1
|
T R, C D, A R, Jc Y. Nine years of imported malaria in a teaching hospital in Belgium: Demographics, clinical characteristics, and outcomes. Diagn Microbiol Infect Dis 2024; 108:116206. [PMID: 38335879 DOI: 10.1016/j.diagmicrobio.2024.116206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 10/06/2023] [Accepted: 01/30/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND Imported malaria is often misdiagnosed due to the aspecific symptoms and lack of familiarity among clinicians. This study aims to evaluate a decade-long trend of imported malaria cases in a Belgian teaching hospital by analyzing demographics, clinical characteristics, and outcomes. METHODS Medical records of 223 patients with confirmed malaria diagnoses between 2010 and 2019 were analyzed. RESULTS Most patients were male (63.2%), aged 18-65 years (77.1%), and visiting friends or relatives (40.8%). Central Africa was the most common travel destination (54.3%), and 63.7% did not take prophylaxis. Symptoms were flu-like, with fever (91.9%) being most prevalent. P. falciparum was identified in 88.3% of cases. A high proportion of severe cases (41.7%) and a low mortality rate (0.9%) were recorded. A severe form of the disease is associated with a more extended hospital stay than uncomplicated form (median of 5 vs. 4 days, p < 0.001). Thirty-five-point five percent [33/93] of patients with severe malaria have had a previous malaria infection compared to 50.8% [66/130] of uncomplicated patients (p= 0.013) wich was statistically significant. CONCLUSION Malaria disproportionately affects VFRs traveling to Central Africa, and flu-like symptoms should raise suspicion. Prophylaxis is essential to prevent the disease, and early diagnosis is critical for effective management. A severe form of the disease is associated with a more extended hospital stay than uncomplicated form and people with a previous history of malaria have a less severe disease.
Collapse
Affiliation(s)
- Ratovonjanahary T
- Epidemiology and Biostatistics Unit, Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels, Belgium
| | - Danwang C
- Clinton Health Access Initiative, Inc., Boston, MA, USA
| | - Robert A
- Epidemiology and Biostatistics Unit, Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels, Belgium
| | - Yombi Jc
- Department of Internal Medicine and Infectious Diseases, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium; Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels, Belgium.
| |
Collapse
|
2
|
Akafity G, Kumi N, Ashong J. Diagnosis and management of malaria in the intensive care unit. JOURNAL OF INTENSIVE MEDICINE 2024; 4:3-15. [PMID: 38263976 PMCID: PMC10800773 DOI: 10.1016/j.jointm.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 08/17/2023] [Accepted: 09/02/2023] [Indexed: 01/25/2024]
Abstract
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.
Collapse
Affiliation(s)
- George Akafity
- Department of Research, Monitoring, and Evaluation, Cape Coast Teaching Hospital, Cape Coast, Ghana
| | - Nicholas Kumi
- Intensive Care Unit, Department of Critical Care and Anesthesia, Cape Coast Teaching Hospital, Cape Coast, Ghana
| | - Joyce Ashong
- Department of Paediatrics and Child Health, Cape Coast Teaching Hospital, Cape Coast, Ghana
| |
Collapse
|
3
|
Kotepui M, Kotepui KU, Masangkay FR, Wilairatana P. Evidence of malarial chemoprophylaxis among travellers who died from malaria: a systematic review and meta-analysis. Malar J 2023; 22:359. [PMID: 38001503 PMCID: PMC10675877 DOI: 10.1186/s12936-023-04794-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 11/16/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Chemoprophylaxis is a prevention method for malaria during travel in malaria-endemic countries. This study aimed to collate and synthesize the evidence of malarial chemoprophylaxis among malaria death cases. METHODS Studies documenting malarial chemoprophylaxis related to malaria deaths were searched in PubMed, Scopus, MEDLINE, Embase, and CENTRAL until 3 July 2022. The pooled proportion of malarial chemoprophylaxis among death cases was synthesized using logit transformation and back transformation to a proportion performed using generalized linear mixed models. The pooled log odds ratio (log-OR) with a 95% confidence interval (CI) of malarial chemoprophylaxis in death cases compared to survivors were synthesized. RESULTS Fifty-eight studies were included in the systematic review and the meta-analysis. Of 602 pooled malaria death cases, the number of patients who took chemoprophylaxis was 187 (30%) (95% CI 22-40, P < 0.01, 58 studies), and those who took adequate chemoprophylaxis were 24 (5%) (95% CI 2-13, P < 0.01, 42 studies). A comparable log-OR of underwent chemoprophylaxis was observed between malaria death cases and survivors (P = 0.94, pooled log-OR: - 0.02, 95% CI - 0.46-0.42, I2: 0%, 17 studies). Similarly, a comparable log-OR of adequate chemoprophylaxis was identified between malaria death cases and survivors (P = 0.15, pooled log-OR: 0.83, 95% CI - 0.30-1.97, I2: 47.08%, 11 studies). CONCLUSIONS Among the studies where malarial chemoprophylaxis was reported, approximately 30% of malaria death cases had taken such prophylaxis. Notably, only 5% of these cases adhered fully or adequately to the recommended chemoprophylactic regimen. However, the analysis did not reveal a significant difference in the odds of malarial chemoprophylaxis between malaria death cases and survivors.
Collapse
Affiliation(s)
- Manas Kotepui
- Medical Technology, School of Allied Health Sciences, Walailak University, Tha Sala, Nakhon Si Thammarat, Thailand.
| | - Kwuntida Uthaisar Kotepui
- Medical Technology, School of Allied Health Sciences, Walailak University, Tha Sala, Nakhon Si Thammarat, Thailand
| | | | - Polrat Wilairatana
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
| |
Collapse
|
4
|
Tunali V, Korkmaz M. Emerging and Re-Emerging Parasitic Infections of the Central Nervous System (CNS) in Europe. Infect Dis Rep 2023; 15:679-699. [PMID: 37987400 PMCID: PMC10660548 DOI: 10.3390/idr15060062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 10/12/2023] [Accepted: 10/20/2023] [Indexed: 11/22/2023] Open
Abstract
In a rapidly evolving global landscape characterized by increased international travel, migration, and ecological shifts, this study sheds light on the emergence of protozoal and helminthic infections targeting the central nervous system (CNS) within Europe. Despite being traditionally associated with tropical regions, these infections are progressively becoming more prevalent in non-endemic areas. By scrutinizing the inherent risks, potential outcomes, and attendant challenges, this study underscores the intricate interplay between diagnostic limitations, susceptibility of specific population subsets, and the profound influence of climate fluctuations. The contemporary interconnectedness of societies serves as a conduit for introducing and establishing these infections, warranting comprehensive assessment. This study emphasizes the pivotal role of heightened clinician vigilance, judicious public health interventions, and synergistic research collaborations to mitigate the potential consequences of these infections. Though rare, their profound impact on morbidity and mortality underscores the collective urgency required to safeguard the neurological well-being of the European populace. Through this multifaceted approach, Europe can effectively navigate the complex terrain posed with these emergent infections.
Collapse
Affiliation(s)
- Varol Tunali
- Department of Parasitology, Faculty of Medicine, Manisa Celal Bayar University, 45030 Manisa, Turkey
- Department of Emergency Medicine, Izmir Metropolitan Municipality Eşrefpaşa Hospital, 35170 Izmir, Turkey
| | - Metin Korkmaz
- Department of Parasitology, Faculty of Medicine, Ege University, 35100 Izmir, Turkey;
| |
Collapse
|
5
|
Bonsergent M, Tching-Sin M, Honoré S, Bertault-Peres P, Lepelletier A, Flet L, Perez T. Use of artesunate in the treatment of severe imported malaria in France: review of the effectiveness and real-life safety in two French university hospitals. BMC Infect Dis 2023; 23:359. [PMID: 37231336 DOI: 10.1186/s12879-023-08260-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 04/17/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Intravenous artesunate (AS) is the first-line treatment for patients with severe imported malaria (SIM) worldwide. However, after 10 years of use in France, AS hasn't yet received marketing authorization.The purpose of this study was to assess the real-life effectiveness and safety of AS in the treatment of SIM in two Hospitals in France. METHODS We performed a bicenter retrospective and observational study. All patients treated with AS for SIM between 2014 and 2018 and 2016-2020 were included. The effectiveness of AS was evaluated by parasite clearance, number of deaths, and the length of hospital stay. The real-life safety was assessed by related adverse events (AE) and monitoring of biological blood parameters during the hospital stay and follow-up period. RESULTS 110 patients were included during the six-year study period. 71.8% of patients were parasite-negative of their day 3 thick and thin blood smears after AS treatment. No patients discontinued AS due to an AE and no serious AE were declared. Two cases of delayed post-artesunate hemolysis occurred and required blood transfusions. CONCLUSION This study highlights effectiveness and safety of AS in non-endemic areas. Administrative procedures must be accelerated in order to obtain full registration and facilitate access to AS in France.
Collapse
Affiliation(s)
- M Bonsergent
- Nantes Université, CHU Nantes, Pharmacie, Nantes, F-44000, France.
| | - M Tching-Sin
- Nantes Université, CHU Nantes, Pharmacie, Nantes, F-44000, France
| | - S Honoré
- Assistance Publique des Hôpitaux de Marseille, CHU Marseille, Pharmacie, Marseille, France
| | - P Bertault-Peres
- Assistance Publique des Hôpitaux de Marseille, CHU Marseille, Pharmacie, Marseille, France
| | - A Lepelletier
- Nantes Université, CHU Nantes, Pharmacie, Nantes, F-44000, France
| | - L Flet
- Nantes Université, CHU Nantes, Pharmacie, Nantes, F-44000, France
| | - T Perez
- Assistance Publique des Hôpitaux de Marseille, CHU Marseille, Pharmacie, Marseille, France
| |
Collapse
|
6
|
Severe Malaria in an Adult Patient from Low-Endemic Area in Flores Island, East Nusa Tenggara. Case Rep Med 2023; 2023:1239318. [PMID: 36865611 PMCID: PMC9974305 DOI: 10.1155/2023/1239318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 01/31/2023] [Accepted: 02/02/2023] [Indexed: 02/23/2023] Open
Abstract
Malaria is an infection caused by protozoa of the genus Plasmodium, commonly found in tropical and subtropical regions worldwide. Plasmodium falciparum causes the most severe form of the disease and may progress to life-threatening manifestations. This case describes a 26-year-old man who suffered cerebral malaria with multiple organ dysfunction and successfully recovered despite poor initial prognosis. Negligent and late diagnosis of malaria leads to severe complications and a worse prognosis. This case emphasizes despite living in a low-endemic malaria area, physicians should remain meticulous and consider malaria as differential diagnosis even after initially presenting with nonspecific symptoms. Consequently, malarial screening should be performed to modify the risk of mortality. Furthermore, close monitoring and early administration of intravenous artesunate are also particularly critical.
Collapse
|
7
|
Desmet S, Henckaerts L, Ombelet S, Damanet B, Vanbrabant P. Imported diseases in travellers presenting to the emergency department after a stay in a malaria-endemic country: a retrospective observational study. Trop Dis Travel Med Vaccines 2023; 9:3. [PMID: 36803441 PMCID: PMC9939251 DOI: 10.1186/s40794-023-00190-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 02/06/2023] [Indexed: 02/21/2023] Open
Abstract
BACKGROUND We aimed to investigate the aetiology and outcomes of illnesses in patients presenting to an emergency department after travelling to a malaria-endemic country, in order to raise awareness of both tropical and cosmopolitan diseases. METHODS A retrospective chart review was performed for all patients who underwent blood smear testing for malaria at the Emergency Department of the University Hospitals Leuven from 2017 to 2020. Patient characteristics, results of laboratory and radiological examinations, diagnoses, disease course and outcome were collected and analysed. RESULTS A total of 253 patients were included in the study. The majority of ill travellers returned from Sub-Saharan Africa (68.4%) and Southeast Asia (19.4%). Their diagnoses fell into three major syndrome categories: systemic febrile illness (30.8%), inflammatory syndrome of unknown origin (23.3%) and acute diarrhoea (18.2%). Malaria (15.8%) was the most common specific diagnosis in patients with systemic febrile illness, followed by influenza (5.1%), rickettsiosis (3.2%), dengue (1.6%), enteric fever (0.8%), chikungunya (0.8%) and leptospirosis (0.8%). The presence of hyperbilirubinemia and thrombocytopenia increased the probability of malaria, with a likelihood ratio of 4.01 and 6.03, respectively. Seven patients (2.8%) were treated in the intensive care unit, and none died. CONCLUSION Systemic febrile illness, inflammatory syndrome of unknown origin and acute diarrhoea were the three major syndromic categories in returning travellers presenting to our emergency department after a stay in a malaria-endemic country. Malaria was the most common specific diagnosis in patients with systemic febrile illness. None of the patients died.
Collapse
Affiliation(s)
- Sofie Desmet
- grid.410569.f0000 0004 0626 3338Department of General Internal Medicine, KU Leuven, University Hospitals Leuven, Herestraat 49, Leuven, Belgium
| | - Liesbet Henckaerts
- grid.410569.f0000 0004 0626 3338Department of General Internal Medicine, KU Leuven, University Hospitals Leuven, Herestraat 49, Leuven, Belgium ,grid.410569.f0000 0004 0626 3338Department of Microbiology, Immunology and Transplantation, KU Leuven, University Hospitals Leuven, Herestraat 49, Leuven, Belgium
| | - Sien Ombelet
- grid.410569.f0000 0004 0626 3338Department of Laboratory Medicine, KU Leuven, University Hospitals Leuven, Herestraat 49, Leuven, Belgium
| | - Benjamin Damanet
- grid.8767.e0000 0001 2290 8069School of Public Health, Free University of Brussels, Brussels, Belgium ,grid.489075.70000 0001 2287 089XNational Institute for Health and Disability Insurance (NIHDI), Brussels, Belgium
| | - Peter Vanbrabant
- Department of General Internal Medicine, KU Leuven, University Hospitals Leuven, Herestraat 49, Leuven, Belgium.
| |
Collapse
|
8
|
Abstract
Several tropical or geographically confined infectious diseases may lead to organ failure requiring management in an intensive care unit (ICU), both in endemic low- and middle-income countries where ICU facilities are increasingly being developed and in (nonendemic) high-income countries through an increase in international travel and migration. The ICU physician must know which of these diseases may be encountered and how to recognize, differentiate, and treat them. The four historically most prevalent "tropical" diseases (malaria, enteric fever, dengue, and rickettsiosis) can present with single or multiple organ failure in a very similar manner, which makes differentiation based solely on clinical signs very difficult. Specific but frequently subtle symptoms should be considered and related to the travel history of the patient, the geographic distribution of these diseases, and the incubation period. In the future, ICU physicians may also be more frequently confronted with rare but frequently lethal diseases, such as Ebola and other viral hemorrhagic fevers, leptospirosis, and yellow fever. No one could have foreseen the worldwide 2019-up to now coronavirus disease 2019 (COVID-19) crisis caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which was initially spread by travel too. In addition, the actual pandemic due to SARS-CoV-2 reminds us of the actual and potential threat of (re)-emerging pathogens. If left untreated or when treated with a delay, many travel-related diseases remain an important cause of morbidity and even mortality, even when high-quality critical care is provided. Awareness and a high index of suspicion of these diseases is a key skill for the ICU physicians of today and tomorrow to develop.
Collapse
|
9
|
Bittaye SO, Jagne A, Jaiteh LE, Nadjm B, Amambua-Ngwa A, Sesay AK, Singhateh Y, Effa E, Nyan O, Njie R. Clinical manifestations and outcomes of severe malaria in adult patients admitted to a tertiary hospital in the Gambia. Malar J 2022; 21:270. [PMID: 36131306 PMCID: PMC9491657 DOI: 10.1186/s12936-022-04294-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 09/15/2022] [Indexed: 11/10/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Sheikh Omar Bittaye
- Department of Internal Medicine, Edward Francis Small teaching hospital, Banjul, The Gambia. .,School of Medicine and Allied Health Sciences, University of The Gambia, Banjul, The Gambia.
| | - Abubacarr Jagne
- Department of Internal Medicine, Edward Francis Small teaching hospital, Banjul, The Gambia.,School of Medicine and Allied Health Sciences, University of The Gambia, Banjul, The Gambia
| | - Lamin Es Jaiteh
- Department of Internal Medicine, Edward Francis Small teaching hospital, Banjul, The Gambia.,School of Medicine and Allied Health Sciences, University of The Gambia, Banjul, The Gambia
| | - Behzad Nadjm
- Medical Research Council, London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Alfred Amambua-Ngwa
- Medical Research Council, London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Abdul Karim Sesay
- Medical Research Council, London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Yankuba Singhateh
- Epidemiology and disease control unit, Ministry of Health, Banjul, The Gambia
| | - Emmanuel Effa
- Department of Internal Medicine, Edward Francis Small teaching hospital, Banjul, The Gambia.,School of Medicine and Allied Health Sciences, University of The Gambia, Banjul, The Gambia
| | - Ousman Nyan
- Department of Internal Medicine, Edward Francis Small teaching hospital, Banjul, The Gambia.,School of Medicine and Allied Health Sciences, University of The Gambia, Banjul, The Gambia
| | - Ramou Njie
- Department of Internal Medicine, Edward Francis Small teaching hospital, Banjul, The Gambia.,School of Medicine and Allied Health Sciences, University of The Gambia, Banjul, The Gambia
| |
Collapse
|
10
|
Mahittikorn A, Mala W, Wilairatana P, Siri S, Masangkay FR, Kotepui KU, Kotepui M. Prevalence, anti-malarial chemoprophylaxis and causes of deaths for severe imported malaria: A systematic review and meta-analysis. Travel Med Infect Dis 2022; 49:102408. [PMID: 35985533 DOI: 10.1016/j.tmaid.2022.102408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 07/16/2022] [Accepted: 07/25/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND There are limited data regarding prevalence, anti-malarial chemoprophylaxis, and causes of death for severe imported malaria. Thus, we conducted a systematic review and meta-analysis to characterise these variables. METHODS We searched studies reporting deaths attributable to severe imported malaria. The following pooled prevalence rates were determined: 1) the pooled prevalence of severe malaria among patients with imported malaria, 2) the pooled prevalence of deaths among patients with severe imported malaria, 3) the pooled prevalence of anti-malarial chemoprophylaxis among patients with severe imported malaria, and 4) the causes of death among patients with severe imported malaria. RESULTS The search identified 52 studies that were mainly conducted in Europe (25, 48.1%), North America (16, 30.8%) and Asia (7, 13.5%). The pooled prevalence of severe imported malaria was 12.5% (95% confidence interval [CI] = 10.3%-14.6%, I2 = 99.32%, 12393 severe cases/118325 imported cases). The pooled prevalence of deaths attributable to severe imported malaria was 5.1% (95% CI = 4.0%-6.2%, I2 = 91.72%, 721 deaths/16310 severe cases). The pooled prevalence of adequate anti-malarial chemoprophylaxis among patients with severe imported malaria was 9.7% (95% CI = 6.5%-13.0%, I2 = 89.9%, 203/2049 cases). The most common cause of death was multi-organ failure (12.3%). CONCLUSION The results highlighted the need for education and preventative measures for travellers, immigrants, or workers who plan to visit malaria-endemic areas to minimize the risk of severe disease or death.
Collapse
Affiliation(s)
- Aongart Mahittikorn
- Department of Protozoology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
| | - Wanida Mala
- Medical Technology, School of Allied Health Sciences, Walailak University, Tha Sala, Nakhon Si Thammarat, Thailand.
| | - Polrat Wilairatana
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
| | - Sukhontha Siri
- Department of Epidemiology, Faculty of Public Health, Mahidol University, Bangkok, Thailand.
| | | | - Kwuntida Uthaisar Kotepui
- Medical Technology, School of Allied Health Sciences, Walailak University, Tha Sala, Nakhon Si Thammarat, Thailand.
| | - Manas Kotepui
- Medical Technology, School of Allied Health Sciences, Walailak University, Tha Sala, Nakhon Si Thammarat, Thailand.
| |
Collapse
|
11
|
Kalkman LC, Hänscheid T, Krishna S, Grobusch MP. Fluid therapy for severe malaria. THE LANCET. INFECTIOUS DISEASES 2022; 22:e160-e170. [PMID: 35051406 DOI: 10.1016/s1473-3099(21)00471-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 07/20/2021] [Accepted: 07/28/2021] [Indexed: 06/14/2023]
Abstract
Fluid therapy is an important supportive measure for patients with severe malaria. Patients with severe malaria usually have normal cardiac index, vascular resistance, and blood pressure and a small degree of hypovolaemia due to dehydration. Cell hypoxia, reduced kidney function, and acidosis result from microcirculatory compromise and malarial anaemia, which reduce tissue oxygenation, not hypovolaemia. Hence, aggressive fluid loading does not correct acid-base status, enhance kidney function, or improve patient outcomes, and it risks complications such as pulmonary oedema. Individualised conservative fluid management is recommended in patients with severe malaria. Physical examination and physiological indices have limited reliability in guiding fluid therapy. Invasive measures can be more accurate than physical examination and physiological indices but are often unavailable in endemic areas, and non-invasive measures, such as ultrasound, are mostly unexplored. Research into reliable methods applicable in low-resource settings to measure fluid status and response is a priority. In this Review, we outline the current knowledge on fluid management in severe malaria and highlight research needed to optimise fluid therapy and improve survival in severe malaria.
Collapse
Affiliation(s)
- Laura C Kalkman
- Centre of Tropical Medicine and Travel Medicine, Amsterdam University Medical Centre, Department of Infectious Diseases, University of Amsterdam, Amsterdam, Netherlands; Centre de Recherches Médicales en Lambaréné, Lambaréné, Gabon
| | - Thomas Hänscheid
- Instituto de Microbiologia, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Sanjeev Krishna
- Centre de Recherches Médicales en Lambaréné, Lambaréné, Gabon; Clinical Academic Group, Institute for Infection and Immunity, and St George's University Hospitals NHS Foundation Trust, St George's University of London, London, UK; Institut für Tropenmedizin, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Martin P Grobusch
- Centre of Tropical Medicine and Travel Medicine, Amsterdam University Medical Centre, Department of Infectious Diseases, University of Amsterdam, Amsterdam, Netherlands; Centre de Recherches Médicales en Lambaréné, Lambaréné, Gabon; Institut für Tropenmedizin, Universitätsklinikum Tübingen, Tübingen, Germany; Masanga Medical Research Unit, Masanga, Sierra Leone; Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa.
| |
Collapse
|
12
|
Kendjo E, Thellier M, Noël H, Jauréguiberry S, Septfons A, Mouri O, Gay F, Tantaoui I, Caumes E, Houzé S, Piarroux R. Mortality from malaria in France, 2005 to 2014. ACTA ACUST UNITED AC 2021; 25. [PMID: 32914747 PMCID: PMC7502900 DOI: 10.2807/1560-7917.es.2020.25.36.1900579] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Introduction Malaria is a notifiable disease in all European Union and European Economic Area countries except Belgium and France, where only autochthonous malaria is notifiable. Although morbidity caused by malaria has been assessed, little is known about mortality incidence. Objective Our aim was to estimate the number of imported malaria-related deaths in hospital in metropolitan France. Methods We matched individual deaths reported between 1 January 2005 and 31 December 2014 to the French National Reference Centre for malaria (FNRCm) with malaria-related deaths from two other sources: the French National Registry on medical causes of death and the French national hospital discharge database. A capture–recapture method with log-linear modelling was used. Age, sex and place of death stratification were applied to remove heterogeneity. Results The estimated malaria-related deaths in metropolitan France during the study period were 205 (95% confidence interval (CI): 191–219). The annual mean number of malaria-related deaths was estimated at 21 (95% CI: 19–22). The FNRCm malaria-related deaths surveillance had a 38% sensitivity (95% CI: 32–44). Among 161 in-hospital individual malaria-related deaths reported from three data sources, the sex ratio (male to female) was 2.6. Median age of the patients was 57 years, ranging from 1 to 89 years. Conclusion The pertinent finding of this report is that malaria-related death records were significantly more complete than case records. Therefore, data comparison of imported malaria morbidity and mortality between countries should imperatively be assessed using standard indicators weighted according to the completeness of health surveillance systems.
Collapse
Affiliation(s)
- Eric Kendjo
- AP-HP, Centre National de Référence du Paludisme, Paris, France.,Sorbonne Université, INSERM, Institut Pierre-Louis d'Epidémiologie et de Santé Publique, AP-HP, Laboratoire de Parasitologie, Mycologie, Hôpital Pitié-Salpêtrière, Paris, France
| | - Marc Thellier
- AP-HP, Centre National de Référence du Paludisme, Paris, France.,Sorbonne Université, INSERM, Institut Pierre-Louis d'Epidémiologie et de Santé Publique, AP-HP, Laboratoire de Parasitologie, Mycologie, Hôpital Pitié-Salpêtrière, Paris, France
| | - Harold Noël
- Santé Publique France, Direction des Maladies Infectieuses, Saint-Maurice, France
| | - Stéphane Jauréguiberry
- Sorbonne Université, INSERM, Institut Pierre-Louis d'Epidémiologie et de Santé Publique, AP-HP, Service des Maladies Infectieuses, Hôpital Pitié-Salpêtrière, Paris, France.,AP-HP, Centre National de Référence du Paludisme, Paris, France
| | - Alexandra Septfons
- Santé Publique France, Direction des Maladies Infectieuses, Saint-Maurice, France
| | - Oussama Mouri
- AP-HP, Centre National de Référence du Paludisme, Paris, France.,Sorbonne Université, INSERM, Institut Pierre-Louis d'Epidémiologie et de Santé Publique, AP-HP, Laboratoire de Parasitologie, Mycologie, Hôpital Pitié-Salpêtrière, Paris, France
| | - Frédérick Gay
- AP-HP, Centre National de Référence du Paludisme, Paris, France.,Sorbonne Université, INSERM, Institut Pierre-Louis d'Epidémiologie et de Santé Publique, AP-HP, Laboratoire de Parasitologie, Mycologie, Hôpital Pitié-Salpêtrière, Paris, France
| | - Ilhame Tantaoui
- AP-HP, Centre National de Référence du Paludisme, Paris, France.,Sorbonne Université, INSERM, Institut Pierre-Louis d'Epidémiologie et de Santé Publique, AP-HP, Laboratoire de Parasitologie, Mycologie, Hôpital Pitié-Salpêtrière, Paris, France
| | - Eric Caumes
- Sorbonne Université, INSERM, Institut Pierre-Louis d'Epidémiologie et de Santé Publique, AP-HP, Service des Maladies Infectieuses, Hôpital Pitié-Salpêtrière, Paris, France
| | - Sandrine Houzé
- Université de Paris, MERIT, IRD, Paris, France.,Centre National de Référence du Paludisme, Hôpital Bichat, AP-HP, Paris, France
| | - Renaud Piarroux
- AP-HP, Centre National de Référence du Paludisme, Paris, France.,Sorbonne Université, INSERM, Institut Pierre-Louis d'Epidémiologie et de Santé Publique, AP-HP, Laboratoire de Parasitologie, Mycologie, Hôpital Pitié-Salpêtrière, Paris, France
| | -
- The members of the French imported malaria Study group are acknowledged at the end of this article
| |
Collapse
|
13
|
Abstract
Asia is the largest and most populous continent and has huge differences in socioeconomic status, development, and health care between the different countries and regions within each country. This manifests in the varied causes of acute kidney injury (AKI), particularly higher rates of community-acquired AKI and in the differential access to health care for the population. Because of resource limitations, prevention and treatment of AKI is a difficult challenge. This review highlights the differences in AKI in Asia compared with the developed world and discusses prevention and treatment of AKI within the context of resource limitations.
Collapse
|
14
|
Adequacy of Severe Malaria Markers and Prognostic Scores in an Intensive Care Unit in Luanda, Angola: A Clinical Study. J Clin Med 2020; 9:jcm9123862. [PMID: 33261096 PMCID: PMC7760046 DOI: 10.3390/jcm9123862] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 10/24/2020] [Accepted: 11/20/2020] [Indexed: 11/17/2022] Open
Abstract
Severe Plasmodium falciparum malaria remains the primary cause of mortality in several African countries, including Angola, where severe malaria patient admission into intensive care units (ICU) is mandatory. The present observational and prospective study enrolled 101 consecutive severe malaria patients admitted at the ICU of Américo Boavida University Hospital (Luanda, Angola). Malaria was confirmed by microscopy and RDT, and WHO criteria were used to define severe malaria. The Sequential Organ Failure Assessment (SOFA) score was used to monitor organ dysfunctions. Surviving and nonsurviving patients were compared using bivariate statistical methods. Two-step cluster analysis was used to find discriminant organ dysfunctions that may correlate better with the observed mortality (16.8%), which was much lower than the one generated by the SOFA score. The study population was young, and 87% of the patients were local native residents. There was no statistically significant correlation between the parasitemia and the outcome. Hematological and cerebral dysfunctions were prevalent but were not discriminant when cluster analyses were performed to detect homogeneous subgroups of patients. In conclusion, the SOFA score was readily applicable and efficient in monitoring daily organ dysfunction but was not effective enough in predicting the outcome of severe malaria patients.
Collapse
|
15
|
Hanson J, Nyein PP, Aung NM, Kyi MM. Time for pragmatic, prospective clinical trials to determine the role of empirical antibacterial therapy in critically ill adults hospitalized with malaria. Int J Infect Dis 2020; 102:28-31. [PMID: 33017698 DOI: 10.1016/j.ijid.2020.09.1472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 09/25/2020] [Accepted: 09/25/2020] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Children with severe falciparum malaria in malaria-endemic regions are predisposed to developing life-threatening bacterial co-infection. International guidelines therefore recommend empirical broad-spectrum antibacterial therapy in these children. Few studies have examined co-infection in adults, although it has been believed to be relatively rare; antibacterial therapy is therefore not routinely recommended in adults with falciparum malaria. DISCUSSION However, the fundamental pathophysiology of falciparum malaria in adults and children is the same; it is therefore unclear why adults would not also be predisposed to bacterial infection. Indeed, recent studies have identified bacteraemia in >10% of adults hospitalized with malaria. Some have suggested that these adults probably had bacterial sepsis, with the parasitaemia an incidental finding. However, it is usually impossible in resource-limited settings to determine-at presentation-whether critically ill, parasitaemic adults have severe malaria, bacterial sepsis, or both. Given the significant case-fatality rates of severe malaria and bacterial sepsis, the pragmatic initial approach would be to cover both possibilities. CONCLUSIONS Life-threatening bacterial co-infection may be more common in critically ill adults with malaria than previously believed. While further prospective data are awaited to confirm these findings, it might be more appropriate to provide empirical aantibacterial cover in these patients than current guidelines suggest.
Collapse
Affiliation(s)
- Josh Hanson
- The Kirby Institute, University of New South Wales, Sydney, Australia; University of Medicine 2, North Okkalapa Township, Yangon, Myanmar; Myanmar Australia Research Collaboration for Health (MARCH), Yangon, Myanmar.
| | - Phyo Pyae Nyein
- Myanmar Australia Research Collaboration for Health (MARCH), Yangon, Myanmar; Mingaladon Specialist Hospital, Mingaladon Township, Yangon, Myanmar
| | - Ne Myo Aung
- University of Medicine 2, North Okkalapa Township, Yangon, Myanmar; Myanmar Australia Research Collaboration for Health (MARCH), Yangon, Myanmar; Insein General Hospital, Insein Township, Yangon, Myanmar
| | - Mar Mar Kyi
- University of Medicine 2, North Okkalapa Township, Yangon, Myanmar; Myanmar Australia Research Collaboration for Health (MARCH), Yangon, Myanmar; Insein General Hospital, Insein Township, Yangon, Myanmar
| |
Collapse
|
16
|
Lebut J, Mourvillier B, Argy N, Dupuis C, Vinclair C, Radjou A, de Montmollin E, Sinnah F, Patrier J, Le Bihan C, Magalahes E, Smonig R, Kendjo E, Thellier M, Ruckly S, Bouadma L, Wolff M, Sonneville R, Houzé S, Timsit JF. Changes in the clinical presentation and outcomes of patients treated for severe malaria in a referral French university intensive care unit from 2004 to 2017. Ann Intensive Care 2020; 10:21. [PMID: 32052207 PMCID: PMC7016155 DOI: 10.1186/s13613-020-0634-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Accepted: 01/30/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND In France, the incidence of severe imported malaria cases increased since early 2000. Artesunate was available (temporarily use authorization) since mid-2011 in France and commonly used for severe malaria since early 2013. Thus, the study objectives were to describe the patients with severe imported malaria admitted in intensive care unit (ICU) and assess the changes in clinical presentation and outcomes before and after this date. METHODS Retrospective observational single-center study in the infectious diseases ICU of a referral university hospital, conducted on patients admitted for severe imported malaria from 2004 to 2017. Demographic variables, severity scores, WHO's severity criteria on admission, treatment, and ICU and hospital lengths of stay were collected. Patients' characteristics and outcomes were compared between both periods. A poor outcome was defined as the composite endpoint of death, or requirement for vasopressors, invasive mechanical ventilation and/or renal replacement therapy. RESULTS 189 patients were included, 98 in 2004-2012 and 91 in 2013-2017, most often from West and Central African countries (96%). The number of WHO criteria for severe malaria was comparable in both groups, but SAPS II, SOFA and ICU length of stay were significantly higher in 2004-2012, while patients of African origin living in France were less frequent (p < 0.01). The outcome was poor for 41/98 cases in 2004-2012 and 12/91 cases in 2013-2017 (p < 0.01). The risk factors of poor outcome on the multivariate logistic regression were a neurological failure (adjusted odds ratio (adjOR = 3.23; 95% CI (1.03-10.08), p = 0.004), cardio-circulatory failure (adjOR = 9.92; 95% CI (2.34-42), p = <0.01) and creatinine blood levels > 265 µmol/L (adjOR = 10.76; 95% CI (3.17-36.53), p < 0.01). In the multivariate analysis, IV artesunate was not associated with a better outcome. Patients of African origin did not seem to have a better outcome than Caucasian patients or those from other origins (adjOR = 0.59; 95% CI (0.21-1.65), p = 0.31). CONCLUSION Patients with imported malaria admitted in ICU in 2013-2017 were less severely ill than those in 2004-2012. These trends could be partially explained by the increasing proportion of African patients visiting friends or relatives or living in endemic areas.
Collapse
Affiliation(s)
- Jordane Lebut
- AP-HP, Bichat Hospital, Medical and Infectious Diseases ICU (MI2), University of Paris, IAME, INSERM U1137 (IAME), 75018, Paris, France
- Longjumeau Hospital, ICU, Longjumeau, France
| | - Bruno Mourvillier
- AP-HP, Bichat Hospital, Medical and Infectious Diseases ICU (MI2), University of Paris, IAME, INSERM U1137 (IAME), 75018, Paris, France
- UMRS 1136, iPLESP, Institut Pierre-Louis d'épidémiologie et de santé publique, Sorbonne Université, 27, Rue Chaligny, 75571, Paris 12, France
| | - Nicolas Argy
- AP-HP, Bichat Hospital, Mycology Parasitology Department, Malaria National Reference Center, 75018, Paris, France
| | - Claire Dupuis
- AP-HP, Bichat Hospital, Medical and Infectious Diseases ICU (MI2), University of Paris, IAME, INSERM U1137 (IAME), 75018, Paris, France
- University of Paris, IAME, INSERM, 75018, Paris, France
| | - Camille Vinclair
- AP-HP, Bichat Hospital, Medical and Infectious Diseases ICU (MI2), University of Paris, IAME, INSERM U1137 (IAME), 75018, Paris, France
| | - Aguila Radjou
- AP-HP, Bichat Hospital, Medical and Infectious Diseases ICU (MI2), University of Paris, IAME, INSERM U1137 (IAME), 75018, Paris, France
| | - Etienne de Montmollin
- AP-HP, Bichat Hospital, Medical and Infectious Diseases ICU (MI2), University of Paris, IAME, INSERM U1137 (IAME), 75018, Paris, France
- University of Paris, IAME, INSERM, 75018, Paris, France
| | - Fabrice Sinnah
- AP-HP, Bichat Hospital, Medical and Infectious Diseases ICU (MI2), University of Paris, IAME, INSERM U1137 (IAME), 75018, Paris, France
| | - Juliette Patrier
- AP-HP, Bichat Hospital, Medical and Infectious Diseases ICU (MI2), University of Paris, IAME, INSERM U1137 (IAME), 75018, Paris, France
| | - Clément Le Bihan
- AP-HP, Bichat Hospital, Medical and Infectious Diseases ICU (MI2), University of Paris, IAME, INSERM U1137 (IAME), 75018, Paris, France
- University of Paris, IAME, INSERM, 75018, Paris, France
| | - Eric Magalahes
- AP-HP, Bichat Hospital, Medical and Infectious Diseases ICU (MI2), University of Paris, IAME, INSERM U1137 (IAME), 75018, Paris, France
| | - Roland Smonig
- AP-HP, Bichat Hospital, Medical and Infectious Diseases ICU (MI2), University of Paris, IAME, INSERM U1137 (IAME), 75018, Paris, France
| | - Eric Kendjo
- UMRS 1136, iPLESP, Institut Pierre-Louis d'épidémiologie et de santé publique, Sorbonne Université, 27, Rue Chaligny, 75571, Paris 12, France
| | - Marc Thellier
- UMRS 1136, iPLESP, Institut Pierre-Louis d'épidémiologie et de santé publique, Sorbonne Université, 27, Rue Chaligny, 75571, Paris 12, France
| | | | - Lila Bouadma
- AP-HP, Bichat Hospital, Medical and Infectious Diseases ICU (MI2), University of Paris, IAME, INSERM U1137 (IAME), 75018, Paris, France
- University of Paris, IAME, INSERM, 75018, Paris, France
| | - Michel Wolff
- AP-HP, Bichat Hospital, Medical and Infectious Diseases ICU (MI2), University of Paris, IAME, INSERM U1137 (IAME), 75018, Paris, France
- University of Paris, IAME, INSERM, 75018, Paris, France
| | - Romain Sonneville
- AP-HP, Bichat Hospital, Medical and Infectious Diseases ICU (MI2), University of Paris, IAME, INSERM U1137 (IAME), 75018, Paris, France
- University of Paris, IAME, INSERM, 75018, Paris, France
| | - Sandrine Houzé
- AP-HP, Bichat Hospital, Mycology Parasitology Department, Malaria National Reference Center, 75018, Paris, France
| | - Jean-François Timsit
- AP-HP, Bichat Hospital, Medical and Infectious Diseases ICU (MI2), University of Paris, IAME, INSERM U1137 (IAME), 75018, Paris, France.
- University of Paris, IAME, INSERM, 75018, Paris, France.
- OUTCOMEREA Research Network, Drancy, France.
| |
Collapse
|
17
|
Takaya S, Kato Y, Katanami Y, Yamamoto K, Kutsuna S, Takeshita N, Hayakawa K, Kanagawa S, Komaki-Yasuda K, Kano S, Ohmagari N. Imported Malaria at a Referral Hospital in Tokyo from 2005 to 2016: Clinical Experience and Challenges in a Non-Endemic Setting. Am J Trop Med Hyg 2020; 100:828-834. [PMID: 30675850 PMCID: PMC6447110 DOI: 10.4269/ajtmh.18-0722] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
In this study, we reviewed imported malaria cases observed at the National Center for Global Health and Medicine, Tokyo, between 2005 and 2016, to comprehend their demographic and clinical characteristics. Data on 169 cases were used to analyze demographic information; data on 146 cases were used for the analysis of clinical information. The median patients’ age was 34 years, and 79.3% of them were male. The proportion of non-Japanese patients increased and surpassed that of Japanese patients after 2015. In 82.2% of the cases, the region of acquisition was Africa, and Plasmodium falciparum was the dominant species (74.0%) followed by Plasmodium vivax (15.4%). We observed 19 (18.4%, 19/103) severe falciparum malaria cases. Mefloquine was the most commonly used drug for treatment until the early 2010s; atovaquone/proguanil was the most commonly used after its licensure in 2013. Although none of the patients died, four recrudescence episodes after artemether/lumefantrine (A/L) treatment and one relapse episode were observed. Overall, malaria was diagnosed on median day 4 of illness, and, thereon, treatment was initiated without delay. Diagnosis on day 5 or later was significantly associated with severe disease in Japanese cases (odds ratio = 4.1; 95% CI = 1.2–14.3). We observed a dominance of falciparum malaria, an increase in the number of non-Japanese cases, late treatment failure after A/L treatment, a low relapse rate, and an association between delayed malaria diagnosis and higher disease severity. Pretravel care and early diagnosis are necessary to reduce malaria-related mortality and morbidity in settings such as ours.
Collapse
Affiliation(s)
- Saho Takaya
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Shinjuku, Japan
| | - Yasuyuki Kato
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Shinjuku, Japan
| | - Yuichi Katanami
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Shinjuku, Japan
| | - Kei Yamamoto
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Shinjuku, Japan
| | - Satoshi Kutsuna
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Shinjuku, Japan
| | - Nozomi Takeshita
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Shinjuku, Japan
| | - Kayoko Hayakawa
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Shinjuku, Japan
| | - Shuzo Kanagawa
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Shinjuku, Japan
| | - Kanako Komaki-Yasuda
- Department of Tropical Medicine and Malaria, National Center for Global Health and Medicine Research Institute, Shinjuku, Japan
| | - Shigeyuki Kano
- Department of Tropical Medicine and Malaria, National Center for Global Health and Medicine Research Institute, Shinjuku, Japan
| | - Norio Ohmagari
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Shinjuku, Japan
| |
Collapse
|
18
|
Malaria. HIGHLY INFECTIOUS DISEASES IN CRITICAL CARE 2020. [PMCID: PMC7120402 DOI: 10.1007/978-3-030-33803-9_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Malaria is a significant cause of morbidity and mortality throughout the world, and environmental changes are likely to increase its importance in the coming years. Diagnosing this disease is difficult and requires a high index of suspicion, especially in non-endemic countries. Critical care providers play a major role in treating severe malaria and its complications, which has management particularities that might not be readily apparent. Fluid resuscitation should be carefully tailored to avoid complications, and dysperfusion seems more related to degree of parasitemia than hypovolemia. Antimalarial agents are effective, but resistance is growing. Complications can be found in nearly every organ, including cerebral malaria, acute respiratory distress syndrome, and acute kidney injury. As such, a critical care unit is frequently required for organ support when they appear. Superimposed infections are not infrequent. Despite all of this, mortality is encouragingly low with a timely diagnosis and access to appropriate treatment.
Collapse
|
19
|
Al Farsi F, Chandwani J, Mahdi AS, Petersen E. Severe imported malaria in an intensive care unit: A case series. IDCases 2019; 17:e00544. [PMID: 31080736 PMCID: PMC6505063 DOI: 10.1016/j.idcr.2019.e00544] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 04/26/2019] [Accepted: 04/26/2019] [Indexed: 11/16/2022] Open
Abstract
Introduction Complicated malaria is a medical emergency with a high mortality if untreated. Aim To describe the clinical spectrum, treatment practices and outcome of severe malaria cases admitted to an intensive care unit. Method Thirteen severe malaria cases admitted to the ICU over a 6 years period (2012 – October 2018) were included. The data was retrospectively extracted from the hospital patient data management system. Results Nine patients had P. falciparum malaria, three had P.Vivax, and one had both. Only one had received malarial chemoprophylaxis. The median time of attending to medical health facility after symptoms started was 7 days (range: 2–21 days). All cases responded to antimalarial therapy and supportive management. Complications included shock 54%, kidney failure 38%, respiratory failure 69%, cerebral malaria 61%, hypoglycemia 23%, coagulation derangement 8%, and acidosis 23%. There were no fatal outcomes but one case had permanent brain damage and the rest recovered completely. Conclusion The median treatment delay of seven days explains why these patients ended in intensive care with multiple symptoms of severe malaria and often multiorgan failure. Pretravel advice and use of malaria chemoprophylaxis when visiting high risk areas would probably have prevented infection and timely attendance to healthcare once symptomatic would have reduced the morbidity associated with infection, reduced length of stay in hospital and hence resources.
Collapse
Affiliation(s)
- Fatma Al Farsi
- Medical Microbiology Residency Program, Oman Medical Specialty Board, Al Azaiba, 130 Muscat, Oman
| | - Juhi Chandwani
- Department of Intensive Care, The Royal Hospital, Al Ghubrah Street, 111 Muscat, Oman
| | - Asmaa S Mahdi
- Department of Infectious Diseases, The Royal Hospital, Al Ghubrah Street, 111 Muscat, Oman
| | - Eskild Petersen
- Department of Infectious Diseases, The Royal Hospital, Al Ghubrah Street, 111 Muscat, Oman.,Institute for Clinical Medicine, Faculty of Health Science, University of Aarhus, Denmark
| |
Collapse
|
20
|
Abstract
Background Previous studies have documented a spectrum of brain magnetic resonance imaging (MRI) abnormalities in patients with cerebral malaria, but little is known about the prevalence of such abnormalities in patients with non-cerebral malaria. The aim of this study was to assess the frequency of brain MRI findings in returning travellers with non-cerebral malaria. Methods A total of 17 inpatients with microscopically confirmed Plasmodium falciparum non-cerebral malaria underwent structural brain MRI at 3.0 Tesla, including susceptibility-weighted imaging (SWI). Presence of imaging findings was recorded and correlated with clinical findings and parasitaemia. Results Structural brain abnormalities included a hyperintense lesion of the splenium on T2-weighted imaging (n = 3) accompanied by visible diffusion restriction (n = 2). Isolated brain microhaemorrhage was detected in 3 patients. T2-hyperintense signal abnormalities of the white matter ranged from absent to diffuse (n = 10 had 0–5 lesions, n = 5 had 5–20 lesions and 2 patients had more than 50 lesions). Imaging findings were not associated with parasitaemia or HRP2 levels. Conclusion Brain MRI reveals a considerable frequency of T2-hyperintense splenial lesions in returning travellers with non-cerebral malaria, which appears to be independent of parasitaemia.
Collapse
|
21
|
|
22
|
Bruneel F, Raffetin A, Corne P, Llitjos JF, Mourvillier B, Argaud L, Wolff M, Laurent V, Jauréguiberry S. Management of severe imported malaria in adults. Med Mal Infect 2018; 50:213-225. [PMID: 30266432 DOI: 10.1016/j.medmal.2018.08.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 08/30/2018] [Indexed: 11/28/2022]
Abstract
Severe malaria accounts for approximately 10% of all cases of imported malaria in France; cases are mainly due to Plasmodium falciparum, while other Plasmodium species are possible but uncommon (P. vivax, P. knowlesi, P. malariae, and P. ovale). On the basis of WHO criteria for endemic areas, the French criteria defining severe imported malaria in adults have been progressively adapted to the European healthcare level. Management of severe imported malaria is a diagnostic and treatment emergency and must be initially conducted in the intensive care unit. Anti-infective treatment is now based on intravenous artesunate, which must be available in every hospital of the country likely to receive severe imported malaria patients. Intravenous quinine is thus used as a second-line treatment and is restricted to limited indications. Critical care management of organ failure is essential, particularly in patients presenting with very severe malaria. To date, no adjunctive therapy (including exchange transfusion) has demonstrated clear beneficial effects.
Collapse
Affiliation(s)
- F Bruneel
- Réanimation médico-chirurgicale, hôpital Mignot, centre hospitalier de Versailles, 177, rue de Versailles, 78150 Le Chesnay, France.
| | - A Raffetin
- Médecine interne, maladies infectieuses et tropicales, CHI Villeneuve-Saint-Georges, 94190 Villeneuve-Saint-Georges, France
| | - P Corne
- Réanimation médicale, CHU de Montpellier, 34000 Montpellier, France
| | - J F Llitjos
- Réanimation médicale, CHU Cochin, 75014 Paris, France
| | - B Mourvillier
- Réanimation médicale et infectieuse, CHU Bichat-Claude-Bernard, 75018 Paris, France
| | - L Argaud
- Réanimation médicale, CHU Edouard-Herriot, 69000 Lyon, France
| | - M Wolff
- Réanimation médicale et infectieuse, CHU Bichat-Claude-Bernard, 75018 Paris, France
| | - V Laurent
- Réanimation médico-chirurgicale, hôpital Mignot, centre hospitalier de Versailles, 177, rue de Versailles, 78150 Le Chesnay, France
| | - S Jauréguiberry
- Maladies infectieuses et tropicales, CHU Pitié-Salpêtrière, 75013 Paris, France
| |
Collapse
|
23
|
Bruneel F, Raffetin A, Roujansky A, Corne P, Tridon C, Llitjos JF, Mourvillier B, Laurent V, Jauréguiberry S. Prise en charge du paludisme grave d’importation de l’adulte. MEDECINE INTENSIVE REANIMATION 2018. [DOI: 10.3166/rea-2018-0051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
En France, le paludisme grave d’importation concerne environ 12 à 14 % des accès palustres et implique très majoritairement Plasmodium falciparum. À partir de la définition du paludisme grave de l’Organisation mondiale de la santé utilisée en zone d’endémie palustre, la définition française du paludisme grave d’importation de l’adulte a été adaptée aux données et au contexte européens. La prise en charge du paludisme grave est une urgence diagnostique et thérapeutique qui doit être réalisée initialement en réanimation. Le traitement curatif du paludisme grave d’importation repose maintenant sur l’artésunate intraveineux (IV) qui doit être disponible dans chaque hôpital susceptible de recevoir ces patients. Dès lors, la quinine IV devient un traitement de seconde ligne réservé à quelques circonstances. La prise en charge symptomatique des défaillances d’organes est primordiale, notamment au cours des formes les plus sévères. Enfin, aucun traitement adjuvant n’a prouvé, à ce jour, son efficacité en pratique clinique.
Collapse
|
24
|
Mòdol JM, Roure S, Smithson À, Fernández-Rivas G, Esquerrà A, Robert N, Méndez M, Ramos J, Carreres A, Valerio L. Epidemiological and clinical assessment of a shared territorial malaria guideline in the 10 years of its implementation (Barcelona, North Metropolitan Area, Catalonia, Spain, 2007-2016). Malar J 2017; 16:365. [PMID: 28893258 PMCID: PMC5594461 DOI: 10.1186/s12936-017-2007-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 09/02/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Malaria remains a major source of morbi-mortality among travellers. In 2007, a consensual multicenter Primary Care-Hospital shared guideline on travel-prior chemoprophylaxis, diagnosis and clinical management of imported malaria was set up in the Barcelona North Metropolitan area. The aim of the study is to assess the evolution of malaria cases in the area as well as its clinical management over the 10 years of its implementation. RESULTS A total of 190 malaria cases, all them imported, have been recorded. The overall estimated malaria crude incidence was of 0.47 cases per 10,000 population/year (95% CI 0.34-0.59) with a slight significant positive slope especially at the expense of an increase in Indian sub-continent Plasmodium vivax cases. The number of patients who attended the pre-travel consultation was low (13.7%) as well as those with prescribed chemoprophylaxis (10%). Severe malaria was diagnosed in 34 (17.9%) patients and ICU admittance was required in 2.6% of them. Organ sequelae (two renal failures and one post-acute distress respiratory syndrome) were recorded in 3 patients at hospital discharge, although all three were recovered at 30 days. None of the patients died. Patients complying with severity criteria were significantly males (p = 0.04), came from Africa (p = 0.02), were mainly non-immigrant travellers (p = 0.01) and were attended in a hospital setting (p < 0.001). The most frequently identified species was Plasmodium falciparum (64.2%), P. vivax (23.2%), Plasmodium malariae (1.6%) and Plasmodium ovale (1.1%). Those patients diagnosed with P. falciparum malaria came more often from sub-Saharan Africa (p < 0.001) and those with P. vivax came largely from the Indian sub-continent (p = 0.003). Among the 126 patients in whom an immunochromatographic antigenic test was performed, the result was interpreted as falsely negative in 12.1% of them. False negative results can be related to cases with <1% parasitaemia. CONCLUSIONS After 10 years of surveillance, a moderate increase in malaria incidence was observed, mostly P. vivax cases imported from the Indian sub-continent. Although severe malaria cases have been frequently reported, none of the patients died and organ sequelae were rare. Conceivably, the participation of the Primary Care and the District and Third Level Hospital professionals defining surveillance, diagnostic tests, referral criteria and clinical management can be considered a useful tool to minimize malaria morbi-mortality.
Collapse
Affiliation(s)
- Josep M. Mòdol
- Emergency Department, Hospital Universitari Germans Trias i Pujol, Badalona, Catalonia Spain
| | - Sílvia Roure
- Unitat de Salut Internacional Metropolitana Nord, Santa Coloma de Gramenet, Catalonia Spain
| | - Àlex Smithson
- Internal Medicine Service, Hospital de l’Esperit Sant, Santa Coloma de Gramenet, Barcelona, Catalonia Spain
| | - Gema Fernández-Rivas
- Department of Microbiology, Hospital Universitari Germans Trias i Pujol, Badalona, Catalonia Spain
| | - Anna Esquerrà
- Internal Medicine, Hospital Universitari Germans Trias i Pujol, Badalona, Catalonia Spain
| | - Neus Robert
- Emergency Department, Hospital Universitari Germans Trias i Pujol, Badalona, Catalonia Spain
| | - María Méndez
- Pediatrics Department, Hospital Universitari Germans Trias i Pujol, Badalona, Catalonia Spain
| | - Javier Ramos
- Internal Medicine Service, Hospital de l’Esperit Sant, Santa Coloma de Gramenet, Barcelona, Catalonia Spain
| | - Anna Carreres
- Emergency Department, Hospital Universitari Germans Trias i Pujol, Badalona, Catalonia Spain
| | - Lluís Valerio
- Unitat de Salut Internacional Metropolitana Nord, Santa Coloma de Gramenet, Catalonia Spain
| |
Collapse
|
25
|
Antinori S, Corona A, Castelli A, Rech R, Borghi B, Giannotti C, Colombo R, Fossali T, Ballone E, Minari C, Perotti A, Bergomi P, Galimberti L, Milazzo L, Ricaboni D, Scorza D, Grande R, Genderini F, Ieri M, Raimondi F, Catena E, Galli M, Corbellino M. Severe Plasmodium falciparum malaria in the intensive care unit: A 6-year experience in Milano, Italy. Travel Med Infect Dis 2017; 17:43-49. [PMID: 28554853 DOI: 10.1016/j.tmaid.2017.05.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 05/02/2017] [Accepted: 05/23/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND Severe imported Plasmodium falciparum malaria is a potentially life-threatening disease with a reported mortality rate of 5-10% when patients are admitted to the Intensive Care Unit. METHODS To retrospectively review the clinical aspects, the value of severity predictive scores and the management of patients with severe P. falciparum malaria admitted to an ICU in Milano, Italy between January 2010 and December 2015. RESULTS Twelve patients were included: seven were male and five female with a median age of 43 years. All were initially treated with intravenous quinine. Median parasitaemia upon admission was 14,5% (range 1-20%). At the time of ICU admission, 3 patients (25%) had 5 or more World Health Organization criteria for severe malaria while another 6 of them developed one or more of the latter during their stay in ICU. Five required mechanical ventilation because of respiratory failure due to ARDS. Four patients required renal replacement therapy. Three patients underwent blood exchange transfusion. All patients survived. CONCLUSIONS Our retrospective evaluation of adults patients admitted to the ICU with severe imported P. falciparum malaria demonstrated a favourable outcome. Severity predictive scores currently in use probably overestimate the risk of malaria mortality in patients treated in health care systems of high income countries.
Collapse
Affiliation(s)
- Spinello Antinori
- Department of Clinical and Biomedical Sciences Luigi Sacco, University of Milano, Italy; III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy.
| | - Alberto Corona
- Intensive Care Unit 1, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy
| | - Antonio Castelli
- Intensive Care Unit 1, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy
| | - Roberto Rech
- Intensive Care Unit 1, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy
| | - Beatrice Borghi
- Intensive Care Unit 1, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy
| | - Claudia Giannotti
- Intensive Care Unit 1, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy
| | - Riccardo Colombo
- Intensive Care Unit 1, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy
| | - Tommaso Fossali
- Intensive Care Unit 1, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy
| | - Elisabetta Ballone
- Intensive Care Unit 1, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy
| | - Caterina Minari
- Intensive Care Unit 1, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy
| | - Andrea Perotti
- Intensive Care Unit 1, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy
| | - Paola Bergomi
- Intensive Care Unit 1, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy
| | - Laura Galimberti
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy
| | - Laura Milazzo
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy
| | - Davide Ricaboni
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy
| | - Daniele Scorza
- Nephrology and Dialysis Unit, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy
| | - Romualdo Grande
- Department of Diagnostic Services, Clinical Microbiology, Virology and Bioemergence Diagnostics, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy
| | - Francesco Genderini
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy
| | - Marco Ieri
- Hematology and Transfusion Medicine, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy
| | - Ferdinando Raimondi
- Intensive Care Unit 1, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy
| | - Emanuele Catena
- Intensive Care Unit 1, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy
| | - Massimo Galli
- Department of Clinical and Biomedical Sciences Luigi Sacco, University of Milano, Italy; III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy
| | - Mario Corbellino
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy
| |
Collapse
|
26
|
Argy N, Kendjo E, Augé-Courtoi C, Cojean S, Clain J, Houzé P, Thellier M, Hubert V, Deloron P, Houzé S. Influence of host factors and parasite biomass on the severity of imported Plasmodium falciparum malaria. PLoS One 2017; 12:e0175328. [PMID: 28410415 PMCID: PMC5391917 DOI: 10.1371/journal.pone.0175328] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 03/23/2017] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES Imported malaria in France is characterized by various clinical manifestations observed in a heterogeneous population of patients such as travelers/expatriates and African migrants. In this population, host factors and parasite biomass associated with severe imported malaria are poorly known. METHODS From data collected by the Centre National de Référence du Paludisme, we identified epidemiological, demographic and biological features including parasite biomass and anti-plasmodial antibody levels (negative, positive and strongly positive serology) associated with different disease severity groups (very severe, moderately severe, and uncomplicated malaria) in 3 epidemiological groups (travelers/expatriates, first- and second-generation migrants). RESULTS Age, ethnicity, absence of prior infection with P. falciparum, antibody levels, plasma PfHRP2 levels, total and circulating parasite biomass were related to severe malaria onset. Sequestered parasite biomass tended to be increased in very severe malaria, and was strongly correlated to the antibody level of the host. CONCLUSIONS Prior exposure to P. falciparum is associated with high anti-plasmodial antibody levels which influence clinical presentation of imported malaria and its correlated circulating and sequestered parasite burden.
Collapse
Affiliation(s)
- Nicolas Argy
- Laboratoire de parasitologie, hôpital Bichat-Claude Bernard, APHP, Paris, France
- Centre National de Référence du Paludisme, hôpital Bichat-Claude Bernard, APHP, Paris, France
- Faculté de Pharmacie, Université Paris Descartes, COMUE Sorbonne Paris Cité, Paris, France
- UMR MERIT 216, Institut de recherche pour le développement, Paris, France
| | - Eric Kendjo
- Centre National de Référence du Paludisme, hôpital Bichat-Claude Bernard, APHP, Paris, France
| | - Claire Augé-Courtoi
- Faculté de Pharmacie, Université Paris Descartes, COMUE Sorbonne Paris Cité, Paris, France
- UMR MERIT 216, Institut de recherche pour le développement, Paris, France
| | - Sandrine Cojean
- Centre National de Référence du Paludisme, hôpital Bichat-Claude Bernard, APHP, Paris, France
| | - Jérôme Clain
- Centre National de Référence du Paludisme, hôpital Bichat-Claude Bernard, APHP, Paris, France
- Faculté de Pharmacie, Université Paris Descartes, COMUE Sorbonne Paris Cité, Paris, France
- UMR MERIT 216, Institut de recherche pour le développement, Paris, France
| | - Pascal Houzé
- Faculté de Pharmacie, Université Paris Descartes, COMUE Sorbonne Paris Cité, Paris, France
- Laboratoire de pharmacologie, hôpital Saint-Louis, APHP, Paris, France
| | - Marc Thellier
- Laboratoire de parasitologie, hôpital Pitié-Salpêtrière, APHP, Paris, France
- Faculté de Médecine, Université Pierre et Marie Curie, COMUE Sorbonne Paris Cité, Paris, France
| | - Veronique Hubert
- Centre National de Référence du Paludisme, hôpital Bichat-Claude Bernard, APHP, Paris, France
| | - Philippe Deloron
- Faculté de Pharmacie, Université Paris Descartes, COMUE Sorbonne Paris Cité, Paris, France
- UMR MERIT 216, Institut de recherche pour le développement, Paris, France
| | - Sandrine Houzé
- Laboratoire de parasitologie, hôpital Bichat-Claude Bernard, APHP, Paris, France
- Centre National de Référence du Paludisme, hôpital Bichat-Claude Bernard, APHP, Paris, France
- Faculté de Pharmacie, Université Paris Descartes, COMUE Sorbonne Paris Cité, Paris, France
- UMR MERIT 216, Institut de recherche pour le développement, Paris, France
| | | |
Collapse
|
27
|
Aggarwal HK, Jain D, Rao A, Kalra R. Role of Coma Acidosis Malaria Score in Patients with Severe Malaria among Indian Population: a Tertiary Care Center Experience. Eurasian J Med 2017; 49:30-35. [PMID: 28416929 DOI: 10.5152/eurasianjmed.2017.16069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE Malaria is a prime public health threat in developing countries like India. There is an unmet need of a simplified methodology for the purpose of triage and provision of intensive care to the severely infected patients in these areas. MATERIALS AND METHODS We did a prospective study in patients (n=60) admitted with severe malaria in a single tertiary care center in the state of Haryana, India. We assessed the role of coma acidosis malaria (CAM) score in these patients when predicting mortality and morbidity events. Stepwise logistic regression analysis was applied to identify patients requiring intensive care based on the CAM score, and the prediction value of the scoring system was assessed among these patients. RESULTS Cerebral malaria (measured using the Glasgow coma scale) and acidosis (base deficit) were the major determinants of the CAM score. Serum bicarbonate levels and respiratory rates were assessed as the proxy markers of the base deficit as it is not always available. Morbidity increased steadily as the CAM scores increased. Sensitivity and negative predictive value of 100% depicted that the scoring system was able to identify patients who needed intensive care and accurately exclude the patients who could be conservatively managed in the ward. Positive predictive values of 73.9%, 68%, and 80.9% indicated that CAM, bicarbonate-based CAM (BCAM), and respiratory rate-based CAM (RCAM) scores, respectively, could precisely predict the morbidity and mortality events among patients with CAM scores ≥2. CONCLUSION CAM scores have precise predictive values in assessing patients with severe malaria. The scoring system helps in accurate and systemic triage of patients, irrespective of species, and directs the treating physicians toward vigilant treatment and emergency care.
Collapse
Affiliation(s)
- Hari Krishan Aggarwal
- Department of Medicine, Pt B.D. Sharma University of Health Sciences, Haryana, India
| | - Deepak Jain
- Department of Medicine, Pt B.D. Sharma University of Health Sciences, Haryana, India
| | - Avinash Rao
- Department of Medicine, Pt B.D. Sharma University of Health Sciences, Haryana, India
| | - Rajinish Kalra
- Department of Pathology, Pt B.D. Sharma University of Health Sciences, Haryana, India
| |
Collapse
|
28
|
Kurth F, Develoux M, Mechain M, Malvy D, Clerinx J, Antinori S, Gjørup IE, Gascon J, Mørch K, Nicastri E, Ramharter M, Bartoloni A, Visser L, Rolling T, Zanger P, Calleri G, Salas-Coronas J, Nielsen H, Just-Nübling G, Neumayr A, Hachfeld A, Schmid ML, Antonini P, Lingscheid T, Kern P, Kapaun A, da Cunha JS, Pongratz P, Soriano-Arandes A, Schunk M, Suttorp N, Hatz C, Zoller T. Severe malaria in Europe: an 8-year multi-centre observational study. Malar J 2017; 16:57. [PMID: 28143519 PMCID: PMC5286792 DOI: 10.1186/s12936-016-1673-z] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 12/30/2016] [Indexed: 11/26/2022] Open
Abstract
Background Malaria remains one of the most serious infections for travellers to tropical countries. Due to the lack of harmonized guidelines a large variety of treatment regimens is used in Europe to treat severe malaria. Methods The European Network for Tropical Medicine and Travel Health (TropNet) conducted an 8-year, multicentre, observational study to analyse epidemiology, treatment practices and outcomes of severe malaria in its member sites across Europe. Physicians at participating TropNet centres were asked to report pseudonymized retrospective data from all patients treated at their centre for microscopically confirmed severe Plasmodium falciparum malaria according to the 2006 WHO criteria. Results From 2006 to 2014 a total of 185 patients with severe malaria treated in 12 European countries were included. Three patients died, resulting in a 28-day survival rate of 98.4%. The majority of infections were acquired in West Africa (109/185, 59%). The proportion of patients treated with intravenous artesunate increased from 27% in 2006 to 60% in 2013. Altogether, 56 different combinations of intravenous and oral drugs were used across 28 study centres. The risk of acute renal failure (36 vs 17% p = 0.04) or cerebral malaria (54 vs 20%, p = 0.001) was significantly higher in patients ≥60 years than in younger patients. Respiratory distress with the need for mechanical ventilation was significantly associated with the risk of death in the study population (13 vs 0%, p = 0.001). Post-artemisinin delayed haemolysis was reported in 19/70 (27%) patients treated with intravenous artesunate. Conclusion The majority of patients with severe malaria in this study were tourists or migrants acquiring the infection in West Africa. Intravenous artesunate is increasingly used for treatment of severe malaria in many European treatment centres and can be given safely to European patients with severe malaria. Patients treated with intravenous artesunate should be followed up to detect and manage late haemolytic events.
Collapse
Affiliation(s)
- Florian Kurth
- Medizinische Klinik mit Schwerpunkt Infektiologie und Pneumologie, Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | - Matthieu Mechain
- Section Tropical Medicine and Clinical International Health, Division of Infectious and Tropical Diseases, Department of Medicine, University Hospital Centre, Bordeaux, France
| | - Denis Malvy
- Section Tropical Medicine and Clinical International Health, Division of Infectious and Tropical Diseases, Department of Medicine, University Hospital Centre, Bordeaux, France
| | - Jan Clerinx
- Institute of Tropical Medicine, Antwerp, Belgium
| | - Spinello Antinori
- Department of Biomedical and Clinical Sciences L.Sacco, University of Milano, Milan, Italy
| | - Ida E Gjørup
- Infectious Diseases Unit, Herlev University Hospital, Copenhagen, Denmark
| | - Joaquím Gascon
- ISGlobal, Barcelona Center for International Health Research. (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - Kristine Mørch
- Department of Medicine, National Centre for Tropical Infectious Diseases, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Emanuele Nicastri
- National Institute of Infectious Diseases Lazzaro Spallanzani, Rome, Italy
| | - Michael Ramharter
- Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria.,Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany
| | - Alessandro Bartoloni
- SOD Malattie Infettive e Tropicali, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Leo Visser
- Department of Infectious Diseases, Leiden University Medical Centre, Leiden, The Netherlands
| | - Thierry Rolling
- Section Tropical Medicine, Department of Internal Medicine I, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Clinical Research, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Philipp Zanger
- Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany.,Institute of Public Health, University of Heidelberg, Heidelberg, Germany
| | - Guido Calleri
- Travel Medicine Unit, Department of Infectious Diseases, Amedeo di Savoia Hospital-ASLTO2, Turin, Italy
| | | | - Henrik Nielsen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark
| | - Gudrun Just-Nübling
- Department of Internal Medicine II, Section Infectious Diseases and Tropical Medicine, University Hospital Frankfurt/Main, Frankfurt/Main, Germany
| | - Andreas Neumayr
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Anna Hachfeld
- Department of Infectious Diseases, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Matthias L Schmid
- Department of Infection & Tropical Medicine, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | | | - Tilman Lingscheid
- Medizinische Klinik mit Schwerpunkt Infektiologie und Pneumologie, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Peter Kern
- Comprehensive Infectious Diseases Center, Department of Internal Medicine III, Ulm University Hospital, Ulm, Germany
| | - Annette Kapaun
- Section Clinical Tropical Medicine, Department of Infectious Diseases, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Peter Pongratz
- Division of Tropical Medicine and Infectious Diseases, Center of Internal Medicine II, University of Rostock, Rostock, Germany
| | - Antoni Soriano-Arandes
- Hospital Universitari Joan XXIII, Tarragona, Spain.,Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Mirjam Schunk
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (LMU), Munich, Germany
| | - Norbert Suttorp
- Medizinische Klinik mit Schwerpunkt Infektiologie und Pneumologie, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Christoph Hatz
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Thomas Zoller
- Medizinische Klinik mit Schwerpunkt Infektiologie und Pneumologie, Charité Universitätsmedizin Berlin, Berlin, Germany. .,Swiss Tropical and Public Health Institute, Basel, Switzerland. .,University of Basel, Basel, Switzerland.
| |
Collapse
|
29
|
Marks M, Armstrong M, Whitty CJM, Doherty JF. Geographical and temporal trends in imported infections from the tropics requiring inpatient care at the Hospital for Tropical Diseases, London - a 15 year study. Trans R Soc Trop Med Hyg 2016; 110:456-63. [PMID: 27618924 PMCID: PMC5034884 DOI: 10.1093/trstmh/trw053] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 07/29/2016] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Understanding geographic and temporal trends in imported infections is key to the management of unwell travellers. Many tropical infections can be managed as outpatients, with admission reserved for severe cases. METHODS We prospectively recorded the diagnosis and travel history of patients admitted between 2000 and 2015. We describe the common tropical and non-tropical infectious diseases and how these varied based on region, reason for travel and over time. RESULTS A total of 4362 admissions followed an episode of travel. Falciparum malaria was the most common diagnosis (n=1089). Among individuals who travelled to Africa 1206/1724 (70.0%) had a tropical diagnosis. The risk of a tropical infection was higher among travellers visiting friends and relatives than holidaymakers (OR 2.8, p<0.001). Among travellers to Asia non-tropical infections were more common than tropical infections (349/782, 44.6%), but enteric fever (117, 33.5%) of the tropical infections and dengue (70, 20.1%) remained important. The number of patients admitted with falciparum malaria declined over the study but those of enteric fever and dengue did not. CONCLUSIONS Most of those arriving from sub-Saharan Africa with an illness requiring admission have a classical tropical infection, and malaria still predominates. In contrast, fewer patients who travelled to Asia have a tropical diagnosis but enteric fever and dengue remain relatively common. Those visiting friends and relatives are most likely to have a tropical infection.
Collapse
Affiliation(s)
- Michael Marks
- Hospital for Tropical Diseases, London, UK Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Christopher J M Whitty
- Hospital for Tropical Diseases, London, UK Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK
| | | |
Collapse
|
30
|
Casalino E, Etienne A, Mentré F, Houzé S. Hospitalization and ambulatory care in imported-malaria: evaluation of trends and impact on mortality. A prospective multicentric 14-year observational study. Malar J 2016; 15:312. [PMID: 27267597 PMCID: PMC4897798 DOI: 10.1186/s12936-016-1364-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 05/27/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hospitalization is usually recommended for imported malaria. The goal of the present study is to evaluate the evolution in clinical pathways while measuring their impact on mortality. METHODS This is a 14-year prospective observational study divided into three periods. We evaluated for adult (≥15 years) and paediatric (<15 years) case trends in severity, clinical pathways (hospitalization in medical ward (MW) or intensive care unit (ICU), ambulatory care) and mortality. RESULTS In total, 21,386 imported malaria cases were included, 4269 of them were paediatrics (20 %). Rises in severe forms for adults [from 8 % in period 1-14 % in period 3 (p = 0.0001)] and paediatrics [from 12 to 18 % (p < 0.0001)] were found. For adults, MW admission rates decreased [-15 % (CI 95 % -17; -13)] while ambulatory care [+7 % (CI 95 % 5-9)] and ICU admission rates [+4 % (CI 95 % 3-5)] increased. For paediatrics, increase in ICU admissions (+3 %) was shown. We did not observe any change in overall mortality during the study periods, whether among adults or children, regardless of care pathway. CONCLUSIONS The present study indicates a changing management of imported malaria in adults, with an increasing trend for ambulatory care. The absence of change in mortality for adults indicates that ambulatory care can be proposed for adults presenting non-severe imported malaria.
Collapse
Affiliation(s)
- Enrique Casalino
- />Service d’Accueil des Urgences, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Bichat-Claude Bernard, 46 rue Henri Huchard, 75018 Paris, France
- />Université Paris Diderot, PRES Sorbonne Paris Cité, EA 7334 «Recherche clinique coordonnée ville-hôpital, Méthodologies et Société (REMES)», Paris, France
| | - Aurélie Etienne
- />INSERM, IAME, UMR 1137, 75018 Paris, France
- />Service de Biostatistique, AP-HP, Hôpital Bichat, 75018 Paris, France
| | - France Mentré
- />INSERM, IAME, UMR 1137, 75018 Paris, France
- />Service de Biostatistique, AP-HP, Hôpital Bichat, 75018 Paris, France
- />Université Paris Diderot, Sorbonne Paris Cité, 75018 Paris, France
| | - Sandrine Houzé
- />Parasitology Laboratory, Centre National de Référence du Paludisme, Assistance Publique-Hôpitaux de Paris (AP-HP), University Hospital Bichat-Claude Bernard, Paris, France
- />RD UMR216, Mère et enfant face aux infections tropicales, 75006 Paris, France
- />Faculté des Sciences Pharmaceutiques et Biologiques, PRES Sorbonne Paris Cité, Université Paris Descartes, 75270 Paris, France
| | | |
Collapse
|
31
|
Francis BC, Gonzalo X, Duggineni S, Thomas JM, NicFhogartaigh C, Babiker ZOE. Epidemiology and clinical features of imported malaria in East London. J Travel Med 2016; 23:taw060. [PMID: 27601534 DOI: 10.1093/jtm/taw060] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 08/11/2016] [Indexed: 11/14/2022]
Abstract
BACKGROUND Malaria is the most common imported tropical disease in the United Kingdom (UK). The overall mortality is low but inter-regional differences have been observed. METHODS We conducted a 2-year retrospective review of clinical and laboratory records of patients with malaria attending three acute hospitals in East London from 1 April 2013 through 31 March 2015. Epidemiological and clinical characteristics of imported malaria were described and risk factors associated with severe falciparum malaria were explored. RESULTS In total, 133 patients with laboratory-confirmed malaria were identified including three requiring critical care admission but no deaths. The median age at presentation was 41 years (IQR 30-50). The majority of patients were males (64.7%, 86/133) and had Black or Black British ethnicity (67.5%, 79/117). West Africa was the most frequent region of travel (70.4%, 76/108). Chemoprophylaxis use was poor (25.3%, 20/79). The interval between arriving in the UK and presenting to hospital was short (median 10 days; IQR 5-15.5, n = 84). July-September was the peak season of presentation (34.6%, 46/133). Plasmodium falciparum was the commonest species (76.7%, 102/133) and 31.4% (32/102) of these patients had parasitaemia >2%. Severe falciparum malaria was documented in 36.3% (37/102) of patients and the October-March season presentation was associated with an increased risk of severity (OR 3.00; 95% CI 1.30-6.93). Black patients appeared to have reduced risk of severe falciparum malaria (OR 0.46; 95% CI 0.16-1.35) but this was not statistically significant. HIV sero-status was determined in only 27.1% (36/133) of cases. Only 8.5% (10/117) of all malaria patients were treated as outpatients. CONCLUSION Clinicians need to raise awareness on malaria prevention strategies, improve rates of HIV testing in tropical travellers, and familiarise themselves with ambulatory management of malaria. The relationship between season of presentation, ethnicity and severity of falciparum malaria should be explored further.
Collapse
Affiliation(s)
- Benjamin C Francis
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, 4 Newark Street, London, E1 2AT, UK
| | - Ximena Gonzalo
- Department of Infection, Royal London Hospital, Barts Health NHS Trust, 80 Newark Street, London, E1 2ES, UK
| | - Sirisha Duggineni
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, 4 Newark Street, London, E1 2AT, UK
| | - Janice M Thomas
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
| | - Caoimhe NicFhogartaigh
- Department of Infection, Royal London Hospital, Barts Health NHS Trust, 80 Newark Street, London, E1 2ES, UK
| | - Zahir Osman Eltahir Babiker
- Department of Infection, Royal London Hospital, Barts Health NHS Trust, 80 Newark Street, London, E1 2ES, UK
| |
Collapse
|
32
|
Hahn WO, Pottinger PS. Malaria in the Traveler: How to Manage Before Departure and Evaluate Upon Return. Med Clin North Am 2016; 100:289-302. [PMID: 26900114 PMCID: PMC4764883 DOI: 10.1016/j.mcna.2015.09.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Malaria is the clinical syndrome when a patient experiences symptoms in response to infection with one of several strains of the Plasmodium parasite. This article is intended for health care providers to become familiar with some of the basics of care of patients who are travelling to or returning from an area with ongoing malaria transmission. The specific focus is on patients from nonendemic areas who plan on travel for a finite period to an area where malaria is endemic.
Collapse
Affiliation(s)
- William O. Hahn
- Fellow, Medicine (Division of Infectious Disease), University of Washington, Seattle, WA
| | - Paul S. Pottinger
- Associate Professor, Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA
| |
Collapse
|
33
|
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.
Collapse
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.
| |
Collapse
|
34
|
Koopmans LC, van Wolfswinkel ME, Hesselink DA, Hoorn EJ, Koelewijn R, van Hellemond JJ, van Genderen PJJ. Acute kidney injury in imported Plasmodium falciparum malaria. Malar J 2015; 14:523. [PMID: 26702815 PMCID: PMC4690233 DOI: 10.1186/s12936-015-1057-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 12/17/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Acute kidney injury (AKI) is a known complication of malaria, and is reported to occur in up to 40% of adult patients with a severe Plasmodium falciparum infection in endemic regions. To gain insight in the incidence and risk factors of AKI in imported P. falciparum malaria, a retrospective analysis was performed on a large cohort of mostly non-immune patients with imported P. falciparum malaria. Aiming to include not only severe but also milder forms of renal failure, the KDIGO criteria were used to define AKI. METHODS Clinical and laboratory data from 485 consecutive cases of imported P. falciparum malaria were extracted from the Rotterdam Malaria Cohort database. Acute kidney injury (AKI) was defined using the KDIGO criteria. Univariate and multivariate logistic regression analyses were used to identify risk factors for AKI. RESULTS AKI was seen in 39 (8%) of all patients and in 23 (38%) of the 61 patients with severe malaria. Eight patients eventually needed renal replacement therapy (RRT); seven of them already had AKI at presentation. Higher age, higher leucocyte count and thrombocytopaenia were independently-associated with AKI but their positive predictive values were relatively poor. CONCLUSION AKI was found to be a common complication in adults with imported P. falciparum necessitating RRT in only a small minority of patients. The use of the KDIGO staging allows early recognition of a decline in renal function.
Collapse
Affiliation(s)
- Liese C Koopmans
- Institute for Tropical Diseases, Harbour Hospital, Haringvliet 2, 3011 TD, Rotterdam, The Netherlands.
| | - Marlies E van Wolfswinkel
- Institute for Tropical Diseases, Harbour Hospital, Haringvliet 2, 3011 TD, Rotterdam, The Netherlands. .,Department of Medical Microbiology and Infectious Diseases, Erasmus MC, Rotterdam, The Netherlands.
| | - Dennis A Hesselink
- Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands.
| | - Ewout J Hoorn
- Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands.
| | - Rob Koelewijn
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, Rotterdam, The Netherlands.
| | - Jaap J van Hellemond
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, Rotterdam, The Netherlands.
| | - Perry J J van Genderen
- Institute for Tropical Diseases, Harbour Hospital, Haringvliet 2, 3011 TD, Rotterdam, The Netherlands.
| |
Collapse
|
35
|
Affiliation(s)
- Florian Kurth
- Medizinische Klinik mit Schwerpunkt Infektiologie und Pneumologie, Charité Universitätsmedizin Berlin, Germany
| | - Thomas Zoller
- Swiss Tropical and Public Health Institute, Basel, Switzerland
| |
Collapse
|
36
|
Kurth F, Develoux M, Mechain M, Clerinx J, Antinori S, Gjørup IE, Gascon J, Mørch K, Nicastri E, Ramharter M, Bartoloni A, Visser L, Rolling T, Zanger P, Calleri G, Salas-Coronas J, Nielsen H, Just-Nübling G, Neumayr A, Hachfeld A, Schmid ML, Antonini P, Pongratz P, Kern P, Saraiva da Cunha J, Soriano-Arandes A, Schunk M, Suttorp N, Hatz C, Zoller T. Intravenous Artesunate Reduces Parasite Clearance Time, Duration of Intensive Care, and Hospital Treatment in Patients With Severe Malaria in Europe: The TropNet Severe Malaria Study. Clin Infect Dis 2015; 61:1441-4. [PMID: 26187021 DOI: 10.1093/cid/civ575] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 07/08/2015] [Indexed: 11/13/2022] Open
Abstract
Intravenous artesunate improves survival in severe malaria, but clinical trial data from nonendemic countries are scarce. The TropNet severe malaria database was analyzed to compare outcomes of artesunate vs quinine treatment. Artesunate reduced parasite clearance time and duration of intensive care unit and hospital treatment in European patients with imported severe malaria.
Collapse
Affiliation(s)
- Florian Kurth
- Medizinische Klinik mit Schwerpunkt Infektiologie und Pneumologie, Charité Universitätsmedizin Berlin, Germany
| | | | - Matthieu Mechain
- Section Tropical Medicine and Clinical International Health, Division of Infectious and Tropical Diseases, Department of Medicine, University Hospital Centre, Bordeaux, France
| | - Jan Clerinx
- Institute of Tropical Medicine, Antwerp, Belgium
| | - Spinello Antinori
- Department of Biomedical and Clinical Sciences L. Sacco, University of Milan, Italy
| | - Ida E Gjørup
- Infectious Diseases Unit, Herlev University Hospital, Copenhagen, Denmark
| | - Joaquím Gascon
- ISGlobal, Barcelona Centre for International Health Research, Spain
| | - Kristine Mørch
- National Centre for Tropical Infectious Diseases, Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Emanuele Nicastri
- National Institute of Infectious Diseases Lazzaro Spallanzani, Rome, Italy
| | - Michael Ramharter
- Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Austria
| | - Alessandro Bartoloni
- SOD Malattie Infettive e Tropicali, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Leo Visser
- Department of Infectious Diseases, Leiden University Medical Centre, The Netherlands
| | - Thierry Rolling
- Department of Internal Medicine I, Section Tropical Medicine, University Medical Center Hamburg-Eppendorf Department of Clinical Research, Bernhard Nocht Institute for Tropical Medicine, Hamburg
| | - Philipp Zanger
- Institute of Public Health, University of Heidelberg Institute of Tropical Medicine, University of Tübingen, Germany
| | - Guido Calleri
- Travel Medicine Unit, Department of Infectious Diseases, Amedeo di Savoia Hospital-ASLTO2, Turin, Italy
| | | | - Henrik Nielsen
- Department of Infectious Diseases, Aalborg University Hospital, Denmark
| | - Gudrun Just-Nübling
- Department of Internal Medicine II, Section Infectious diseases and Tropical Medicine, University Hospital Frankfurt/Main, Germany
| | | | - Anna Hachfeld
- Department of Infectious Diseases, Bern University Hospital and University of Bern, Switzerland
| | - Matthias L Schmid
- Department of Infection and Tropical Medicine, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | | | - Peter Pongratz
- Medizinische Klinik mit Schwerpunkt Infektiologie und Pneumologie, Charité Universitätsmedizin Berlin, Germany
| | - Peter Kern
- Comprehensive Infectious Diseases Center, Department of Internal Medicine III, Ulm University Hospital, Germany
| | | | | | - Mirjam Schunk
- Abteilung für Infektions- und Tropenmedizin, Medizinische Poliklinik, University of Munich, Germany
| | - Norbert Suttorp
- Medizinische Klinik mit Schwerpunkt Infektiologie und Pneumologie, Charité Universitätsmedizin Berlin, Germany
| | | | | | | |
Collapse
|
37
|
Kaung M, Kyi TT, Aung NM, Kyaw MP, Min M, Htet ZW, Anstey NM, Kyi MM, Hanson J. The prognostic utility of bedside assessment of adults hospitalized with malaria in Myanmar: a retrospective analysis. Malar J 2015; 14:63. [PMID: 25881290 PMCID: PMC4323221 DOI: 10.1186/s12936-015-0549-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 01/06/2015] [Indexed: 01/03/2023] Open
Abstract
Background Data collected in clinical trials have been used to develop scoring systems that identify adults with malaria at greatest risk of death. One of these, the RCAM score, can be simply determined by measuring a patient’s Glasgow Coma Score and respiratory rate on admission to hospital. However the safety of using the RCAM score to define high-risk patients has not been assessed outside of the clinical trial setting. Methods A retrospective audit of medical records of all adults admitted with a diagnosis of malaria to two tertiary referral hospitals in Lower Myanmar in 2013 was undertaken. An RCAM score was calculated in all patients and related to their subsequent clinical course. Results The recent decline in malaria hospitalizations at both sites continued in 2013. During the year 90 adults were hospitalized with malaria; 62 (69%) had Plasmodium falciparum mono-infection, 11 (12%) had Plasmodium vivax mono-infection, 17 (19%) had mixed infection. All seven (7.7%) deaths occurred in patients infected with P. falciparum. An admission RCAM score <2 identified all the patients that would survive to discharge (positive predictive value (95% confidence interval (CI)) 100% (94.9-100%) and also predicted a requirement for less supportive care: 9/70 (13%) patients with an admission RCAM score <2 required supportive care (blood transfusion, vasopressor support or oxygen supplementation) during their hospitalization compared with 12/20 (60%) patients with an admission RCAM score ≥2 (p < 0.0001). No patient with P. vivax mono-infection required supportive care during their hospitalization. Patients with an oxygen saturation ≤95% on room air on admission were more likely to die before discharge (odds ratio 17.3 (95% CI: 2.9-101.2) than patients with a higher oxygen saturation (p = 0.002). Conclusions Even outside a clinical trial setting the RCAM score reliably identifies adults with malaria who are at greatest risk of death and can be safely used in the initial triage and management of these patients.
Collapse
Affiliation(s)
- Myat Kaung
- Hpa-an Hospital, Hpa-an, Kayin State, Myanmar.
| | | | - Ne Myo Aung
- Insein Hospital, Insein Township, Yangon, Myanmar.
| | - Myat Phone Kyaw
- Department of Medical Research (Lower Myanmar), Yangon, Myanmar.
| | - Myo Min
- Myanmar Medical Association, Yangon, Myanmar.
| | - Zaw Win Htet
- Insein Hospital, Insein Township, Yangon, Myanmar.
| | - Nicholas M Anstey
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia.
| | - Mar Mar Kyi
- Insein Hospital, Insein Township, Yangon, Myanmar.
| | - Josh Hanson
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia.
| |
Collapse
|
38
|
Imported malaria in portugal 2000-2009: a role for hospital statistics for better estimates and surveillance. Malar Res Treat 2014; 2014:373029. [PMID: 25548715 PMCID: PMC4273509 DOI: 10.1155/2014/373029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Revised: 10/03/2014] [Accepted: 11/17/2014] [Indexed: 11/18/2022] Open
Abstract
Background. Although eradicated in Portugal, malaria keeps taking its toll on travelers and migrants from endemic countries. Disease notification is mandatory but is compromised by underreporting. Methods. A retrospective study on malaria hospitalizations for 10 consecutive years (2000–2009) was conducted. Data on hospitalizations and notifications were obtained from Central Administration of Health System and Health Protection Agency, respectively. For data selection ICD-9 CM and ICD-10 were used: codes 084*, 647.4, and B50–B54. Variables were gender, age, agent and origin of infection, length of stay (LOS), lethality, and comorbidities. Analysis included description, hypothesis testing, and regression. Results. There were 2003 malaria hospitalizations and 480 notified hospitalized cases, mainly in young male adults. P. falciparum was the main agent of infection acquired mainly in sub-Saharan Africa. Lethality was 1.95% and mean LOS was 8.09 days. Older age entailed longer LOS and increased lethality. Discussion. From 2000 to 2009, there were 2003 malaria hospitalizations with decreasing annual incidence, these numbers being remarkably higher than those notified. The national database of diagnosis related groups, reflecting hospitalizations on NHS hospitals, may be an unexplored complementary source for better estimates on imported malaria.
Collapse
|
39
|
Hanson J, Anstey NM, Bihari D, White NJ, Day NP, Dondorp AM. The fluid management of adults with severe malaria. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2014; 18:642. [PMID: 25629462 PMCID: PMC4318383 DOI: 10.1186/s13054-014-0642-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Fluid resuscitation has long been considered a key intervention in the treatment of adults with severe falciparum malaria. Profound hypovolemia is common in these patients and has the potential to exacerbate the acidosis and acute kidney injury that are independent predictors of death. However, new microvascular imaging techniques have shown that disease severity correlates more strongly with obstruction of the microcirculation by parasitized erythrocytes - a process termed sequestration. Fluid loading has little effect on sequestration and increases the risk of complications, particularly pulmonary edema, a condition that can develop suddenly and unpredictably and that is frequently fatal in this population. Accordingly, even if a patient is clinically hypovolemic, if there is an adequate blood pressure and urine output, there may be little advantage in infusing intravenous fluid beyond a maintenance rate of 1 to 2 mL/kg per hour. The optimal agent for fluid resuscitation remains uncertain; significant anemia requires blood transfusion, but colloid solutions may be associated with harm and should be avoided. The preferred crystalloid is unclear, although the use of balanced solutions requires investigation. There are fewer data to guide the fluid management of severe vivax and knowlesi malaria, although a similar conservative strategy would appear prudent.
Collapse
|
40
|
Determinants of mortality, intensive care requirement and prolonged hospitalization in malaria - a tertiary care hospital based cohort study from South-Western India. Malar J 2014; 13:370. [PMID: 25233836 PMCID: PMC4177244 DOI: 10.1186/1475-2875-13-370] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Accepted: 09/12/2014] [Indexed: 11/20/2022] Open
Abstract
Background There is a remarkable dearth of literature on less pronounced outcomes in malaria, namely prolonged hospitalization and intensive care requirement. Limitations on routine clinical applicability of the World Health Organization’s (WHO) guidelines for determination of severity in malaria does result in underestimation of the true burden of clinicians’ perceived severity in malaria. This study was conducted to evaluate the clinico-laboratory and malarial severity features to determine their association with mortality, prolonged hospitalization and requirement of intensive care outcomes. Methods A tertiary care hospital based retrospective study was conducted from the year 2007 to 2011 among microscopically proven adult malaria patients. Logistic regression analysis was performed to determine the factors associated with mortality, more than seven days hospitalization, intensive care and other supportive requirements. Results Of a total of 922 malaria cases studied, more than seven days of hospitalization was the most frequent outcome (21.8% (201), 95% CI = 19.1-24.5%) followed by intensive care requirement (8.6% (79), 95% CI = 6.8-10.4%) and in-hospital mortality (1.2% (11), 95% CI = 0.5-1.9%). Odds of mortality were significantly higher with cerebral malaria, pulmonary oedema/acute respiratory distress syndrome (PE/ARDS), liver dysfunction, severe anaemia, renal failure, respiratory distress, metabolic acidosis and leucocytosis. More than seven days hospitalization had inverse association with mortality. Plasmodium falciparum infection, more than three days of history of fever, haemoglobinuria, renal failure, shock, leucocytosis, severe thrombocytopaenia and every 10 mmHg fall in systolic blood pressure were the independent predictors of more than seven days of hospitalization. More than three days of history of fever, cerebral malaria, PE/ARDS, renal failure, metabolic acidosis, hyperparasitaemia, leucocytosis and severe thrombocytopaenia were independently associated factors with intensive care requirement. Conclusions For routine clinical settings, severity definition for malaria needs to be redefined or modified from the existing WHO guidelines. Leucocytosis and severe thrombocytopaenia should be identified as severity determinant in malaria. Patients having more than three days history of fever, leucocytosis, severe thrombocytopaenia and renal failure are more likely to require either prolonged hospitalization and/or intensive care. PE/ARDS alone in Plasmodium vivax may result in mortality, whereas multiorgan involvement is common in P. falciparum related mortalities. Electronic supplementary material The online version of this article (doi:10.1186/1475-2875-13-370) contains supplementary material, which is available to authorized users.
Collapse
|
41
|
Marks M, Gupta-Wright A, Doherty JF, Singer M, Walker D. Managing malaria in the intensive care unit. Br J Anaesth 2014; 113:910-21. [PMID: 24946778 PMCID: PMC4235570 DOI: 10.1093/bja/aeu157] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The number of people travelling to malaria-endemic countries continues to increase, and malaria remains the commonest cause of serious imported infection in non-endemic areas. Severe malaria, mostly caused by Plasmodium falciparum, often requires intensive care unit (ICU) admission and can be complicated by cerebral malaria, respiratory distress, acute kidney injury, bleeding complications, and co-infection. The mortality from imported malaria remains significant. This article reviews the manifestations, complications and principles of management of severe malaria as relevant to critical care clinicians, incorporating recent studies of anti-malarial and adjunctive treatment. Effective management of severe malaria includes prompt diagnosis and early institution of effective anti-malarial therapy, recognition of complications, and appropriate supportive management in an ICU. All cases should be discussed with a specialist unit and transfer of the patient considered.
Collapse
Affiliation(s)
- M Marks
- The Hospital for Tropical Diseases, Mortimer Market Centre, Capper Street, London, UK Department of Clinical Research, Faculty of Infectious and Tropical Diseases London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - A Gupta-Wright
- The Hospital for Tropical Diseases, Mortimer Market Centre, Capper Street, London, UK Department of Clinical Research, Faculty of Infectious and Tropical Diseases London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - J F Doherty
- The Hospital for Tropical Diseases, Mortimer Market Centre, Capper Street, London, UK
| | - M Singer
- Department of Critical Care, University College London Hospital NHS Foundation Trust, 3rd Floor, 235 Euston Road, London NW1 2BU, UK
| | - D Walker
- Department of Critical Care, University College London Hospital NHS Foundation Trust, 3rd Floor, 235 Euston Road, London NW1 2BU, UK
| |
Collapse
|
42
|
Aesif SW, Swierzbinski MJ, Keiser JF. Positive Blood Culture Results After Plasmodium falciparumDiagnosis. Lab Med 2014. [DOI: 10.1309/lm8bldcrh6wt0vpp] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
|
43
|
Marks M, Armstrong M, Walker D, Doherty T. Imported falciparum malaria among adults requiring intensive care: analysis of the literature. Malar J 2014; 13:79. [PMID: 24602328 PMCID: PMC4015364 DOI: 10.1186/1475-2875-13-79] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Accepted: 02/26/2014] [Indexed: 11/28/2022] Open
Abstract
Background Malaria is the most important imported tropical disease. Infection with Plasmodium falciparum is responsible for most of the morbidity and mortality. There are differences in both the epidemiology of imported malaria and in the facilities available to treat travellers with severe malaria between different parts of the world. There are limited data to guide clinicians caring for adults with imported malaria in an intensive care unit (ICU). Available data from the English-speaking literature concerning such patients was reviewed. Methods PubMed was searched for studies on adults with imported malaria treated in an ICU. Data were extracted on the epidemiology, management, rates of concomitant community-acquired bacterial infection and outcomes. Results Thirteen studies were identified, which between them included 1,001 patients over more than 40 years. Forty-one per cent were born and often still resident in an endemic country and were assumed to have at least partial immunity to the disease. Acute kidney injury (AKI) (36%), acute respiratory distress syndrome (ARDS) (31%) and impaired consciousness (25%) were common. Hyperparasitaemia (more than 2%) was seen in 57%. Thirty-four per cent required mechanical ventilation and 22% required renal replacement therapy. Community-acquired bacterial co-infection was seen in 8%; 2% had gram-negative bacteraemia at admission. Overall the case fatality rate was 9%. Conclusions Many patients who require admission to ICU were originally from malaria-endemic countries and many did not have hyperparasitaemia. Gram-negative bacteraemia was uncommon among adults with severe malaria. The case fatality rate remains high; however, improvements in ICU care and increasing use of artemisinins may reduce this in the future.
Collapse
Affiliation(s)
| | | | | | - Tom Doherty
- The Hospital for Tropical Diseases, Mortimer Market Centre, Capper Street, London WC1E 6JB, UK.
| |
Collapse
|
44
|
Abstract
Malaria is the most important infectious disease imported by travelers and migrants from tropical and subtropical areas. It is imported quite frequently. It is a life-threatening disease. Symptoms are nonspecific and cannot easily be distinguished from a wide range of other febrile conditions. Therefore, travel history must be taken in all patients with fever of unknown origin and malaria diagnostics must be performed immediately on suspicion of malaria. Uncomplicated falciparum malaria should be treated in the hospital with either atovaquone-proguanil or with an artemisinin-based combination preparation. If there is evidence of severe malaria, the patient must be moved to an intensive care unit. The antiparasitic agent of choice is then artesunate.
Collapse
Affiliation(s)
- G D Burchard
- ifi - Institut für Interdisziplinäre Medizin, Lohmühlenstr. 5, 20099, Hamburg, Deutschland,
| |
Collapse
|
45
|
Sagaki P, Thanachartwet V, Desakorn V, Sahassananda D, Chamnanchanunt S, Chierakul W, Pitisuttithum P, Ruangkanchanasetr P. Clinical factors for severity of Plasmodium falciparum malaria in hospitalized adults in Thailand. PLoS One 2013; 8:e71503. [PMID: 23951178 PMCID: PMC3741184 DOI: 10.1371/journal.pone.0071503] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Accepted: 07/01/2013] [Indexed: 11/28/2022] Open
Abstract
Plasmodium falciparum is a major cause of severe malaria in Southeast Asia, however, there is limited information regarding clinical factors associated with the severity of falciparum malaria from this region. We performed a retrospective case-control study to compare clinical factors and outcomes between patients with severe and non-severe malaria, and to identify clinical factors associated with the requirement for intensive care unit (ICU) admission of patients with severe falciparum malaria among hospitalized adults in Southeast Asia. A total of 255 patients with falciparum malaria in the Hospital for Tropical Diseases in Bangkok, Thailand between 2006 and 2012 were included. We identified 104 patients with severe malaria (cases) and 151 patients with non-severe malaria (controls). Patients with falciparum malaria with following clinical and laboratory characteristics on admission (1) referrals, (2) no prior history of malaria, (3) body temperature of >38.5°C, (4) white blood cell counts >10×109/µL, (5) presence of schizonts in peripheral blood smears, and (6) albumin concentrations of <3.5 g/dL, were more likely to develop severe malaria (P<0.05). Among patients with severe malaria, patients who met ≥3 of the 2010 WHO criteria had sensitivity of 79.2% and specificity of 81.8% for requiring ICU admission. Multivariate analysis identified the following as independent associated factors for severe malaria requiring ICU admission; (1) ethnicity of Thai [odds ratio (OR) = 3.601, 95% confidence interval (CI) = 1.011–12.822] or Myanmar [OR = 3.610, 95% CI = 1.138–11.445]; (2) referrals [OR = 3.571, 95% CI = 1.306–9.762]; (3) no prior history of malaria [OR = 5.887, 95% CI = 1.354–25.594]; and (4) albumin concentrations of <3.5 g/dL [OR = 7.200, 95% CI = 1.802–28.759]. Our findings are important for the clinical management of patients with malaria because it can help early identification of patients that could develop severe malaria and require ICU admission. Early identification and the timely initiation of appropriate treatments may well improve the outcomes and reduce the mortality of these patients.
Collapse
Affiliation(s)
- Patrick Sagaki
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Amudat Hospital, Amudat, Uganda
| | - Vipa Thanachartwet
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- * E-mail:
| | - Varunee Desakorn
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Duangjai Sahassananda
- Information Technology Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Supat Chamnanchanunt
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Wirongrong Chierakul
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Punnee Pitisuttithum
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | | |
Collapse
|