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Gómez-Hernández MT, Martínez EJ, Fuentes MG, Paz M, Rodríguez I, Novoa NM, Jiménez MF. Extracorporeal membrane oxygenation (ECMO) as bridge therapy to surgery in a patient with acute respiratory distress syndrome (ARDS) due to rupture of a pulmonary hydatid cyst. Arch Bronconeumol 2021; 57:503-504. [PMID: 35698964 DOI: 10.1016/j.arbr.2021.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 11/01/2020] [Indexed: 06/15/2023]
Affiliation(s)
| | - Ernest J Martínez
- Unidad de Cuidados Intensivos, Hospital Universitario de Salamanca, Salamanca, Spain
| | - Marta G Fuentes
- Departamento de Cirugía Torácica, Hospital Universitario de Salamanca, Salamanca, Spain
| | - Marta Paz
- Unidad de Cuidados Intensivos, Hospital Universitario de Salamanca, Salamanca, Spain
| | - Israel Rodríguez
- Departamento de Cirugía Torácica, Hospital Universitario de Salamanca, Salamanca, Spain
| | - Nuria M Novoa
- Departamento de Cirugía Torácica, Hospital Universitario de Salamanca, Salamanca, Spain
| | - Marcelo F Jiménez
- Departamento de Cirugía Torácica, Hospital Universitario de Salamanca, Salamanca, Spain
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2
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Gómez-Hernández MT, Martínez EJ, Fuentes MG, Paz M, Rodríguez I, Novoa NM, Jiménez MF. Pulmonar Extracorporeal Oxygenation Membrane (ECMO) as Bridge Therapy to Surgery in a Patient with Acute Respiratory Dystres Syndrome (ARDS) due to the Rupture of a Pulmonary Hydathid Cyst. Arch Bronconeumol 2020:S0300-2896(20)30518-4. [PMID: 33358225 DOI: 10.1016/j.arbres.2020.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 10/14/2020] [Accepted: 11/01/2020] [Indexed: 11/15/2022]
Affiliation(s)
| | - Ernest J Martínez
- Unidad de Cuidados Intensivos. Hospital Universitario de Salamanca, Salamanca, España
| | - Marta G Fuentes
- Departamento de Cirugía Torácica, Hospital Universitario de Salamanca, Salamanca, España
| | - Marta Paz
- Unidad de Cuidados Intensivos. Hospital Universitario de Salamanca, Salamanca, España
| | - Israel Rodríguez
- Departamento de Cirugía Torácica, Hospital Universitario de Salamanca, Salamanca, España
| | - Nuria M Novoa
- Departamento de Cirugía Torácica, Hospital Universitario de Salamanca, Salamanca, España
| | - Marcelo F Jiménez
- Departamento de Cirugía Torácica, Hospital Universitario de Salamanca, Salamanca, España
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Kotepui M, Kotepui KU, Milanez GDJ, Masangkay FR. Prevalence and risk factors related to poor outcome of patients with severe Plasmodium vivax infection: a systematic review, meta-analysis, and analysis of case reports. BMC Infect Dis 2020; 20:363. [PMID: 32448216 PMCID: PMC7245863 DOI: 10.1186/s12879-020-05046-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 04/20/2020] [Indexed: 12/17/2022] Open
Abstract
Background Plasmodium vivax rarely develops severe complications when compared to severe falciparum malaria. However, severe vivax malaria also needs urgent, intensive care and treatment as severe falciparum malaria. This systematic review aimed to explore pooled prevalence of severe vivax malaria and to identify factors related to poor outcome of patients who developed severe manifestation. Methods The systematic review conducted by two reviewers independently through searching of research publications related to severe P. vivax malaria in three databases including MEDLINE, Web of Science (ISI), and Scopus until October, 22 2019. The pooled prevalence of severe vivax malaria was achieved using STATA and RevMan 5 Software. Factors related to poor outcome of patients with severe vivax malaria were analyzed using SPSS 11.5 Software. Results Among 2615 research publications retrieved from three databases, 49 articles reporting on 42,325 severity cases were selected for calculating pooled prevalence. Seventy-six patients from case reports, case series, letter to editors, and research communications were collected to identify factors related to poor outcome of patients with severe vivax malaria. The results showed that severe anemia, jaundice, respiratory distress, impaired consciousness, and renal failure were the most common major manifestations of severe malaria guided by the World Health Organization (WHO) criterion. The meta-analysis indicated that severe malaria was less frequent in patient with P. vivax compared to those with P. falciparum (P -value < 0.00001, OR = 0.38, 95% CI = 0.25–0.56, I2 = 87%). In addition, thrombocytopenia, anemia, hepatitis, and severe thrombocytopenia were the most common minor complications. Analysis of cases indicated that convulsion, respiratory distress, renal failure, jaundice, anuria/oliguria, and complication during treatment impacted on longer hospital stays compared to other severe complications (P-value < 0.05). Respiratory distress was frequently found after first treatment with anti-malarial drugs (P-value = 0.002). Renal failure was frequently found before treatment with anti-malarial drugs (P-value = 0.016). Mean days of fever and higher pulse rates at presentation were predictors of poor outcome among patients with severe vivax malaria (P-value < 0.05). Conclusions Severe anemia was the most common major manifestation of P. vivax malaria guided by the WHO criterion. Severe anemia was found less frequently in patients with P. vivax than those with P. falciparum. Renal failure, jaundice, anuria/oliguria, and complication during treatment along with, mean days of fever and higher pulse rates at presentation might be predictors of poor outcome of patients with severe vivax malaria.
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Affiliation(s)
- Manas Kotepui
- Medical Technology, School of Allied Health Sciences, Walailak University, Thasala, Nakhon Si Thammarat, Thailand.
| | - Kwuntida Uthaisar Kotepui
- Medical Technology, School of Allied Health Sciences, Walailak University, Thasala, Nakhon Si Thammarat, Thailand
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Hirako IC, Assis PA, Galvão-Filho B, Luster AD, Antonelli LR, Gazzinelli RT. Monocyte-derived dendritic cells in malaria. Curr Opin Microbiol 2019; 52:139-150. [PMID: 31542508 DOI: 10.1016/j.mib.2019.08.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 08/03/2019] [Accepted: 08/17/2019] [Indexed: 12/16/2022]
Abstract
The pathogenesis of malaria is a multifactorial syndrome associated with a deleterious inflammatory response that is responsible for many of the clinical manifestations. While dendritic cells (DCs) play a critical role in initiating acquired immunity and host resistance to infection, they also play a pathogenic role in inflammatory diseases. In our recent studies, we found in different rodent malaria models that the monocyte-derived DCs (MO-DCs) become, transiently, a main DC population in spleens and inflamed non-lymphoid organs. These studies suggest that acute infection with Plasmodium berghei promotes the differentiation of splenic monocytes into inflammatory monocytes (iMOs) and thereafter into MO-DCs that play a pathogenic role by promoting inflammation and tissue damage. The recruitment of MO-DCs to the lungs and brain are dependent on expression of CCR4 and CCR5, respectively, and expression of respective chemokine ligands in each organ. Once they reach the target organ the MO-DCs produce the CXCR3 ligands (CXCL9 and CXCL10), recruit CD8+ T cells, and produce toxic metabolites that play an important role in the development of experimental cerebral malaria (ECM) and acute respiratory distress syndrome (ARDS).
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Affiliation(s)
- Isabella C Hirako
- Fundação Oswaldo Cruz - Minas, 30190-002 Belo Horizonte, MG, Brazil; University of Massachusetts Medical School, 01605 Worcester, MA, United States
| | - Patrícia A Assis
- University of Massachusetts Medical School, 01605 Worcester, MA, United States
| | | | - Andrew D Luster
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Lis Rv Antonelli
- Fundação Oswaldo Cruz - Minas, 30190-002 Belo Horizonte, MG, Brazil
| | - Ricardo T Gazzinelli
- Fundação Oswaldo Cruz - Minas, 30190-002 Belo Horizonte, MG, Brazil; University of Massachusetts Medical School, 01605 Worcester, MA, United States; Plataforma de Medicina Translacional, Fundação Oswaldo Cruz, 14049-900, Ribeirão Preto, SP, Brazil.
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5
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Galvão-Filho B, de Castro JT, Figueiredo MM, Rosmaninho CG, Antonelli LRDV, Gazzinelli RT. The emergence of pathogenic TNF/iNOS producing dendritic cells (Tip-DCs) in a malaria model of acute respiratory distress syndrome (ARDS) is dependent on CCR4. Mucosal Immunol 2019; 12:312-322. [PMID: 30337650 PMCID: PMC6375779 DOI: 10.1038/s41385-018-0093-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 09/02/2018] [Accepted: 09/10/2018] [Indexed: 02/04/2023]
Abstract
Malaria-associated acute respiratory distress syndrome (MA-ARDS) and acute lung injury (ALI) are complications that cause lung damage and often leads to death. The MA-ARDS/ALI is associated with a Type 1 inflammatory response mediated by T lymphocytes and IFN-γ. Here, we used the Plasmodium berghei NK65 (PbN)-induced MA-ALI/ARDS model that resembles human disease and confirmed that lung CD4+ and CD8+ T cells predominantly expressed Tbet and IFN-γ. Surprisingly, we found that development of MA-ALI/ARDS was dependent on functional CCR4, known to mediate the recruitment of Th2 lymphocytes and regulatory T cells. However, in this Type 1 inflammation-ARDS model, CCR4 was not involved in the recruitment of T lymphocytes, but was required for the emergence of TNF-α/iNOS producing dendritic cells (Tip-DCs) in the lungs. In contrast, recruitment of Tip-DCs and development of MA-ALI/ARDS were not altered in CCR2-/- mice. Importantly, we showed that NOS2-/- mice are resistant to PbN-induced lung damage, indicating that reactive nitrogen species produced by Tip-DCs play an essential role in inducing MA-ARDS/ALI. Lastly, our experiments suggest that production of IFN-γ primarily by CD8+ T cells is required for inducing Tip-DCs differentiation in the lungs and the development of MA-ALI/ARDS model.
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Affiliation(s)
- Bruno Galvão-Filho
- Departamento de Bioquímica e Imunologia, ICB, Universidade Federal de Minas Gerais, 31270-901, Belo Horizonte, MG, Brazil,Laboratório de Imunopatologia, Instituto Rene Rachou, Fundação Oswaldo Cruz –Minas, 30190-002, Belo Horizonte, MG, Brazil
| | - Júlia Teixeira de Castro
- Laboratório de Imunopatologia, Instituto Rene Rachou, Fundação Oswaldo Cruz –Minas, 30190-002, Belo Horizonte, MG, Brazil
| | - Maria Marta Figueiredo
- Laboratório de Imunopatologia, Instituto Rene Rachou, Fundação Oswaldo Cruz –Minas, 30190-002, Belo Horizonte, MG, Brazil
| | - Claudio Gonçalves Rosmaninho
- Laboratório de Imunopatologia, Instituto Rene Rachou, Fundação Oswaldo Cruz –Minas, 30190-002, Belo Horizonte, MG, Brazil
| | - Lis Ribeiro do Valle Antonelli
- Departamento de Bioquímica e Imunologia, ICB, Universidade Federal de Minas Gerais, 31270-901, Belo Horizonte, MG, Brazil,Laboratório de Biologia e Imunologia de Doenças Infecciosas e Parasitárias, Instituto Rene Rachou, FIOCRUZ-MG, 30190-002, Belo Horizonte, MG, Brazil
| | - Ricardo Tostes Gazzinelli
- Laboratório de Imunopatologia, Instituto Rene Rachou, Fundação Oswaldo Cruz –Minas, 30190-002, Belo Horizonte, MG, Brazil,Department of Medicine, University of Massachusetts Medical School, 01605, Worcester, MA, USA,Plataforma de Medicinal Translacional-Fundação Oswaldo Cruz/Faculdade de Medicina de Ribeirão Preto-Universidade de São Paulo, 14049-900, Ribeirão Preto, SP, Brazil
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6
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Pereira MLM, Marinho CRF, Epiphanio S. Could Heme Oxygenase-1 Be a New Target for Therapeutic Intervention in Malaria-Associated Acute Lung Injury/Acute Respiratory Distress Syndrome? Front Cell Infect Microbiol 2018; 8:161. [PMID: 29868517 PMCID: PMC5964746 DOI: 10.3389/fcimb.2018.00161] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Accepted: 04/26/2018] [Indexed: 01/17/2023] Open
Abstract
Malaria is a serious disease and was responsible for 429,000 deaths in 2015. Acute lung injury/acute respiratory distress syndrome (ALI/ARDS) is one of the main clinical complications of severe malaria; it is characterized by a high mortality rate and can even occur after antimalarial treatment when parasitemia is not detected. Rodent models of ALI/ARDS show similar clinical signs as in humans when the rodents are infected with murine Plasmodium. In these models, it was shown that the induction of the enzyme heme oxygenase 1 (HO-1) is protective against severe malaria complications, including cerebral malaria and ALI/ARDS. Increased lung endothelial permeability and upregulation of VEGF and other pro-inflammatory cytokines were found to be associated with malaria-associated ALI/ARDS (MA-ALI/ARDS), and both were reduced after HO-1 induction. Additionally, mice were protected against MA-ALI/ARDS after treatment with carbon monoxide- releasing molecules or with carbon monoxide, which is also released by the HO-1 activity. However, high HO-1 levels in inflammatory cells were associated with the respiratory burst of neutrophils and with an intensification of inflammation during episodes of severe malaria in humans. Here, we review the main aspects of HO-1 in malaria and ALI/ARDS, presenting the dual role of HO-1 and possibilities for therapeutic intervention by modulating this important enzyme.
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Affiliation(s)
- Marcelo L M Pereira
- Departamento de Imunologia, Instituto de Ciências Biomédicas, Universidade de São Paulo, São Paulo, Brazil
| | - Claudio R F Marinho
- Departamento de Parasitologia, Instituto de Ciências Biomédicas, Universidade de São Paulo, São Paulo, Brazil
| | - Sabrina Epiphanio
- Departamento de Análises Clínicas e Toxicológicas, Faculdade de Ciências Farmacêuticas, Universidade de São Paulo, São Paulo, Brazil
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Abstract
Extracorporeal membrane oxygenation (ECMO) is widely used in acute respiratory distress syndrome (ARDS) and myocarditis. Severe vector-mediated diseases may be complicated by ARDS or myocarditis, which are both associated with a high mortality rate. We present six cases of severe dengue, malaria, and acute Chagas disease that were treated with ECMO from September 2007 to September 2015. Patients included two pediatric and four adults (aged 12-48). Survival to decannulation was 83% and to discharge was 66%. Overall, the mean duration on ECMO was 25.4 days. We conclude that ECMO treatment can be beneficial in patients with severe dengue, malaria, and acute Chagas disease, if complicated by pulmonary or cardiac complications.
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Kaur H, Sehgal R, Bansal D, Sultan AA, Bhalla A, Singhi SC. Development of Visually Improved Loop Mediated Isothermal Amplification for the Diagnosis of Plasmodium vivax Malaria in a Tertiary Hospital in Chandigarh, North India. Am J Trop Med Hyg 2018; 98:1374-1381. [PMID: 29557335 DOI: 10.4269/ajtmh.17-0857] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
More than 80% of the global burden of the Plasmodium vivax is contributed by mainly three countries (India, Indonesia, and Pakistan). Reports from last decades have highlighted the occurrence of severe P. vivax malaria which was earlier considered to be benign. The recent trends of increasing P. vivax-associated morbidity and mortality emphasizes the need for early and accurate diagnosis of P. vivax malaria for the timely management of patients. Microscopy is considered a gold standard but needs experienced laboratory technologists. Over the last few years, Polymerase chain reaction (PCR) is being used as a highly sensitive and specific test but it requires expensive equipment which limits its use in the field. Therefore, in the present study, utility of visually improved loop-mediated isothermal amplification (LAMP) for the detection of P. vivax was evaluated targeting 18SrRNA gene in 145 microscopically confirmed P. vivax and 20 P. vivax negative patients. Sensitivity and specificity of LAMP was assessed with respect to microscopy and multiplex nested PCR (nPCR). Results of the LAMP assay was also correlated with rapid diagnostic test, multiplex nPCR and real-time PCR results. Overall, sensitivity and specificity of P. vivax-specific LAMP compared with microscopy were found to be 100% and 85%, respectively. Furthermore, detection limit for LAMP was found to be 0.8 copies/μL and it was also able to detect three complicated cases of P. vivax which were missed by microscopy. This study showed a LAMP assay to be a rapid and very sensitive method for the early diagnosis of both complicated and uncomplicated P. vivax malaria.
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Affiliation(s)
- Hargobinder Kaur
- Department of Medical Parasitology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rakesh Sehgal
- Department of Medical Parasitology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Devendra Bansal
- Department of Microbiology and Immunology, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation-Education City, Doha, Qatar
| | - Ali A Sultan
- Department of Microbiology and Immunology, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation-Education City, Doha, Qatar
| | - Ashish Bhalla
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sunit C Singhi
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Val F, Machado K, Barbosa L, Salinas JL, Siqueira AM, Costa Alecrim MG, del Portillo H, Bassat Q, Monteiro WM, Guimarães Lacerda MV. Respiratory Complications of Plasmodium vivax Malaria: Systematic Review and Meta-Analysis. Am J Trop Med Hyg 2017; 97:733-743. [PMID: 28722625 PMCID: PMC5590608 DOI: 10.4269/ajtmh.17-0131] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Accepted: 04/19/2017] [Indexed: 12/12/2022] Open
Abstract
Malaria, a major global public health problem, is mainly caused by Plasmodium falciparum and Plasmodium vivax, and is responsible for nearly half a million deaths annually. Although P. vivax malaria was not believed to cause severe disease, recent robust studies have proved otherwise. However, the clinical spectrum and pathogenesis of severe vivax malaria and, especially, its respiratory complications remain poorly understood. A systematic search for articles reporting respiratory complications associated with vivax malaria was performed in Lilacs, Cochrane, Scielo, Web of Science, and Medline databases irrespective of publication date. Prevalence of acute respiratory distress syndrome (ARDS) and associated mortality among vivax patients were calculated from cross-sectional and longitudinal studies, whereas factors associated with mortality were calculated from data pooled from case reports and series of cases. A total of 101 studies were included (49 cross-sectional or longitudinal and 52 case reports or series of cases). Prevalence of ARDS was 2.8% and 2.2% in children and adults, respectively, with nearly 50% mortality. Moreover, female sex (P = 0.013), having any comorbidity (P = 0.036), lower body temperature (P = 0.032), lower hemoglobin (P = 0.043), and oxygen saturation (P = 0.053) values were significantly associated with mortality. Plasmodium vivax malaria respiratory complications included ARDS and were associated with high mortality. Demographics and clinical characteristics upon presentation to hospital were associated with mortality among patients with respiratory complications in vivax malaria. This study reaffirms the evidence of severe and fatal complications of P. vivax malaria and its associated respiratory complications.
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Affiliation(s)
- Fernando Val
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil
- Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil
| | - Kim Machado
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil
- Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil
| | - Lisiane Barbosa
- Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil
| | | | - André Machado Siqueira
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Maria Graças Costa Alecrim
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil
- Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil
| | - Hernando del Portillo
- Barcelona Institute for Global Health (ISGlobal) and ICREA and Institut d’Investigacioì Germans Trias i Pujol (IGTP), Badalona, Spain
| | - Quique Bassat
- Barcelona Institute for Global Health (ISGlobal) and ICREA, Badalona, Spain
| | - Wuelton Marcelo Monteiro
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil
- Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil
| | - Marcus Vinícius Guimarães Lacerda
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil
- Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil
- Instituto de Pesquisas Leônidas and Maria Deane, Fundação Oswaldo Cruz, Manaus, Amazonas, Brazil
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Im JH, Kwon HY, Baek J, Park SW, Durey A, Lee KH, Chung MH, Lee JS. Severe Plasmodium vivax infection in Korea. Malar J 2017; 16:51. [PMID: 28129766 PMCID: PMC5273855 DOI: 10.1186/s12936-017-1684-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 01/05/2017] [Indexed: 01/05/2023] Open
Abstract
Background Although severe malaria by Plasmodium vivax has been increasingly reported, there are marked variations in the type and rate of the complications by geographic area. This is possibly because of the presence of concurrent falciparum malaria or bacteraemia, and of differences in underlying immune status among the infected subjects. Furthermore, published studies on P. vivax in temperate regions are limited. The present study investigated severe vivax malaria in Korea, where only vivax malaria occurs. Hence, other compounding factors are rare. Additionally, most of the patients are possibly non-immune to this malarial disease. Methods Adults with vivax malaria observed in one 860-bed university hospital from January 2006 to December 2012 were retrospectively evaluated. Seventeen patients who had travelled overseas within 6 months before the presentation of malaria were excluded. Severe vivax malaria was diagnosed according to World Health Organization criteria. Other complications were also investigated. Results Two-hundred and ten patients were enrolled, of which 88 (41.9%) were treated as inpatients and the remainder as outpatients. Eleven patients were treated in an intensive care unit; among them, five patients received mechanical ventilation, and one needed extracorporeal membrane oxygenation therapy (ECMO) additionally. Severe vivax malaria was identified in 44 patients (21.0%), and the most common severe complication was pulmonary manifestation (40/188, 21.9%), which was followed by cerebral malaria (5/210, 2.4%), shock (4/210, 1.9%), spontaneous bleeding (3/210, 1.4%), metabolic acidosis (3/210, 3.5%) and acute kidney injury (2/210, 1.0%). Unusual complications, such as splenic infarction (ten patients) and retinal haemorrhage (two patients) were sometimes observed. There were no deaths, but the case involving ECMO was potentially fatal. Conclusions Plasmodium vivax infection can be severe to be fatal and is frequently associated with various complications in non-immune adults. The frequency of each complication seems to differ from other countries. Hence, further investigation is needed to elucidate the causes and mechanisms responsible for these differences. Electronic supplementary material The online version of this article (doi:10.1186/s12936-017-1684-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jae Hyoung Im
- Department of Internal Medicine, Inha University School of Medicine, Incheon, 400-711, South Korea.
| | - Hea Yoon Kwon
- Department of Internal Medicine, Inha University School of Medicine, Incheon, 400-711, South Korea
| | - JiHyeon Baek
- Department of Internal Medicine, Inha University School of Medicine, Incheon, 400-711, South Korea
| | - Seong Wook Park
- Department of Internal Medicine, Inha University School of Medicine, Incheon, 400-711, South Korea
| | - Areum Durey
- Department of Emergency Medicine, Incheon, 400-711, South Korea
| | - Kyung Hee Lee
- Department of Radiology, Inha University School of Medicine, 7-206, Shinheung-Dong, Jung-Gu, Incheon, 400-711, South Korea
| | - Moon-Hyun Chung
- Department of Internal Medicine, Jeju University Hospital, Jeju, South Korea
| | - Jin-Soo Lee
- Department of Internal Medicine, Inha University School of Medicine, Incheon, 400-711, South Korea.
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Antinori S, Corona A, Ridolfo AL, Galimberti L, Ricaboni D, Milazzo L, Corbellino M. Imported Plasmodium vivax malaria with severe thrombocytopaenia: can it be severe malaria or not? Malar J 2016; 15:105. [PMID: 26893220 PMCID: PMC4759958 DOI: 10.1186/s12936-016-1150-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 02/04/2016] [Indexed: 01/20/2023] Open
Abstract
Background Thrombocytopaenia is the most frequent malaria-associated haematologic alteration observed with all five Plasmodium parasites causing disease in humans. Although not included in the World Health Organization criteria for severe Plasmodium falciparum malaria, severe thrombocytopaenia has been increasingly mentioned as an indicator of P. vivax malaria severity. Case Here, it is described a case of imported P. vivax malaria in a 37-year old man from Pakistan who presented with severe thrombocytopaenia (5 × 109/L). He was admitted to the intensive care unit and initially treated with a 1-day course of intravenous quinine followed by oral chloroquine and primaquine. The patient’s platelet count increased as early as 4 hours after treatment inception and the clinical course was favourable and uneventful. Discussion This case report, along with a review of published cases focusing on the relationship between thrombocytopaenia and severe P. vivax malaria, suggests that the prognostic role of severe thrombocytopaenia is ambiguous in absence of severe haemorraghic complications and its use as diagnostic criterion of malaria severity may lead to overestimation of severe P. vivax malaria cases. Conclusion Due to the lack of high quality studies it is at present unclear if severe thrombocytopaenia in the setting of P. vivax malaria should be considered indicative of severe malaria.
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Affiliation(s)
- Spinello Antinori
- Department of Clinical and Biomedical Sciences Luigi Sacco, III Division of Infectious Diseases, University of Milano, Via GB Grassi, 74, 20157, Milan, Italy.
| | | | - Anna Lisa Ridolfo
- Department of Clinical and Biomedical Sciences Luigi Sacco, III Division of Infectious Diseases, University of Milano, Via GB Grassi, 74, 20157, Milan, Italy.
| | - Laura Galimberti
- Department of Clinical and Biomedical Sciences Luigi Sacco, III Division of Infectious Diseases, University of Milano, Via GB Grassi, 74, 20157, Milan, Italy.
| | - Davide Ricaboni
- Department of Clinical and Biomedical Sciences Luigi Sacco, III Division of Infectious Diseases, University of Milano, Via GB Grassi, 74, 20157, Milan, Italy.
| | - Laura Milazzo
- Department of Clinical and Biomedical Sciences Luigi Sacco, III Division of Infectious Diseases, University of Milano, Via GB Grassi, 74, 20157, Milan, Italy.
| | - Mario Corbellino
- Department of Clinical and Biomedical Sciences Luigi Sacco, III Division of Infectious Diseases, University of Milano, Via GB Grassi, 74, 20157, Milan, Italy.
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