsen B, Mitragotri N, Rivas B, Ventura OG, Boughton J, Fox JC. Ultrasound diagnosis of malaria: examination of the spleen, liver, and optic nerve sheath diameter. World J Emerg Med 2015; 6:10-5. [PMID: 25802560 PMCID: PMC4369524 DOI: 10.5847/wjem.j.1920-8642.2015.01.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 11/28/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Over 90% of all cases of malaria worldwide occur in Africa. Current methods of diagnosis are time and labor intensive, and could lead to delayed treatment. METHODS In this study we investigated the effectiveness of measurements of spleen, liver, and optic nerve sheath diameter (ONSD) in identifying patients with malaria or severe malaria through the use of hand-held ultrasound devices. We recruited 40 adult patients with malaria and 16 adult control subjects at two hospitals in Mwanza, Tanzania. Ultrasonographic diagnosis was compared with rapid antigen diagnostic test and peripheral blood smear as the gold standards. An receiver operating characteristic curve test was performed to determine the most optimal diagnostic threshold for malaria and severe malaria, using each of the measurements for liver size, spleen size, and ONSD. The thresholds were determined to be >12 cm for spleen length and >15.1 cm for liver length, whereas ONSD was not significant in this study. RESULTS The sensitivities for malaria diagnosis were 66.7% and 58.3% for liver and spleen length respectively, suggesting that these measurements may not be suitable for identifying patients with severe malaria. However, the high specificity of 90.9% for spleen length and the acceptable specificity of 75.0% for liver length suggest that these measurements can be used as a method to eliminate false-positive diagnoses (i.e. patients who do not have severe malaria but are classified as having it by a test with a high sensitivity), giving a high positive predictive value. CONCLUSIONS We report a high specificity for spleen size and a moderate specificity for liver size in the ultrasonographic diagnosis of severe malaria. Thus when paired with a highly sensitive method of malaria diagnosis, ultrasonographic measurement of spleen and liver size is promising as part of a diagnostic algorithm for malaria. It could be used to stratify risk in patients diagnosed with malaria and assist in their triage. If no sensitive tests are available, ultrasound might be useful to suggest malaria as a cause of a patient's constellation of clinical symptoms.
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Affiliation(s)
- Yuanting Zha
- Irvine School of Medicine, University of California, 1001 Health Sciences Road, 252 Irvine Hall, Irvine, CA 92697, USA
| | - Michelle Zhou
- Irvine School of Medicine, University of California, 1001 Health Sciences Road, 252 Irvine Hall, Irvine, CA 92697, USA
| | - Anjali Hari
- Irvine School of Medicine, University of California, 1001 Health Sciences Road, 252 Irvine Hall, Irvine, CA 92697, USA
| | - Bradley Jacobsen
- Irvine School of Medicine, University of California, 1001 Health Sciences Road, 252 Irvine Hall, Irvine, CA 92697, USA
| | - Neha Mitragotri
- Irvine School of Medicine, University of California, 1001 Health Sciences Road, 252 Irvine Hall, Irvine, CA 92697, USA
| | - Bianca Rivas
- Irvine School of Medicine, University of California, 1001 Health Sciences Road, 252 Irvine Hall, Irvine, CA 92697, USA
| | - Olga Gabriela Ventura
- Irvine School of Medicine, University of California, 1001 Health Sciences Road, 252 Irvine Hall, Irvine, CA 92697, USA
| | - Janice Boughton
- Gritman Medical Center, 700 S Main Street, Moscow, ID, 83843, USA
| | - John Christian Fox
- Irvine School of Medicine, University of California, 1001 Health Sciences Road, 252 Irvine Hall, Irvine, CA 92697, USA
- Department of Emergency Medicine, Irvine Medical Center, University of California, 101 The City Drive, Orange, CA, 92868, USA
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9
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KUTSUNA S, KOBAYASHI T, KATO Y, FUJIYA Y, MAWATARI M, UJIIE M, TAKESHITA N, HAYAKAWA K, KANAGAWA S, MIZUNO Y, KANO S, OHMAGARI N. Malaria Cases Treated with Artemether/Lumefantrine in Japanese Travelers. ACTA ACUST UNITED AC 2014; 88:833-9. [DOI: 10.11150/kansenshogakuzasshi.88.833] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Satoshi KUTSUNA
- Disease Control and Prevention Center, National Center for Global Health and Medicine
| | - Taiichiro KOBAYASHI
- Disease Control and Prevention Center, National Center for Global Health and Medicine
- Division of AIDS Clinical Center, National Center for Global Health and Medicine
| | - Yasuyuki KATO
- Disease Control and Prevention Center, National Center for Global Health and Medicine
| | - Yoshihiro FUJIYA
- Disease Control and Prevention Center, National Center for Global Health and Medicine
| | - Momoko MAWATARI
- Disease Control and Prevention Center, National Center for Global Health and Medicine
| | - Mugen UJIIE
- Disease Control and Prevention Center, National Center for Global Health and Medicine
| | - Nozomi TAKESHITA
- Disease Control and Prevention Center, National Center for Global Health and Medicine
| | - Kayoko HAYAKAWA
- Disease Control and Prevention Center, National Center for Global Health and Medicine
| | - Shuzo KANAGAWA
- Disease Control and Prevention Center, National Center for Global Health and Medicine
| | - Yasutaka MIZUNO
- Disease Control and Prevention Center, National Center for Global Health and Medicine
- Department of Infection Control and Prevention, Tokyo Medical University Hospital
| | - Shigeyuki KANO
- Department of Tropical Medicine and Malaria, Research Institute, National Center for Global Health and Medicine
| | - Norio OHMAGARI
- Disease Control and Prevention Center, National Center for Global Health and Medicine
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Abstract
AIM To review the literature on the prevalence and incidence of peri-implantitis. METHODS Out of 322 potentially relevant publications we identified 29 articles concerning 23 studies, with information on the presence of signs of peri-implantitis in populations of at least 20 cases. RESULTS AND CONCLUSIONS All studies provided data from convenience samples, typically from patients who were treated in a clinical center during a certain period, and most data were cross-sectional or collected retrospectively. Based on the reviewed papers one may state that the prevalence of peri-implantitis seems to be in the order of 10% implants and 20% patients during 5-10 years after implant placement but the individual reported figures are rather variable, not easily comparable and not suitable for meta-analysis. Factors that should be considered to affect prevalence figures are the disease definition, the differential diagnosis, the chosen thresholds for probing depths and bone loss, differences in treatment methods and aftercare of patients, and dissimilarities in the composition of study populations. Smoking and a history of periodontitis have been associated with a higher prevalence of peri-implantitis.
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Affiliation(s)
- Andrea Mombelli
- School of Dental Medicine, Division of Periodontology and Oral Pathophysiology, University of Geneva, Rue Barthélemy-Menn 19, CH-1205, Geneva, Switzerland.
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11
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Anstey NM, Douglas NM, Poespoprodjo JR, Price RN. Plasmodium vivax: clinical spectrum, risk factors and pathogenesis. ADVANCES IN PARASITOLOGY 2013. [PMID: 23199488 DOI: 10.1016/b978-0-12-397900-1.00003-7] [Citation(s) in RCA: 147] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Vivax malaria was historically described as 'benign tertian malaria' because individual clinical episodes were less likely to cause severe illness than Plasmodium falciparum. Despite this, Plasmodium vivax was, and remains, responsible for major morbidity and significant mortality in vivax-endemic areas. Single infections causing febrile illness in otherwise healthy individuals rarely progress to severe disease. Nevertheless, in the presence of co-morbidities, P. vivax can cause severe illness and fatal outcomes. Recurrent or chronic infections in endemic areas can cause severe anaemia and malnutrition, particularly in early childhood. Other severe manifestations include acute lung injury, acute kidney injury and uncommonly, coma. Multiorgan failure and shock are described but further studies are needed to investigate the role of bacterial and other co-infections in these syndromes. In pregnancy, P. vivax infection can cause maternal anaemia, miscarriage, low birth weight and congenital malaria. Compared to P. falciparum, P. vivax has a greater capacity to elicit an inflammatory response, resulting in a lower pyrogenic threshold. Conversely, cytoadherence of P. vivax to endothelial cells is less frequent and parasite sequestration is not thought to be a significant cause of severe illness in vivax malaria. With a predilection for young red cells, P. vivax does not result in the high parasite biomass associated with severe disease in P. falciparum, but a four to fivefold greater removal of uninfected red cells from the circulation relative to P. falciparum is associated with a similar risk of severe anaemia. Mechanisms underlying the pathogenesis of severe vivax syndromes remain incompletely understood.
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Affiliation(s)
- Nicholas M Anstey
- Global Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia
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12
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Cserti-Gazdewich CM, Dhabangi A, Musoke C, Ssewanyana I, Ddungu H, Nakiboneka-Ssenabulya D, Nabukeera-Barungi N, Mpimbaza A, Dzik WH. Inter-relationships of cardinal features and outcomes of symptomatic pediatric Plasmodium falciparum MALARIA in 1,933 children in Kampala, Uganda. Am J Trop Med Hyg 2013; 88:747-756. [PMID: 23358640 PMCID: PMC3617864 DOI: 10.4269/ajtmh.12-0668] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Malaria remains a challenging diagnosis with variable clinical presentation and a wide spectrum of disease severity. Using a structured case report form, we prospectively assessed 1,933 children at Mulago Hospital in Kampala, Uganda with acute Plasmodium falciparum malaria. Children with uncomplicated malaria significantly differed from those with severe disease for 17 features. Among 855 children with severe disease, the case-fatality rate increased as the number of severity features increased. Logistic regression identified five factors independently associated with death: cerebral malaria, hypoxia, severe thrombocytopenia, leukocytosis, and lactic acidosis. Cluster analysis identified two groups: one combining anemia, splenomegaly, and leukocytosis; and a second group centered on death, severe thrombocytopenia, and lactic acidosis, which included cerebral malaria, hypoxia, hypoglycemia, and hyper-parasitemia. Our report updates previous clinical descriptions of severe malaria, quantifies significant clinical and laboratory inter-relationships, and will assist clinicians treating malaria and those planning or assessing future research (NCT00707200) (www.clinicaltrials.gov).
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Affiliation(s)
| | | | | | | | | | | | | | | | - Walter H. Dzik
- *Address correspondence to Walter H. Dzik, Department of Pathology, Blood Transfusion Service, J224, Harvard University, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114. E-mail:
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13
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Magalhães BML, Alexandre MAA, Siqueira AM, Melo GC, Gimaque JBL, Bastos MS, Figueiredo RMP, Carvalho RC, Tavares MA, Naveca FG, Alonso P, Bassat Q, Lacerda MVG, Mourão MPG. Clinical profile of concurrent dengue fever and Plasmodium vivax malaria in the Brazilian Amazon: case series of 11 hospitalized patients. Am J Trop Med Hyg 2012; 87:1119-24. [PMID: 23033396 DOI: 10.4269/ajtmh.2012.12-0210] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Malaria and dengue fever are the most prevalent vector-borne diseases worldwide. This study aims to describe the clinical profile of patients with molecular diagnosis of concurrent malaria and dengue fever in a tropical-endemic area. Eleven patients with concurrent dengue virus (DENV) and Plasmodium vivax infection are reported. Similar frequencies of DENV-2, DENV-3, and DENV-4 were found, including DENV-3/DENV-4 co-infection. In eight patients, the World Health Organization (WHO) criteria for severe malaria could be fulfilled (jaundice being the most common). Only one patient met severe dengue criteria, but warning signs were present in 10. Syndromic surveillance systems must be ready to identify this condition to avoid misinterpretation of severity attributed to a single disease.
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Lacerda MVG, Fragoso SCP, Alecrim MGC, Alexandre MAA, Magalhães BML, Siqueira AM, Ferreira LCL, Araújo JR, Mourão MPG, Ferrer M, Castillo P, Martin-Jaular L, Fernandez-Becerra C, del Portillo H, Ordi J, Alonso PL, Bassat Q. Postmortem characterization of patients with clinical diagnosis of Plasmodium vivax malaria: to what extent does this parasite kill? Clin Infect Dis 2012; 55:e67-74. [PMID: 22772803 DOI: 10.1093/cid/cis615] [Citation(s) in RCA: 150] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Severe disease attributable to Plasmodium vivax infection is already well described worldwide; however, autopsies in these patients are scarce. METHODS From 1996 to 2010, 19 patient deaths with a clinical diagnosis of P. vivax infection occurred in a tertiary care center in the Brazilian Amazon. Seventeen of these 19 deaths were fully autopsied. Clinical charts, macroscopic autopsy reports, and stored paraffinized tissue blocks were retrieved. Nested polymerase chain reaction was performed in paraffinized samples of spleen and lung to confirm P. vivax monoinfection. Immunohistofluorescence was used to detect P. vivax parasitized red blood cells (RBCs). RESULTS Of 17 autopsies, 13 revealed that death could be attributed to P. vivax infection; in the remaining 4, acute diseases other than malaria were found to be the cause of death. The primary complication in patients in which malaria contributed to death was acute respiratory distress syndrome (ARDS) and pulmonary edema associated with the accumulation of neutrophils in the interalveolar space (6 cases). Spleen rupture (3 cases) and multiorgan dysfunction syndrome (3 cases) were the second most common complications. One child evolving with coma was also characterized, but no parasite was detected in the brain tissue. In one patient who developed ARDS and presented negative peripheral parasitemia by the time of death, scattered parasitized red blood cells were seen inside pulmonary capillaries, suggesting some sequestration in the lung. CONCLUSIONS In 13 of 17 deceased patients, P. vivax infection was the plausible cause of death. However, more studies are needed to understand pathogenesis related to severe disease.
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Affiliation(s)
- Marcus V G Lacerda
- Laboratory of Malaria, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Av. Pedro Teixeira, 25, Manaus, Amazonas 69040-000, Brazil.
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15
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Lança EFC, Magalhães BML, Vitor-Silva S, Siqueira AM, Benzecry SG, Alexandre MAA, O'Brien C, Bassat Q, Lacerda MVG. Risk factors and characterization of Plasmodium vivax-associated admissions to pediatric intensive care units in the Brazilian Amazon. PLoS One 2012; 7:e35406. [PMID: 22523591 PMCID: PMC3327677 DOI: 10.1371/journal.pone.0035406] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Accepted: 03/15/2012] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Plasmodium vivax is responsible for a significant proportion of malaria cases worldwide and is increasingly reported as a cause of severe disease. The objective of this study was to characterize severe vivax disease among children hospitalized in intensive care units (ICUs) in the Western Brazilian Amazon, and to identify risk factors associated with disease severity. METHODS AND FINDINGS In this retrospective study, clinical records of 34 children, 0-14 years of age hospitalized in the 11 public pediatric and neonatal ICUs of the Manaus area, were reviewed. P. falciparum monoinfection or P. falciparum/P. vivax mixed infection was diagnosed by microscopy in 10 cases, while P. vivax monoinfection was confirmed in the remaining 24 cases. Two of the 24 patients with P. vivax monoinfection died. Respiratory distress, shock and severe anemia were the most frequent complications associated with P. vivax infection. Ninety-one children hospitalized with P. vivax monoinfections but not requiring ICU were consecutively recruited in a tertiary care hospital for infectious diseases to serve as a reference population (comparators). Male sex (p = 0.039), age less than five years (p = 0.028), parasitemia greater than 500/mm(3) (p = 0.018), and the presence of any acute (p = 0.023) or chronic (p = 0.017) co-morbidity were independently associated with ICU admission. At least one of the WHO severity criteria for malaria (formerly validated for P. falciparum) was present in 23/24 (95.8%) of the patients admitted to the ICU and in 17/91 (18.7%) of controls, making these criteria a good predictor of ICU admission (p = 0.001). The only investigated criterion not associated with ICU admission was hyperbilirubinemia (p = 0.513)]. CONCLUSIONS Our study points to the importance of P. vivax-associated severe disease in children, causing 72.5% of the malaria admissions to pediatric ICUs. WHO severity criteria demonstrated good sensitivity in predicting severe P. vivax infection in this small case series.
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Affiliation(s)
- Ellen Fátima Caetano Lança
- Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil
- Universidade Federal do Amazonas, Manaus, Amazonas, Brazil
| | - Belisa Maria Lopes Magalhães
- Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil
- National Institute of Science and Technology for Innovation in Neglected Diseases, Rio de Janeiro, Brazil
| | - Sheila Vitor-Silva
- Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil
- National Institute of Science and Technology for Innovation in Neglected Diseases, Rio de Janeiro, Brazil
| | - André Machado Siqueira
- Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil
- National Institute of Science and Technology for Innovation in Neglected Diseases, Rio de Janeiro, Brazil
| | | | - Márcia Almeida Araújo Alexandre
- Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil
- Universidade Nilton Lins, Manaus, Amazonas, Brazil
| | - Connor O'Brien
- Columbia University Medical Center, New York, New York, United States of America
| | - Quique Bassat
- Centre de Recerca en Salut Internacional de Barcelona (CRESIB)/Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Marcus Vinícius Guimarães Lacerda
- Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil
- Universidade Nilton Lins, Manaus, Amazonas, Brazil
- National Institute of Science and Technology for Innovation in Neglected Diseases, Rio de Janeiro, Brazil
- * E-mail:
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16
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Prognostic value of clinical and parasitological signs for severe malaria in patients from Colombia. BIOMEDICA 2012. [DOI: 10.7705/biomedica.v32i0.613] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Introducción. El pronto reconocimiento de los signos de peligro en los pacientes con malaria puede reducir las complicaciones y muertes. Sin embargo, se conoce poco sobre su valor pronóstico para la malaria complicada, especialmente en las zonas de transmisión baja e inestable de la enfermedad.Objetivo. Estimar el valor pronóstico de gravedad que tienen diversos signos clínicos y parasitológicos en los pacientes con malaria.Materiales y métodos. Se hizo un estudio en una cohorte prospectiva con pacientes de cinco municipios de Colombia, con diagnóstico de malaria por Plasmodium falciparum y P. vivax, en quienes se estudió la asociación de los signos clínicos y los parasitológicos con la malaria complicada.Resultados. Se obtuvo un modelo de predicción con una sensibilidad de 47,4 % y especificidad de 92,8 %, valor pronóstico positivo de 63,2 % y valor pronóstico negativo de 87,1 %, el cual incluye ictericia, orina oscura, hiperpirexia y signos de deshidratación.Conclusiones. Con el fin de causar un impacto en la morbilidad complicada de la malaria, se propone una estrategia de reconocimiento de los signos de peligro por el personal no médico, que se acompañede otros elementos de la atención, como el suministro de un tratamiento antipalúdico adecuado y oportuno. Se proponen los criterios del diagnóstico de complicación moderada.
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van Wolfswinkel ME, Hesselink DA, Hoorn EJ, de Rijke YB, Koelewijn R, van Hellemond JJ, van Genderen PJJ. Copeptin does not accurately predict disease severity in imported malaria. Malar J 2012; 11:6. [PMID: 22221299 PMCID: PMC3268091 DOI: 10.1186/1475-2875-11-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2011] [Accepted: 01/05/2012] [Indexed: 11/10/2022] Open
Abstract
Background Copeptin has recently been identified to be a stable surrogate marker for the unstable hormone arginine vasopressin (AVP). Copeptin has been shown to correlate with disease severity in leptospirosis and bacterial sepsis. Hyponatraemia is common in severe imported malaria and dysregulation of AVP release has been hypothesized as an underlying pathophysiological mechanism. The aim of the present study was to evaluate the performance of copeptin as a predictor of disease severity in imported malaria. Methods Copeptin was measured in stored serum samples of 204 patients with imported malaria that were admitted to our Institute for Tropical Diseases in Rotterdam in the period 1999-2010. The occurrence of WHO defined severe malaria was the primary end-point. The diagnostic performance of copeptin was compared to that of previously evaluated biomarkers C-reactive protein, procalcitonin, lactate and sodium. Results Of the 204 patients (141 Plasmodium falciparum, 63 non-falciparum infection), 25 had severe malaria. The Area Under the ROC curve of copeptin for severe disease (0.66 [95% confidence interval 0.59-0.72]) was comparable to that of lactate, sodium and procalcitonin. C-reactive protein (0.84 [95% CI 0.79-0.89]) had a significantly better performance as a biomarker for severe malaria than the other biomarkers. Conclusions C-reactive protein but not copeptin was found to be an accurate predictor for disease severity in imported malaria. The applicability of copeptin as a marker for severe malaria in clinical practice is limited to exclusion of severe malaria.
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Affiliation(s)
- Marlies E van Wolfswinkel
- Department of Internal Medicine, Harbour Hospital and Institute for Tropical Diseases, Haringvliet 2, 3011 TD Rotterdam, The Netherlands
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Ampawong S, Combes V, Hunt NH, Radford J, Chan-Ling T, Pongponratn E, Grau GER. Quantitation of brain edema and localisation of aquaporin 4 expression in relation to susceptibility to experimental cerebral malaria. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2011; 4:566-574. [PMID: 21904632 PMCID: PMC3160608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/14/2011] [Accepted: 07/19/2011] [Indexed: 05/31/2023]
Abstract
The pathogenic mechanisms underlying the occurrence of cerebral malaria (CM) are still incompletely understood but, clearly, cerebral complications may result from concomitant microvessel obstruction and inflammation. The extent to which brain edema contributes to pathology has not been investigated. Using the model of P. berghei ANKA infection, we compared brain microvessel morphology of CM-susceptible and CM-resistant mice. By quantitative planimetry, we provide evidence that CM is characterized by enlarged perivascular spaces (PVS). We show a dramatic aquaporin 4 (AQP4) upregulation, selectively at the level of astrocytic foot processes, in both CM and non-CM disease, but significantly more pronounced in mice with malarial-induced neurological syndrome. This suggests that a threshold of AQP4 expression is needed to lead to neurovascular pathology, a view that is supported by significantly higher levels in mice with clinically overt CM. Numbers of intravascular leukocytes significantly correlated with both PVS enlargement and AQP4 overexpression. Thus, brain edema could be a contributing factor in CM pathogenesis and AQP4, specifically in its astrocytic location, a key molecule in this mechanism. Since experimental CM is associated with substantial brain edema, it models paediatric CM better than the adult syndrome and it is tempting to evaluate AQP4 in the former context. If AQP4 changes are confirmed in human CM, it may represent a novel target for therapeutic intervention.
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Affiliation(s)
- Sumate Ampawong
- Vascular Immunology Unit, Dept. of Pathology, Faculty of Medicine and Bosch Institute, University of Sydney, Sydney, Australia
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Vekemans J, Marsh K, Greenwood B, Leach A, Kabore W, Soulanoudjingar S, Asante KP, Ansong D, Evans J, Sacarlal J, Bejon P, Kamthunzi P, Salim N, Njuguna P, Hamel MJ, Otieno W, Gesase S, Schellenberg D. Assessment of severe malaria in a multicenter, phase III, RTS, S/AS01 malaria candidate vaccine trial: case definition, standardization of data collection and patient care. Malar J 2011; 10:221. [PMID: 21816031 PMCID: PMC3221632 DOI: 10.1186/1475-2875-10-221] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2011] [Accepted: 08/04/2011] [Indexed: 11/10/2022] Open
Abstract
Background An effective malaria vaccine, deployed in conjunction with other malaria interventions, is likely to substantially reduce the malaria burden. Efficacy against severe malaria will be a key driver for decisions on implementation. An initial study of an RTS, S vaccine candidate showed promising efficacy against severe malaria in children in Mozambique. Further evidence of its protective efficacy will be gained in a pivotal, multi-centre, phase III study. This paper describes the case definitions of severe malaria used in this study and the programme for standardized assessment of severe malaria according to the case definition. Methods Case definitions of severe malaria were developed from a literature review and a consensus meeting of expert consultants and the RTS, S Clinical Trial Partnership Committee, in collaboration with the World Health Organization and the Malaria Clinical Trials Alliance. The same groups, with input from an Independent Data Monitoring Committee, developed and implemented a programme for standardized data collection. The case definitions developed reflect the typical presentations of severe malaria in African hospitals. Markers of disease severity were chosen on the basis of their association with poor outcome, occurrence in a significant proportion of cases and on an ability to standardize their measurement across research centres. For the primary case definition, one or more clinical and/or laboratory markers of disease severity have to be present, four major co-morbidities (pneumonia, meningitis, bacteraemia or gastroenteritis with severe dehydration) are excluded, and a Plasmodium falciparum parasite density threshold is introduced, in order to maximize the specificity of the case definition. Secondary case definitions allow inclusion of co-morbidities and/or allow for the presence of parasitaemia at any density. The programmatic implementation of standardized case assessment included a clinical algorithm for evaluating seriously sick children, improvements to care delivery and a robust training and evaluation programme for clinicians. Conclusions The case definition developed for the pivotal phase III RTS, S vaccine study is consistent with WHO recommendations, is locally applicable and appropriately balances sensitivity and specificity in the diagnosis of severe malaria. Processes set up to standardize severe malaria data collection will allow robust assessment of the efficacy of the RTS, S vaccine against severe malaria, strengthen local capacity and benefit patient care for subjects in the trial. Trial registration Clinicaltrials.gov NCT00866619
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20
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Knowles SC. The effect of helminth co-infection on malaria in mice: A meta-analysis. Int J Parasitol 2011; 41:1041-51. [DOI: 10.1016/j.ijpara.2011.05.009] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2011] [Revised: 04/08/2011] [Accepted: 05/16/2011] [Indexed: 11/25/2022]
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21
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Lacerda MVGD, Mourão MPG, Santos PJTD, Alecrim MDGC. [Algid malaria: a syndromic diagnosis]. Rev Soc Bras Med Trop 2009; 42:79-81. [PMID: 19287942 DOI: 10.1590/s0037-86822009000100017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2008] [Accepted: 01/19/2009] [Indexed: 11/21/2022] Open
Abstract
Two patients with malaria due to Plasmodium falciparum who progressed to shock syndrome are reported. They received hemodynamic support in an intensive care unit without using antibiotics and presented improvements. Algid malaria should be a syndromic diagnosis of varying etiology (dehydration, bacterial infection, bleeding and/or adrenal insufficiency).
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The pathophysiology of vivax malaria. Trends Parasitol 2009; 25:220-7. [PMID: 19349210 DOI: 10.1016/j.pt.2009.02.003] [Citation(s) in RCA: 275] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2008] [Revised: 02/02/2009] [Accepted: 02/05/2009] [Indexed: 12/12/2022]
Abstract
Long considered a benign infection, Plasmodium vivax is now recognized as a cause of severe and fatal malaria, despite its low parasite biomass, the increased deformability of vivax-infected red blood cells and an apparent paucity of parasite sequestration. Severe anemia is associated with recurrent bouts of hemolysis of predominantly uninfected erythrocytes with increased fragility, and lung injury is associated with inflammatory increases in alveolar-capillary membrane permeability. Although rare, vivax-associated coma challenges our understanding of pathobiology caused by Plasmodium spp. Host and parasite factors contribute to the risk of severe disease, and comorbidities might contribute to vivax mortality. In this review, we discuss potential mechanisms underlying the syndromes of uncomplicated and severe vivax malaria, identifying key areas for future research.
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Imbert P, Rapp C, Buffet PA. Pathological rupture of the spleen in malaria: analysis of 55 cases (1958-2008). Travel Med Infect Dis 2009; 7:147-59. [PMID: 19411041 DOI: 10.1016/j.tmaid.2009.01.002] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2008] [Accepted: 01/08/2009] [Indexed: 10/21/2022]
Abstract
BACKGROUND Splenic rupture during acute malaria is rare but underreported. Because splenic rupture occurs mostly in non-immune adults, ongoing malaria elimination efforts may paradoxically increase the proportion of Plasmodium-infected patients suffering from this life-threatening complication. The pathogenesis and optimal patient management are still debated. METHOD We collected and analysed reports of pathological rupture of the spleen associated with malaria published over the last 50 years in five languages. RESULTS Fifty-five cases were reported, due to Plasmodium falciparum (n=26), Plasmodium vivax (n=23), Plasmodium ovale (n=2), Plasmodium malariae (n=2), or P. vivax-falciparum (n=2), and occurred in travellers (n=24), locals (n=21), expatriates (n=6) or migrants (n=4). Median age was 31.5 years and sex ratio M/F 3.2. Splenic rupture was complete with hemoperitoneum (n=50), or partial (n=5). Death occurred in 12 patients (22%), 8 of whom from early irreversible collapse (n=7) or unexpected death (n=1). Death rate was higher among travellers than in other patients (9/24, 38%, versus 3/31, 10%, p=0.01). Clinical features of P. falciparum- or P. vivax-associated splenic rupture were strikingly similar. Treatment included in-hospital medical observation without surgery (conservative management, n=14), immediate splenectomy (n=29), delayed splenectomy (n=4), or none (patients dying at admission, n=8). The type of treatment, conservative or not, had no influence on prognosis. The median duration of malaria symptoms before diagnosis was longer in our review (5-6 days) than in previous reports on imported malaria (3-4 days), suggesting that early diagnosis and therapy of malaria may reduce the incidence of splenic rupture. CONCLUSIONS Abdominal pain, collapse, or fainting is warning symptoms. Fourteen published observations support conservative management in carefully selected patients. Spleen preservation likely reduces the risk of future severe malaria attacks in patients with potential further exposition to Plasmodium sp., and also that of overwhelming sepsis in all.
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Affiliation(s)
- Patrick Imbert
- Service des Maladies Infectieuses et Tropicales, Hôpital d'Instruction des Armées Bégin, Saint-Mandé, France.
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Multidrug-resistant Plasmodium vivax associated with severe and fatal malaria: a prospective study in Papua, Indonesia. PLoS Med 2008; 5:e128. [PMID: 18563962 PMCID: PMC2429950 DOI: 10.1371/journal.pmed.0050128] [Citation(s) in RCA: 435] [Impact Index Per Article: 27.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2007] [Accepted: 05/02/2008] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Multidrug-resistant Plasmodium vivax (Pv) is widespread in eastern Indonesia, and emerging elsewhere in Asia-Pacific and South America, but is generally regarded as a benign disease. The aim of the study was to review the spectrum of disease associated with malaria due to Pv and P. falciparum (Pf) in patients presenting to a hospital in Timika, southern Papua, Indonesia. METHODS AND FINDINGS Data were prospectively collected from all patients attending the outpatient and inpatient departments of the only hospital in the region using systematic data forms and hospital computerised records. Between January 2004 and December 2007, clinical malaria was present in 16% (60,226/373,450) of hospital outpatients and 32% (12,171/37,800) of inpatients. Among patients admitted with slide-confirmed malaria, 64% of patients had Pf, 24% Pv, and 10.5% mixed infections. The proportion of malarial admissions attributable to Pv rose to 47% (415/887) in children under 1 y of age. Severe disease was present in 2,634 (22%) inpatients with malaria, with the risk greater among Pv (23% [675/2,937]) infections compared to Pf (20% [1,570/7,817]; odds ratio [OR] = 1.19 [95% confidence interval (CI) 1.08-1.32], p = 0.001), and greatest in patients with mixed infections (31% [389/1,273]); overall p < 0.0001. Severe anaemia (haemoglobin < 5 g/dl) was the major complication associated with Pv, accounting for 87% (589/675) of severe disease compared to 73% (1,144/1,570) of severe manifestations with Pf (p < 0.001). Pure Pv infection was also present in 78 patients with respiratory distress and 42 patients with coma. In total 242 (2.0%) patients with malaria died during admission: 2.2% (167/7,722) with Pf, 1.6% (46/2,916) with Pv, and 2.3% (29/1260) with mixed infections (p = 0.126). CONCLUSIONS In this region with established high-grade chloroquine resistance to both Pv and Pf, Pv is associated with severe and fatal malaria particularly in young children. The epidemiology of P. vivax needs to be re-examined elsewhere where chloroquine resistance is increasing.
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