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Sukati S, Wannatung T, Duangchan T, Kotepui KU, Masangkay FR, Tseng CP, Kotepui M. Alteration of prothrombin time in Plasmodium falciparum and Plasmodium vivax infections with different levels of severity: a systematic review and meta-analysis. Sci Rep 2024; 14:9816. [PMID: 38698102 PMCID: PMC11066112 DOI: 10.1038/s41598-024-60170-y] [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: 08/14/2023] [Accepted: 04/19/2024] [Indexed: 05/05/2024] Open
Abstract
Malaria infection leads to hematological abnormalities, including deranged prothrombin time (PT). Given the inconsistent findings regarding PT in malaria across different severities and between Plasmodium falciparum and P. vivax, this study aimed to synthesize available evidence on PT variations in clinical malaria. A systematic literature search was performed in PubMed, Embase, Scopus, Ovid, and Medline from 27 November 2021 to 2 March 2023 to obtain studies documenting PT in malaria. Study quality was evaluated using the Joanna Briggs Institute checklist, with data synthesized through both qualitative and quantitative methods, including meta-regression and subgroup analyses, to explore heterogeneity and publication bias. From 2767 articles, 21 studies were included. Most studies reported prolonged or increased PT in malaria patients compared to controls, a finding substantiated by the meta-analysis (P < 0.01, Mean difference: 8.86 s, 95% CI 5.32-12.40 s, I2: 87.88%, 4 studies). Severe malaria cases also showed significantly higher PT than non-severe ones (P = 0.03, Hedges's g: 1.65, 95% CI 0.20-3.10, I2: 97.91%, 7 studies). No significant PT difference was observed between P. falciparum and P. vivax infections (P = 0.88, Mean difference: 0.06, 95% CI - 0.691-0.8, I2: 65.09%, 2 studies). The relationship between PT and malaria-related mortality remains unclear, underscoring the need for further studies. PT is typically prolonged or increased in malaria, particularly in severe cases, with no notable difference between P. falciparum and P. vivax infections. The inconsistency in PT findings between fatal and non-fatal cases highlights a gap in current understanding, emphasizing the need for future studies to inform therapeutic strategies.
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Affiliation(s)
- Suriyan Sukati
- Medical Technology, School of Allied Health Sciences, Walailak University, Tha Sala, Nakhon Si Thammarat, Thailand
- Hematology and Transfusion Science Research Center, Walailak University, Tha Sala, Nakhon Si Thammarat, Thailand
| | - Tirawat Wannatung
- Faculty of Medicine, Western University, Huai Krachao, Kanchanaburi, Thailand
| | - Thitinat Duangchan
- Medical Technology, School of Allied Health Sciences, Walailak University, Tha Sala, Nakhon Si Thammarat, Thailand
- Hematology and Transfusion Science Research Center, Walailak University, Tha Sala, Nakhon Si Thammarat, Thailand
| | | | | | - Ching-Ping Tseng
- Department of Medical Biotechnology and Laboratory Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Graduate Institute of Biomedical Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Laboratory Medicine, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
| | - Manas Kotepui
- Medical Technology Program, Faculty of Science, Nakhon Phanom University, Nakhon Phanom, Thailand.
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Joste V, Bailly J, Hubert V, Pauc C, Gendrot M, Guillochon E, Madamet M, Thellier M, Kendjo E, Argy N, Pradines B, Houzé S. Plasmodium ovale wallikeri and P. ovale curtisi Infections and Diagnostic Approaches to Imported Malaria, France, 2013-2018. Emerg Infect Dis 2021; 27. [PMID: 33496652 PMCID: PMC7853592 DOI: 10.3201/eid2702.202143] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Patients infected with P. ovale wallikeri displayed deeper thrombocytopenia and a shorter latency period. We retrospectively analyzed epidemiologic, clinical, and biologic characteristics of 368 Plasmodium ovale wallikeri and 309 P. ovale curtisi infections treated in France during January 2013–December 2018. P. ovale wallikeri infections displayed deeper thrombocytopenia and shorter latency periods. Despite similar clinical manifestations, P. ovale wallikeri–infected patients were more frequently treated with artemisinin-based combination therapy. Although the difference was not statistically significant, P. ovale wallikeri–infected patients were 5 times more frequently hospitalized in intensive care or intermediate care and had a higher proportion of severe thrombocytopenia than P. ovale curtisi–infected patients. Rapid diagnostic tests that detect aldolase were more efficient than those detecting Plasmodium lactate dehydrogenase. Sequence analysis of the potra gene from 90 P. ovale isolates reveals an insufficient polymorphism for relapse typing.
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Hasyim H, Dhimal M, Bauer J, Montag D, Groneberg DA, Kuch U, Müller R. Does livestock protect from malaria or facilitate malaria prevalence? A cross-sectional study in endemic rural areas of Indonesia. Malar J 2018; 17:302. [PMID: 30126462 PMCID: PMC6102806 DOI: 10.1186/s12936-018-2447-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 08/05/2018] [Indexed: 11/20/2022] Open
Abstract
Background Ever since it was discovered that zoophilic vectors can transmit malaria, zooprophylaxis has been used to prevent the disease. However, zoopotentiation has also been observed. Thus, the presence of livestock has been widely accepted as an important variable for the prevalence and risk of malaria, but the effectiveness of zooprophylaxis remained subject to debate. This study aims to critically analyse the effects of the presence of livestock on malaria prevalence using a large dataset from Indonesia. Methods This study is based on data from the Indonesia Basic Health Research (“Riskesdas”) cross-sectional survey of 2007 organized by the National Institute of Health Research and Development of Indonesia’s Ministry of Health. The subset of data used in the present study included 259,885 research participants who reside in the rural areas of 176 regencies throughout the 15 provinces of Indonesia where the prevalence of malaria is higher than the national average. The variable “existence of livestock” and other independent demographic, social and behavioural variables were tested as potential determinants for malaria prevalence by multivariate logistic regressions. Results Raising medium-sized animals in the house was a significant predictor of malaria prevalence (OR = 2.980; 95% CI 2.348–3.782, P < 0.001) when compared to keeping such animals outside of the house (OR = 1.713; 95% CI 1.515–1.937, P < 0.001). After adjusting for gender, age, access to community health facility, sewage canal condition, use of mosquito nets and insecticide-treated bed nets, the participants who raised medium-sized animals inside their homes were 2.8 times more likely to contract malaria than respondents who did not (adjusted odds ratio = 2.809; 95% CI 2.207–3.575; P < 0.001). Conclusions The results of this study highlight the importance of livestock for malaria transmission, suggesting that keeping livestock in the house contributes to malaria risk rather than prophylaxis in Indonesia. Livestock-based interventions should therefore play a significant role in the implementation of malaria control programmes, and focus on households with a high proportion of medium-sized animals in rural areas. The implementation of a “One Health” strategy to eliminate malaria in Indonesia by 2030 is strongly recommended. Electronic supplementary material The online version of this article (10.1186/s12936-018-2447-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hamzah Hasyim
- Faculty of Medicine, Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany. .,Faculty of Public Health, Sriwijaya University, Indralaya, South Sumatra, Indonesia.
| | - Meghnath Dhimal
- Faculty of Medicine, Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany.,Nepal Health Research Council, Ramshah Path, Kathmandu, Nepal
| | - Jan Bauer
- Faculty of Medicine, Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Doreen Montag
- Centre for Primary Care and Public Health, Barts and the London School of Medicine, Queen Mary University of London, London, UK
| | - David A Groneberg
- Faculty of Medicine, Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Ulrich Kuch
- Faculty of Medicine, Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Ruth Müller
- Faculty of Medicine, Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
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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.
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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.
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Siqueira-Batista R, Gomes AP, Mendonça EGD, Vitorino RR, Azevedo SFMD, Freitas RDB, Santana LA, Oliveira MGDA. Plasmodium falciparum malaria: proteomic studies. Rev Bras Ter Intensiva 2015; 24:394-400. [PMID: 23917939 PMCID: PMC4031808 DOI: 10.1590/s0103-507x2012000400017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Accepted: 12/04/2012] [Indexed: 01/21/2023] Open
Abstract
Despite advances in treatment and campaigns for prevention and control of malaria on
the various continents where it is still rampant, this disease remains significantly
relevant to the contemporary world. Plasmodium falciparum is the
organism that is mainly responsible for severe malaria, which is characterized by
disturbances in different organs and systems, with possibly fatal outcomes. Although
incipient, proteomic studies of malaria have yielded favorable prospects for
elucidating the biological aspects of Plasmodium as well as the
pathophysiological, diagnostic, prophylactic, and therapeutic mechanisms of the
disease. Thus, the aim of the present article is to present a brief review of the
applications of proteomic analysis in P. falciparum malaria.
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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.
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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
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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.
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Affiliation(s)
| | | | | | - Tom Doherty
- The Hospital for Tropical Diseases, Mortimer Market Centre, Capper Street, London WC1E 6JB, UK.
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Marks ME, Armstrong M, Suvari MM, Batson S, Whitty CJM, Chiodini PL, Bellinghan G, Doherty JF. Severe imported falciparum malaria among adults requiring intensive care: a retrospective study at the hospital for tropical diseases, London. BMC Infect Dis 2013; 13:118. [PMID: 23497139 PMCID: PMC3599148 DOI: 10.1186/1471-2334-13-118] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Accepted: 02/27/2013] [Indexed: 11/25/2022] Open
Abstract
Background Malaria is the commonest imported infection in the UK. Malaria requiring ICU admission has a reported mortality of up to 25%. The relationship between ethnicity, immunity, and risk of malaria is complex. The Malaria Score for Adults (MSA) and Coma Acidosis Malaria (CAM) score have recently been proposed to risk stratify patients with malaria. Methods Retrospective study of patients with WHO severe falciparum malaria admitted to ICU at the Hospital for Tropical Diseases, London, UK. The relationship between clinical variables and risk of death or a prolonged ICU stay were examined with logistic regression. The predictive value of the MSA and CAM score were calculated. Results 124 patients were included. Cerebral malaria and acute kidney injury occurred earlier (median day 1) than acute respiratory distress syndrome (median day 3). Six patients had community acquired bacterial co-infection. Eight patients were co-infected with HIV, five of whom were newly diagnosed. The positive predictive value of a CAM score ≥2 or an MSA ≥5 for death were 12% and 22% respectively. Five patients died. No variable was significantly associated with risk of death. There were no significant differences between individuals raised in endemic countries compared to non-endemic countries. Conclusions Mortality in patients managed in a specialist centre was low. Patients who died succumbed to complications associated with a prolonged stay on ICU rather than malaria per se. The clinical usefulness of the MSA and CAM score was limited. Co-infection with HIV was relatively common but compared to studies in children, bacteraemia was uncommon. The relationship between ethnicity and immunity to severe disease is complex.
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Affiliation(s)
- Michael E Marks
- The Hospital for Tropical Diseases, Mortimer Market Centre, Capper Street, WC1E 6JB, London, UK
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Plasmodium knowlesi: the emerging zoonotic malaria parasite. Acta Trop 2013; 125:191-201. [PMID: 23088834 DOI: 10.1016/j.actatropica.2012.10.008] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2012] [Revised: 10/03/2012] [Accepted: 10/14/2012] [Indexed: 11/20/2022]
Abstract
Plasmodium knowlesi was initially identified in the 30s as a natural Plasmodium of Macaca fascicularis monkey also capable of experimentally infecting humans. It gained a relative notoriety in the mid-30s as an alternative to Plasmodium vivax in the treatment of the general paralysis of the insane (neurosyphilis). In 1965 the first natural human infection was described in a US military surveyor coming back from the Pahang jungle of the Malaysian peninsula. P. knowlesi was again brought to the attention of the medical community when in 2004, Balbir Singh and his co-workers reported that about 58% of malaria cases observed in the Kapit district of the Malaysian Borneo were actually caused by P. knowlesi. In the following years several reports showed that P. knowlesi is much more widespread than initially thought with cases reported across Southeast Asia. This infection should also be considered in the differential diagnosis of any febrile travellers coming back from a recent travel to forested areas of Southeast Asia. P. knowlesi can cause severe malaria with a rate of 6-9% and with a case fatality rate of 3%. Respiratory distress, acute renal failure, shock and hyperbilirubinemia are the most frequently observed complications of severe P. knowlesi malaria. Chloroquine is considered the treatment of choice of uncomplicated malaria caused by P. knowlesi.
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Acute Renal Failure in Patients with Severe Falciparum Malaria: Using the WHO 2006 and RIFLE Criteria. Int J Nephrol 2013; 2013:841518. [PMID: 23431442 PMCID: PMC3569909 DOI: 10.1155/2013/841518] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Revised: 12/21/2012] [Accepted: 01/18/2013] [Indexed: 11/17/2022] Open
Abstract
There are limited data on the application of the RIFLE criteria among patients with severe malaria. This retrospective study was conducted by reviewing 257 medical records of adult hospitalized patients with severe falciparum malaria at the Mae Sot General Hospital, Tak province in the northern part of Thailand. The aims of this study were to determine the incidence of acute renal failure (ARF) in patients with severe falciparum malaria and its association with RRT as well as in-hospital mortality. Using the WHO 2006 criteria, ARF was the second most common complication with incidence of 44.7% (115 patients). The requirement for RRT was 45.2% (52 patients) and the in-hospital mortality was 31.9% (36 patients). Using the RIFLE criteria, 73.9% (190 patients) had acute kidney injury (AKI). The requirement for RRT was 11.6% (5 patients) in patients with RIFLE-I and 44.9% (48 patients) in patients with RIFLE-F. The in-hospital mortality gradually increased with the severity of AKI. The requirement for RRT (P < 0.05) and the in-hospital mortality (P < 0.05) were significantly higher in ARF patients with severe falciparum malaria using both criteria. In conclusion, the RIFLE criteria could be used for diagnosing AKI and predicting outcomes in patients with severe malaria similar to the WHO 2006 criteria.
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Santos LC, Abreu CF, Xerinda SM, Tavares M, Lucas R, Sarmento AC. Severe imported malaria in an intensive care unit: a review of 59 cases. Malar J 2012; 11:96. [PMID: 22458840 PMCID: PMC3350412 DOI: 10.1186/1475-2875-11-96] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Accepted: 03/29/2012] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND In view of the close relationship of Portugal with African countries, particularly former Portuguese colonies, the diagnosis of malaria is not a rare thing. When a traveller returns ill from endemic areas, malaria should be the number one suspect. World Health Organization treatment guidelines recommend that adults with severe malaria should be admitted to an intensive care unit (ICU). METHODS Severe cases of malaria in patients admitted to an ICU were reviewed retrospectively (1990-2011) and identification of variables associated with in-ICU mortality performed. Malaria prediction score (MPS), malaria score for adults (MSA), simplified acute physiology score (SAPSII) and a score based on WHO's malaria severe criteria were applied. Statistical analysis was performed using StataV12. RESULTS Fifty nine patients were included in the study, all but three were adults; 47 (79,6%) were male; parasitaemia on admission, quantified in 48/59 (81.3%) patients, was equal or greater than 2% in 47 of them (97.9%); the most common complications were thrombocytopaenia in 54 (91.5%) patients, associated with disseminated intravascular coagulation (DIC) in seven (11.8%), renal failure in 31 (52.5%) patients, 18 of which (30.5%) oliguric, shock in 29 (49.1%) patients, liver dysfunction in 27 (45.7%) patients, acidaemia in 23 (38.9%) patients, cerebral dysfunction in 22 (37.2%) patients, 11 of whom with unrousable coma, pulmonary oedema/ARDS in 22 (37.2%) patients, hypoglycaemia in 18 (30.5%) patients; 29 (49.1%) patients presented five or more dysfunctions. The case fatality rate was 15.2%. Comparing the four scores, the SAPS II and the WHO score were the most sensitive to death prediction. In the univariate analysis, death was associated with the SAPS II score, cerebral malaria, acute renal and respiratory failure, DIC, spontaneous bleeding, acidosis and hypoglycaemia. Age, partial immunity to malaria, delay in malaria diagnosis and the level of parasitaemia were not associated with death in this cohort. CONCLUSION Severe malaria cases should be continued monitored in the ICUs. SAPS II and the WHO score are good predictors of mortality in malaria patients, but other specific scores deserve to be studied prospectively.
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Affiliation(s)
- Lurdes C Santos
- ICU Infectious Disease Unit, Hospital de S, João, Alameda do Professor Hernâni Monteiro, 4202-451 Porto, Portugal.
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Current World Literature. Curr Opin Neurol 2009; 22:321-9. [DOI: 10.1097/wco.0b013e32832cf9cb] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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