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Manning L, Laman M, Law I, Bona C, Aipit S, Teine D, Warrell J, Rosanas-Urgell A, Lin E, Kiniboro B, Vince J, Hwaiwhanje I, Karunajeewa H, Michon P, Siba P, Mueller I, Davis TME. Features and prognosis of severe malaria caused by Plasmodium falciparum, Plasmodium vivax and mixed Plasmodium species in Papua New Guinean children. PLoS One 2011; 6:e29203. [PMID: 22216212 PMCID: PMC3245265 DOI: 10.1371/journal.pone.0029203] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2011] [Accepted: 11/22/2011] [Indexed: 11/28/2022] Open
Abstract
Background Mortality from severe pediatric falciparum malaria appears low in Oceania but Plasmodium vivax is increasingly recognized as a cause of complications and death. The features and prognosis of mixed Plasmodium species infections are poorly characterized. Detailed prospective studies that include accurate malaria diagnosis and detection of co-morbidities are lacking. Methods and Findings We followed 340 Papua New Guinean (PNG) children with PCR-confirmed severe malaria (77.1% P. falciparum, 7.9% P. vivax, 14.7% P. falciparum/vivax) hospitalized over a 3-year period. Bacterial cultures were performed to identify co-incident sepsis. Clinical management was under national guidelines. Of 262 children with severe falciparum malaria, 30.9%, 24.8% and 23.2% had impaired consciousness, severe anemia, and metabolic acidosis/hyperlactatemia, respectively. Two (0.8%) presented with hypoglycemia, seven (2.7%) were discharged with neurologic impairment, and one child died (0.4%). The 27 severe vivax malaria cases presented with similar phenotypic features to the falciparum malaria cases but respiratory distress was five times more common (P = 0.001); one child died (3.7%). The 50 children with P. falciparum/vivax infections shared phenotypic features of mono-species infections, but were more likely to present in deep coma and had the highest mortality (8.0%; P = 0.003 vs falciparum malaria). Overall, bacterial cultures were positive in only two non-fatal cases. 83.6% of the children had alpha-thalassemia trait and seven with coma/impaired consciousness had South Asian ovalocytosis (SAO). Conclusions The low mortality from severe falciparum malaria in PNG children may reflect protective genetic factors other than alpha-thalassemia trait/SAO, good nutrition, and/or infrequent co-incident sepsis. Severe vivax malaria had similar features but severe P. falciparum/vivax infections were associated with the most severe phenotype and worst prognosis.
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Affiliation(s)
- Laurens Manning
- School of Medicine and Pharmacology, University of Western Australia, Fremantle Hospital, Fremantle, Western Australia, Australia
| | - Moses Laman
- School of Medicine and Pharmacology, University of Western Australia, Fremantle Hospital, Fremantle, Western Australia, Australia
- Papua New Guinea Institute of Medical Research, Madang, Madang Province, Papua New Guinea
| | - Irwin Law
- Papua New Guinea Institute of Medical Research, Madang, Madang Province, Papua New Guinea
| | - Cathy Bona
- Papua New Guinea Institute of Medical Research, Madang, Madang Province, Papua New Guinea
| | - Susan Aipit
- Papua New Guinea Institute of Medical Research, Madang, Madang Province, Papua New Guinea
| | - David Teine
- Papua New Guinea Institute of Medical Research, Madang, Madang Province, Papua New Guinea
| | - Jonathan Warrell
- Papua New Guinea Institute of Medical Research, Madang, Madang Province, Papua New Guinea
| | - Anna Rosanas-Urgell
- Papua New Guinea Institute of Medical Research, Madang, Madang Province, Papua New Guinea
| | - Enmoore Lin
- Papua New Guinea Institute of Medical Research, Madang, Madang Province, Papua New Guinea
| | - Benson Kiniboro
- Papua New Guinea Institute of Medical Research, Madang, Madang Province, Papua New Guinea
| | - John Vince
- School of Medicine and Health Sciences, University of Papua New Guinea, Boroko, Port Moresby, Papua New Guinea
| | - Ilomo Hwaiwhanje
- Department of Pediatrics, Goroka Base Hospital, Goroka, Eastern Highlands Province, Papua New Guinea
| | - Harin Karunajeewa
- School of Medicine and Pharmacology, University of Western Australia, Fremantle Hospital, Fremantle, Western Australia, Australia
| | - Pascal Michon
- Papua New Guinea Institute of Medical Research, Madang, Madang Province, Papua New Guinea
| | - Peter Siba
- Papua New Guinea Institute of Medical Research, Madang, Madang Province, Papua New Guinea
| | - Ivo Mueller
- Papua New Guinea Institute of Medical Research, Madang, Madang Province, Papua New Guinea
| | - Timothy M. E. Davis
- School of Medicine and Pharmacology, University of Western Australia, Fremantle Hospital, Fremantle, Western Australia, Australia
- * E-mail:
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Manning L, Laman M, Stanisic D, Rosanas-Urgell A, Bona C, Teine D, Siba P, Mueller I, Davis TME. Plasma Plasmodium falciparum Histidine-Rich Protein-2 Concentrations Do Not Reflect Severity of Malaria in Papua New Guinean Children. Clin Infect Dis 2011; 52:440-6. [DOI: 10.1093/cid/ciq105] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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