Clinical Features and Mortality Associated with Severe Malaria in Adults in Southern Mauritania

Treatment outcomes and associated factors in severe malaria patients at University of Gondar Hospital, Northwest Ethiopia: A retrospective study (2020-2023)

BACKGROUND

Malaria continues to be the most prevalent life-threatening parasitic illness in Ethiopia. Its clinical spectrum ranges from mild to severe, with a propensity for death. In Ethiopia, it accounts for 10% of hospital admission. Identifying predictors of malaria-related mortality is crucial for aiding high-risk patient identification and enabling timely intervention.

OBJECTIVE

Our study aimed to assess treatment outcomes and factors associated with mortality among severe malaria patients at the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia.

METHODS

A retrospective cross-sectional study examined 383 randomly chosen patients with severe malaria, spanning a four-year period leading up to the data collection date, encompassing July 2023 back to June 2020. Data were collected from the hospital records. A structured questionnaire was used to collect the data. EpiData version 3.1 and SPSS version 20 were used to clean and analyze the data, respectively. Logistic regression analysis was conducted to determine associations and reported by the odds ratio at p < 0.05 with 95% confidence intervals.

RESULTS

Among the 383 eligible patients, the majorities were males (56.66%) and resided in rural areas (66.32%). Over 84% of them were referred from health facilities. Plasmodium falciparum was the major parasite identified in 78% of cases. The magnitude of death among severe malaria patients was 10.97%. Impaired consciousness, convulsions, jaundice, parasitemia level >2, and creatinine level ≥3 were significantly associated with death, with adjusted odds ratios (AOR) of 3.4 (95% CI: 1.3-8.3), 2.7 (95% CI: 1.004-7.492), 3.2 (95% CI: 1.173-9.182), 3.7 (95% CI: 1.516-9.113), and 11.7 (95% CI: 4.756-29.239), respectively.

CONCLUSION

Our study revealed a significant number of malaria-related deaths, with predictors such as age, impaired consciousness, convulsions, jaundice, parasitemia level, and creatinine level identified. Hence, it is imperative to implement intense and timely interventions for patients exhibiting these clinical manifestations to prevent malaria-related fatalities.

Diagnosis and management of malaria in the intensive care unit

Malaria is responsible for approximately three-quarters of a million deaths in humans globally each year. Most of the morbidity and mortality reported are from Sub-Saharan Africa and Asia, where the disease is endemic. In non-endemic areas, malaria is the most common cause of imported infection and is associated with significant mortality despite recent advancements and investments in elimination programs. Severe malaria often requires intensive care unit admission and can be complicated by cerebral malaria, respiratory distress, acute kidney injury, bleeding complications, and co-infection. Intensive care management includes prompt diagnosis and early initiation of effective antimalarial therapy, recognition of complications, and appropriate supportive care. However, the lack of diagnostic capacities due to limited advances in equipment, personnel, and infrastructure presents a challenge to the effective diagnosis and management of malaria. This article reviews the clinical classification, diagnosis, and management of malaria as relevant to critical care clinicians, highlighting the role of diagnostic capacity, treatment options, and supportive care.

Adult malaria mortality during 2019 at Bo Government Hospital, Sierra Leone

It is uncertain whether malaria is an important cause of death among adults in endemic areas. We performed a chart review of adults admitted to Bo Government Hospital during 2019. Of 893 admissions, 149 (59% female, mean age 58.5 years) had a laboratory diagnosis of malaria and 22 (14.8%) died. Mortality was significantly higher among patients with severe malaria compared with those who had non-severe malaria (6/20 [30%] versus 16/129 [12.4%], p=0.031).  Our results suggest that malaria is a common cause of death in hospitalized Sierra Leonian adults.

Etiologies and factors associated with mortality in patients with non-traumatic coma in a tertiary hospital in Bukavu, eastern Democratic Republic of the Congo

Non-traumatic coma (NTC) is a common medical condition often associated with poor outcomes. Identifying underlying causes is crucial for effective management and prognostication, particularly in resource-poor settings. This study aimed to identify the most common causes and prognostic factors of NTC in a tertiary hospital in Bukavu, in the eastern Democratic Republic of the Congo (DRC), using the Glasgow Coma Scale (GCS) as well as other simple and affordable clinical and paraclinical tools. This retrospective observational study included 219 consecutive patients admitted to the intensive care unit of the Provincial General Hospital of Bukavu between January 2016 and December 2018. Sociodemographic, clinical, and laboratory data were also collected. Bivariate and multivariate analyses were performed to identify different causes and factors associated with poor outcomes in these patients. The median age of the patients was 49 (interquartile range [IQR]: 33-61) years, and they were predominantly men (62.8%). The most common causes of NTC were stroke (25.7%), acute metabolic complications of diabetes (21.9%), and primary brain infections (meningoencephalitis, 16.0%; and cerebral malaria, 14.2%). The NTC-related in-hospital mortality rate was 35.2%. A high mortality was significantly and independently associated with a GCS<7 (adjusted odds ratio [OR]: 4.30, 95% confidence interval [CI]: 1.73-10.71), the presence of meningismus at clinical evaluation (adjusted odds ratio [aOR] 3.86, 95%CI: 1.41-10.55), oxygen saturation <90% (aOR 3.99, 95%CI: 1.71-9.28), the consumption of traditional herbal medicines prior to hospital admission (aOR 2.82, 95%CI: 1.16-6.86), and elevated serum creatinine (aOR 1.64, 95%CI: 1.17-2.29). In conclusion, clinical neurological examinations, along with simple and affordable paraclinical investigations, can provide sufficient information to determine the etiology of NTC and evaluate the prognosis of comatose patients, even in resource-poor settings. Physicians may use the GCS as a simple, reliable, and affordable tool to identify patients who require special attention and care.

Post-malarial neurological syndrome in a Gambian adult residing in the Gambia: a case report and a review of literature

BACKGROUND

Post malarial neurological syndrome (PMNS) occurs as a sequel of cerebral malaria which is the most deadly form of severe malaria. In holo-endemic regions (areas of high malarial transmission) all forms of severe malaria as well as cerebral malaria usually occur in children and those who are semi or non-immune like pregnant women, migrants as well as tourists. It also occurs in hypo-endemic regions (areas of limited malarial transmission with low immunity) and malaria- free zones. Survivors however may have neurologic complications after recovery. PMNS has been reported in many parts of the world. Being a sequel to cerebral malaria, it is uncommon in adults who were born and reside in a holo-endemic region all their lives.

CASE REPORT

This is the case of an 18 year old Gambian who has lived in The Gambia all his life that had PMNS five days after recovery from cerebral malaria.

METHODS

This was a predominantly web based literature search. The search comprise all case reports, original articles and reviews on PMNS or neurological deficits associated with malaria or noted after malaria infection. The search engines used were Google, Yahoo and Google scholar.

RESULTS

A total of 62 papers were found. These were used for this review of the literature.

CONCLUSION

Cerebral malaria also occurs in adults in holo-endemic areas though rare and some of the survivors may develop PMNS. It is commoner in the youth age group. There is need for further studies since the youth may be a possible new 'vulnerable group' in holoendemic areas. This may lead to the widening the targeted group for malaria control in the regions of high malarial transmission.

Clinical manifestations and outcomes of severe malaria in adult patients admitted to a tertiary hospital in the Gambia

BACKGROUND

Malaria is a major public health concern in The Gambia. There is limited data on the clinical manifestation and outcome of severe malaria in adult patients in The Gambia. The study therefore assessed the clinical manifestations and outcome of severe malaria in adult patients admitted at the Edward Francis Small Teaching Hospital.

METHODS

The study retrospectively reviewed the records of all malaria patients admitted from 18th October 2020 to 2nd February 2022. Demographic data, clinical features, investigations, treatment, and outcomes were recorded.

RESULTS

A total of 131 confirmed malaria patients were recruited into the study. The median age was 21 yrs, range (15-90) and most of them were within the youth age group (15-24yrs) 85 (64.9%). The majority of the patients were also male 88 (67.2%) with a male to female ratio of 2:1. The most common symptom at presentation was fever 119 (90.8%) and the most common sign was pallor 48 (36.6%). Seventy-six patients (58.1%) and 55 (41.9%) patients met the criteria for severe malaria and uncomplicated malaria diagnosis, respectively. The most common clinical feature amongst patients with severe malaria were impaired consciousness 34 (44.7%), severe anaemia 26 (34.2%) and acute kidney injury 20 (26.3%). Patients with severe malaria were younger with mean age of 22.9 vs. 29 yrs (p = 0.004), more likely to be referred from a lower-level health facility 62 (81.6%) vs. 34 (61.8%) (p = 0.012), to have a longer duration of admission (p = 0.024) and to die 13 (17.1%) vs. 0 (0%) (p = 0.001) as compared to patients with uncomplicated malaria. The total mortality was 13 (9.9%) and all the patients who died had severe malaria. Mortality was higher in patients with impaired consciousness 9 (26.5%) and there was a significant relationship between death and impaired consciousness 9 (69.3%) vs. 25 (21.4%) p = 0.001.

CONCLUSION

Severe malaria still affects young adults in an endemic area with significant mortality. This suggests the need for targeted malaria prevention, surveillance, case management and control strategies in this population group in The Gambia to help reduce morbidity and mortality of malaria.

Molecular Epidemiology of G6PD Genotypes in Different Ethnic Groups Residing in Saharan and Sahelian Zones of Mauritania

Plasmodium vivax malaria is endemic in Mauritania. Individuals with glucose-6-phosphate dehydrogenase (G6PD) deficiency may develop acute hemolytic anemia when exposed to 8-aminoquinoline antimalarial drugs, which are indispensable for a complete cure. The prevalence of G6PD allelic variants was assessed in different ethno-linguistic groups present in Mauritania. A total of 996 blood samples (447 males and 549 females; 499 white Moors and 497 individuals of black African ancestry) were collected from febrile patients in 6 different study sites: Aleg, Atar, Kiffa, Kobeni, Nouakchott, and Rosso. The presence of the African-type G6PD A- (G202A, A376G, A542T, G680T, and T968C mutations) and the Mediterranean-type G6PD B- (C563T) variants was assessed by PCR followed by restriction fragment length polymorphism and/or DNA sequencing. The prevalence of African-type G6PD A- genotype was 3.6% (36/996), with 6.3% (28/447) of hemizygote (A-) males and 1.5% (8/549) of homozygous (A-A-) females. Forty of 549 (7.3%) women were heterozygous (AA-). The following genotypes were observed among hemizygous men and/or homozygous women: A376G/G202A (22/996; 2.2%), A376G/T968C Betica-Selma (12/996; 1.2%), and A376G/A542T Santamaria (2/996; 0.2%). The Mediterranean-type G6PD B- genotype was not observed. The prevalence rates of G6PD A- genotype in male (10/243; 4.1%) and heterozygous female (6/256; 2.3%) white Moors were lower (p < 0.05) than those of males (18/204; 8.8%) and heterozygous females (34/293; 11.6%) of black African ancestry. There were only a few homozygous women among both white Moors (3/256; 1.2%) and those of black African ancestry (5/293; 1.7%). The prevalence of G6PD deficiency in Mauritania was comparable to that of neighboring countries in the Maghreb. Because of the purportedly close ethnic ties between the Mauritanian white Moors and the peoples in the Maghreb, further investigations on the possible existence of the Mediterranean-type allele are required. Moreover, a surveillance system of G6PD phenotype and/or genotype screening is warranted to establish and monitor a population-based prevalence of G6PD deficiency.