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Namayanja C, Eregu EEI, Ongodia P, Okalebo CB, Okiror W, Okello F, Okibure A, Paasi G, Kakungulu H, Grace A, Muhindo R, Banks D, Martin C, Taylor-Robinson S, Olupot-Olupot P. Unusual clinical spectra of childhood severe malaria during malaria epidemic in eastern Uganda: a prospective study. Malar J 2023; 22:169. [PMID: 37259110 DOI: 10.1186/s12936-023-04586-3] [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: 03/22/2023] [Accepted: 05/11/2023] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND In sub-Saharan Africa (SSA), malaria remains a public health problem despite recent reports of declining incidence. Severe malaria is a multiorgan disease with wide-ranging clinical spectra and outcomes that have been reported to vary by age, geographical location, transmission intensity over time. There are reports of recent malaria epidemics or resurgences, but few data, if any, focus on the clinical spectrum of severe malaria during epidemics. This describes the clinical spectrum and outcomes of childhood severe malaria during the disease epidemic in Eastern Uganda. METHODS This prospective cohort study from October 1, 2021, to September 7, 2022, was nested within the 'Malaria Epidemiological, Pathophysiological and Intervention studies in Highly Endemic Eastern Uganda' (TMA2016SF-1514-MEPIE Study) at Mbale Regional Referral Hospital, Uganda. Children aged 60 days to 12 years who at admission tested positive for malaria and fulfilled the clinical WHO criteria for surveillance of severe malaria were enrolled on the study. Follow-up was performed until day 28. Data were collected using a customized proforma on social demographic characteristics, clinical presentation, treatment, and outcomes. Laboratory analyses included complete blood counts, malaria RDT (SD BIOLINE Malaria Ag P.f/Pan, Ref. 05FK60-40-1) and blood slide, lactate, glucose, blood gases and electrolytes. In addition, urinalysis using dipsticks (Multistix® 10 SG, SIEMENS, Ref.2300) at the bedside was done. Data were analysed using STATA V15.0. The study had prior ethical approval. RESULTS A total of 300 participants were recruited. The median age was 4.6 years, mean of 57.2 months and IQR of 44.5 months. Many children, 164/300 (54.7%) were under 5 years, and 171/300 (57.0%) were males. The common clinical features were prostration 236/300 (78.7%), jaundice in 205/300 (68.3%), severe malarial anaemia in 158/300 (52.7%), black water fever 158/300 (52.7%) and multiple convulsions 51/300 (17.0%), impaired consciousness 50/300(16.0%), acidosis 41/300(13.7%), respiratory distress 26/300(6.7%) and coma in 18/300(6.0%). Prolonged hospitalization was found in 56/251 (22.3%) and was associated with acidosis, P = 0.041. The overall mortality was 19/300 (6.3%). Day 28 follow-up was achieved in 247/300 (82.3%). CONCLUSION During the malaria epidemic in Eastern Uganda, severe malaria affected much older children and the spectrum had more of prostration, jaundice severe malarial anaemia, black water fever and multiple convulsions with less of earlier reported respiratory distress and cerebral malaria.
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Affiliation(s)
- Cate Namayanja
- Mbale Clinical Research Institute, P.O. Box 1966, Mbale, Uganda.
- Department of Pediatrics and Child Health, Busitema University Faculty of Health Sciences, Mbale, Uganda.
| | - Egiru Emma Isaiah Eregu
- Mbale Clinical Research Institute, P.O. Box 1966, Mbale, Uganda
- Department of Pediatrics and Child Health, Busitema University Faculty of Health Sciences, Mbale, Uganda
| | - Paul Ongodia
- Mbale Clinical Research Institute, P.O. Box 1966, Mbale, Uganda
| | - Charles Benard Okalebo
- Mbale Clinical Research Institute, P.O. Box 1966, Mbale, Uganda
- Department of Community and Public Health, Busitema University Faculty of Health Sciences, Mbale, Uganda
| | - William Okiror
- Mbale Clinical Research Institute, P.O. Box 1966, Mbale, Uganda
- Department of Community and Public Health, Busitema University Faculty of Health Sciences, Mbale, Uganda
| | - Francis Okello
- Department of Community and Public Health, Busitema University Faculty of Health Sciences, Mbale, Uganda
- Varimetrics Group Limited, Mbale, Uganda
| | | | - George Paasi
- Mbale Clinical Research Institute, P.O. Box 1966, Mbale, Uganda
- Department of Community and Public Health, Busitema University Faculty of Health Sciences, Mbale, Uganda
| | - Hellen Kakungulu
- Mbale Clinical Research Institute, P.O. Box 1966, Mbale, Uganda
- Department of Community and Public Health, Busitema University Faculty of Health Sciences, Mbale, Uganda
- Varimetrics Group Limited, Mbale, Uganda
| | - Abongo Grace
- Mbale Clinical Research Institute, P.O. Box 1966, Mbale, Uganda
| | - Rita Muhindo
- Mbale Clinical Research Institute, P.O. Box 1966, Mbale, Uganda
| | - Duncan Banks
- Busitema University, TORORO, Uganda
- The Open University, Milton Keynes, UK
| | - Chebet Martin
- Department of Pediatrics and Child Health, Busitema University Faculty of Health Sciences, Mbale, Uganda
| | - Simon Taylor-Robinson
- Department of Community and Public Health, Busitema University Faculty of Health Sciences, Mbale, Uganda
- Imperial College London, London, UK
| | - Peter Olupot-Olupot
- Mbale Clinical Research Institute, P.O. Box 1966, Mbale, Uganda
- Department of Community and Public Health, Busitema University Faculty of Health Sciences, Mbale, Uganda
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Hanif H, Shrestha B, Munankami S, Shrestha M, Poudel B, Reddy R, Jaleel S, Powell D. Severe Malaria with a Rare Tetrad of Blackwater Fever, Acute Renal Failure, Disseminated Intravascular Coagulopathy, and Acute Acalculous Cholecystitis. Case Rep Infect Dis 2023; 2023:5796881. [PMID: 37179741 PMCID: PMC10169240 DOI: 10.1155/2023/5796881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 03/31/2023] [Accepted: 04/04/2023] [Indexed: 05/15/2023] Open
Abstract
Background Blackwater fever (BWF) is a severe clinical syndrome occurring as a complication of malarial infection characterized by intravascular hemolysis, hemoglobinuria, and acute renal failure in people exposed to Plasmodium falciparum and, to some extent, in people who were exposed to medications like quinine and mefloquine. The exact pathogenesis of classic BWF remains unclear. The mechanism leading to damage to the red blood cells (RBCs) can be immunologic nonimmunologic, leading to massive intravascular hemolysis. Case Presentation. We present a case of classic blackwater fever in a 24-year-old otherwise previously healthy male without any history of antimalarial prophylaxis use, returning from recent travel to Sierra Leone. He was detected to have P. falciparum malaria in the peripheral smear test. He was treated with artemether/lumefantrine combination therapy. Unfortunately, his presentation was complicated by renal failure and was managed with plasmapheresis and renal replacement therapy. Conclusion Malaria continues to be a parasitic disease that can have devastating effects and continues to be a challenge globally. Although cases of malaria in the United States are rare and cases of severe malaria, mainly attributed to P. falciparum, are even more uncommon. Care should be taken to retain a high level of suspicion to consider the diagnosis, especially in returning travelers from endemic areas.
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Affiliation(s)
- Hira Hanif
- Reading Hospital Tower Health, West Reading, PA, USA
| | | | | | | | | | - Roopika Reddy
- Reading Hospital Tower Health, West Reading, PA, USA
| | - Syed Jaleel
- Reading Hospital Tower Health, West Reading, PA, USA
| | - Debra Powell
- Reading Hospital Tower Health, West Reading, PA, USA
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Hacking SM. Red blood cell exchange for SARS-CoV-2: A Gemini of therapeutic opportunities. Med Hypotheses 2020; 144:110227. [PMID: 33254534 PMCID: PMC7467009 DOI: 10.1016/j.mehy.2020.110227] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 08/28/2020] [Indexed: 01/25/2023]
Abstract
As of now, therapeutic strategies for the novel coronavirus (SARS-CoV-2) are limited and much focus has been placed on social distancing techniques to “flatten the curve”. Initial treatment efforts including ventilation and hydroxychloroquine garnered significant controversy and today, SARS-CoV-2 outbreaks are still occurring throughout the world. Needless to say, new therapeutic strategies are needed to combat this unprecedented pandemic. Nature Reviews Immunology recently published an article hypothesizing the pathogenesis of TAM (Tyro3, Axl, and Mer) receptor signaling in COVID-19. In it they expressed that hypercoagulation and immune hyper-reaction could occur secondary to decreased Protein S (PROS1). And hypoxia has been recently discovered to significantly decrease expression of PROS1. Regarding the cause of hypoxia in COVID-19; NIH funded research utilizing state-of-the-art topologies has recently demonstrated significant metabolomic, proteomic, and lipidomic structural aberrations in hemoglobin (Hb) secondary to infection with SARS-CoV-2. In this setting, Hb may be incapacitated and unable to respond to environmental variations, compromising RBCs and oxygen delivery to tissues. The use of red blood cell exchange would target hypoxia at its source; representing a Gemini of therapeutic opportunities.
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Affiliation(s)
- Sean M Hacking
- Department of Pathology and Laboratory Medicine, Donald and Barbara Zucker School of Medicine at Northwell, New York, USA.
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A Report of Four Cases of Blackwater Fever after Quinine Treatment at Zinder National Hospital, Niger Republic. Case Rep Infect Dis 2019; 2019:2346087. [PMID: 31534807 PMCID: PMC6732635 DOI: 10.1155/2019/2346087] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 07/29/2019] [Indexed: 11/18/2022] Open
Abstract
Background Blackwater fever (BWF) is a rare but serious complication of malaria that is a consequence of antimalarial treatment. Its prevalence seems to have increased. Its diagnosis is based on clinical symptoms and urine color. We report on 4 BWF cases admitted to the infectious diseases department of Zinder National Hospital. Results Four patients were hospitalized in September 2017 for a hepatorenal syndrome of jaundice, port wine-colored urine, renal failure, and hepatic cytolysis following antimalarial treatment with quinine salts. Quinine treatment was stopped and treatment was continued with injectable artemether. Three patients underwent extra-renal purification. Their evolution was favorable. One patient died less than 24 hours after admission. Conclusion A rare and severe complication, blackwater fever must be considered for patients under antimalarial treatment who present with jaundice, abdominal pain, and acute renal insufficiency with port wine-colored urine. Rapid diagnosis and management in an intensive care unit are crucial for improving the prognosis.
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