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Abstract
Background Severe malaria remains a leading cause of death worldwide. A greater understanding of its impact on multiple organ systems is essential in reducing the burden of disease. In this review we will summarize previously reported cardiovascular parameters of both adults and children with severe malaria. Method For this systematic review we searched MEDLINE and PUBMED for all papers published on cardiac function in severe malaria from January 1, 1990 until September 1, 2019. Severe malaria was defined as per World Health Organization. Publications were included if there was data from echocardiography, Pulse Contour Cardiac Output (PiCCO), or Pulmonary Arterial catheters (PAC) reported. Studies were excluded if related to medication induced cardiac dysfunction, malaria in pregnancy, or included subjects with known pre-existing heart disease. Results Twenty-four studies met inclusion criteria, the majority of which were studies of adult patients or a mixed cohort. Six solely involved pediatric patients. Significant heterogeneity existed in the cardiac parameters measured and results reported. One pediatric and one adult study suggested a reduced preload state during severe malaria. Cardiac systolic function was reported primarily within, or above, normative numeric ranges established in uninfected pediatric patients without anemia. Extensive variability existed in adult studies with reports of an elevated cardiac index in two studies, normal cardiac function in two studies, and descriptions of decreased function in two studies. Two reports suggest afterload in pediatric severe malaria is reduced. Reports of changes in the systemic vascular resistance of adults with severe malaria are inconsistent, with two trials demonstrating an increase and two suggesting a decrease. Studies demonstrated a mild rise in pulmonary pressure in both pediatric and adult patients that normalized by discharge. Conclusion Based on limited data, the cardiovascular effects of severe malaria appear to be heterogeneous and vary depending on age. Further detailed studies are required to explore and understand the overall hemodynamic effects of this high burden disease.
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Mutombo AM, Mukuku O, Tshibanda KN, Swana EK, Mukomena E, Ngwej DT, Luboya ON, Kakoma JB, Wembonyama SO, Van Geertruyden JP, Lutumba P. Severe malaria and death risk factors among children under 5 years at Jason Sendwe Hospital in Democratic Republic of Congo. Pan Afr Med J 2018; 29:184. [PMID: 30061962 PMCID: PMC6061819 DOI: 10.11604/pamj.2018.29.184.15235] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 03/13/2018] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Malaria is still a major public health concern in the Democratic Republic of Congo. Its morbidity and mortality challenge the actual strategies of the fight agains malaria. This study was aimed to describe the epidemiology, the clinical caracteristics and the risk factors of death associated to severe malaria in the pediatric population under 5 years at Sendwe Hospital of Lubumbashi. METHODS This analytical retrospective study was conducted in Lubumbashi, in the province of Haut-Katanga. All patients under 5 years hospitalized for severe malaria were registered from January 2014 to December 2016. RESULTS Among the 3,092 patients hospitalised during our study period, 452 (14.6%) were admitted for severe malaria. The average age was 27.04 months, the male sex was the most affected (53.54% with the sex-ratio 1.15). The most frequent forms of gravity noticed were cerebral malaria (48.23%) and severe anemia (46.90%). Death was noted in the evolution in 28.32%. Repeated convulsion (OR = 2.27; 95% CI: 1.47-3.48), coma (OR = 3.55; 95% CI: 2.19-5.74) and severe acute malnutrition (OR = 3.32; 95% CI: 1.56-7.06) were asscociated with a high risk of death. CONCLUSION This research shows that severe malaria is still an important cause of morbidity and mortality among young children in Lubumbashi. Neurologic and anemic forms are the most frequent. The predictive signs of death are: repeated convulsions, coma and severe acute malnutrition.
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Affiliation(s)
- Augustin Mulangu Mutombo
- Département de Pédiatrie, Faculté de Médecine, Université de Lubumbashi, Lubumbashi, Democratic Republic of Congo
| | - Olivier Mukuku
- Institut Supérieur des Techniques Médicales de Lubumbashi, Lubumbashi, Democratic Republic of Congo
| | - Kristel Nzeba Tshibanda
- Institut Supérieur des Techniques Médicales de Lubumbashi, Lubumbashi, Democratic Republic of Congo
| | - Edouard Kawawa Swana
- Département de Santé Publique, Faculté de Médecine, Université de Lubumbashi, Lubumbashi, Democratic Republic of Congo
| | - Eric Mukomena
- Département de Santé Publique, Faculté de Médecine, Université de Lubumbashi, Lubumbashi, Democratic Republic of Congo
| | - Dieudonné Tshikwej Ngwej
- Département de Pédiatrie, Faculté de Médecine, Université de Lubumbashi, Lubumbashi, Democratic Republic of Congo
| | - Oscar Numbi Luboya
- Département de Pédiatrie, Faculté de Médecine, Université de Lubumbashi, Lubumbashi, Democratic Republic of Congo
- Institut Supérieur des Techniques Médicales de Lubumbashi, Lubumbashi, Democratic Republic of Congo
- Département de Santé Publique, Faculté de Médecine, Université de Lubumbashi, Lubumbashi, Democratic Republic of Congo
| | - Jean-Baptiste Kakoma
- Département de Gynécologie-Obstétrique, Faculté de Médecine, Université de Lubumbashi, Lubumbashi, Democratic Republic of Congo
| | | | | | - Pascal Lutumba
- Département de Santé Publique, Faculté de Médecine, Université de Lubumbashi, Lubumbashi, Democratic Republic of Congo
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Budischak SA, Wiria AE, Hamid F, Wammes LJ, Kaisar MMM, van Lieshout L, Sartono E, Supali T, Yazdanbakhsh M, Graham AL. Competing for blood: the ecology of parasite resource competition in human malaria-helminth co-infections. Ecol Lett 2018; 21:536-545. [DOI: 10.1111/ele.12919] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 09/14/2017] [Accepted: 01/03/2018] [Indexed: 02/02/2023]
Affiliation(s)
- Sarah A. Budischak
- Department of Ecology and Evolutionary Biology; Princeton University; Princeton NJ USA
| | - Aprilianto E. Wiria
- Department of Parasitology; Leiden University Medical Center; Leiden The Netherlands
- Department of Parasitology; Faculty of Medicine; Universitas Indonesia; Jakarta Indonesia
| | - Firdaus Hamid
- Department of Parasitology; Leiden University Medical Center; Leiden The Netherlands
- Department of Microbiology; Faculty of Medicine; Hasanuddin University; Makassar Indonesia
| | - Linda J. Wammes
- Department of Parasitology; Leiden University Medical Center; Leiden The Netherlands
- Department of Medical Microbiology; Erasmus MC; Rotterdam The Netherlands
| | - Maria M. M. Kaisar
- Department of Parasitology; Leiden University Medical Center; Leiden The Netherlands
- Department of Parasitology; Faculty of Medicine; Universitas Indonesia; Jakarta Indonesia
| | - Lisette van Lieshout
- Department of Parasitology; Leiden University Medical Center; Leiden The Netherlands
| | - Erliyani Sartono
- Department of Parasitology; Leiden University Medical Center; Leiden The Netherlands
| | - Taniawati Supali
- Department of Parasitology; Faculty of Medicine; Universitas Indonesia; Jakarta Indonesia
| | - Maria Yazdanbakhsh
- Department of Parasitology; Leiden University Medical Center; Leiden The Netherlands
| | - Andrea L. Graham
- Department of Ecology and Evolutionary Biology; Princeton University; Princeton NJ USA
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Mornand P, Verret C, Minodier P, Faye A, Thellier M, Imbert P. Severe imported malaria in children in France. A national retrospective study from 1996 to 2005. PLoS One 2017; 12:e0180758. [PMID: 28749962 PMCID: PMC5531540 DOI: 10.1371/journal.pone.0180758] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 06/21/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUNDS Malaria is a leading cause of imported febrile illnesses in pediatric travelers, but few studies have addressed severe imported pediatric malaria. We aimed to determine the risk factors and the features of imported pediatric severe malaria. METHODS We conducted a retrospective, descriptive study using the French National Reference Center for Imported Malaria database, in children aged 0-15 years who were hospitalized with a falciparum malaria from January 1st 1996 to December 31th 2005. Uncomplicated and severe cases of falciparum malaria were compared to identify risk factors for severe cases. In the hospitals that reported more than five severe cases during the study period, we evaluated severe cases for prognostic factors and assessed the accuracy WHO criteria for predicting severity. Given the rarity of deaths, adverse outcomes were defined as requiring major therapeutic procedures (MTPs)-e.g., sedation, mechanical ventilation, nasal oxygen therapy, blood transfusions, hemodialysis, fluid resuscitation-or pediatric intensive care unit (PICU) admission. RESULTS Of 4150 pediatric malaria cases included in the study, 3299 were uncomplicated and 851 (20.5%) were severe. Only one death was recorded during this period. Predictors for severe falciparum malaria were: age <2 years (OR = 3.2, 95% CI = 2.5-4.0, p <0.0001) and a travel in the Sahelian region (OR = 1.7, 95% CI = 1.3-2.0, p = 0.0001). Of 422 severe malaria cases, a stay in a Sahelian region, lack of chemoprophylaxis, age <2 years or thrombocytopenia <100 x 10^3/mm^3 predicted adverse outcomes. Except for the hyperparasitemia threshold of 4%, the main WHO 2000 criteria for severe malaria reliably predicted adverse outcomes. In our study, the threshold of parasitemia most predictive of a poor outcome was 8%. CONCLUSION In imported pediatric malaria, children younger than 2 years deserve particular attention. The main WHO 2000 criteria for severity are accurate, except for the threshold of hyperparasitemia, which should be revised.
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Affiliation(s)
- Pierre Mornand
- Service de pédiatrie générale, Hôpital d’enfants A. Trousseau, 26 avenue du Dr Arnold Netter, 75571 Paris cedex 12, France
| | - Catherine Verret
- Institut de Recherche Biomédicale des Armées. BP 73, Brétigny Sur Orge Cedex, France
| | - Philippe Minodier
- Urgences pédiatriques, CHU Nord, Chemin des Bourrely, Marseille, France
| | - Albert Faye
- Assistance Publique des Hôpitaux de Paris, Service de Pédiatrie Générale, Hôpital Robert Debré, Paris, France
- INSERM 1123, Université Paris Diderot, Paris Sorbonne Cité, Paris, France
| | - Marc Thellier
- AP-HP, Service de Parasitologie-Mycologie, Centre National de Référence du paludisme, Hôpital Pitié-Salpêtrière, Paris, France
- INSERM, Centre d’Immunologie et des Maladies Infectieuses de Paris, CIMI-PARIS, U 1135 INSERM/UPMC, Paris, France
| | - Patrick Imbert
- Centre de vaccinations internationales, Hôpital d’instruction des armées Bégin, Saint-Mandé, France
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A Hospital-Based Retrospective Comparative Study of Complications, Outcomes, Clinical and Laboratory Parameters of Malaria with and without Neurological Involvement. Mediterr J Hematol Infect Dis 2017; 9:e2017006. [PMID: 28101311 PMCID: PMC5224813 DOI: 10.4084/mjhid.2017.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 11/21/2016] [Indexed: 12/03/2022] Open
Abstract
Background & Objectives Classically associated with Plasmodium (P.) falciparum, neurological complications in severe malaria is associated with increased morbidity and mortality. However, reports implicate the long considered benign P. vivax for causing severe malaria as well. We aimed to analyse the cerebral complications in malaria, and study if there is a species-related difference in the presentation and outcomes. Methods We retrospectively compared patients with malaria hospitalised from 2009–15, with (n=105) and without (n=1155) neurological involvement regarding outcomes, complications, demographic attributes, clinical features, and laboratory parameters. Subsequently, the same parameters were studied in those with cerebral malaria due to mono-infections of P. vivax or P. falciparum and their co-infection. Results Cerebral malaria was observed in 8.3% (58/696), 7.4% (38/513) and 17.6% (6/51) of P. vivax, P. falciparum and combined plasmodial infections respectively. Those with cerebral malaria had significantly (p<0.05) longer hospitalisation, delayed defervescence, required mechanical ventilatory support and dialysis despite comparable levels of azotemia and renal insufficiency, and adverse outcomes compared to non-cerebral malaria. Severe thrombocytopenia, respiratory distress and mechanical ventilation were significantly (p<0.05) associated with P. vivax cerebral malaria. Conclusions The plasmodial species are comparable in clinical and laboratory parameters and outcomes in cerebral malaria in isolation and combination (p>0.05). P. vivax is emerging as the predominant cause of cerebral malaria, and its virulence is comparable to P. falciparum.
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Rath D, Sahu MC. The clinical and biochemical features of complicated falciparum malarial nephropathy. J Taibah Univ Med Sci 2016; 12:110-114. [PMID: 31435224 PMCID: PMC6694963 DOI: 10.1016/j.jtumed.2016.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 10/07/2016] [Accepted: 10/09/2016] [Indexed: 10/24/2022] Open
Abstract
Objective This study aimed to explore renal involvement in complicated falciparum malaria as observed in hospitalized children. Methods This prospective study was conducted for four consecutive years with children 6 months to 14 years old who were affected by malarial nephropathy. Malaria was confirmed by microscopic examination of a blood smear. Detailed clinical evaluation and investigations were carried out to determine multi-organ involvement with special emphasis on renal functions. The staging for Acute Kidney Injury (AKI) was carried out as per Acute Kidney Injury Network Staging, which provided three groups of patients who were further modified by Risk, Injury, Failure, Loss, End stage renal disease (RIFLE) staging. Results Out of 350 cases with malaria, 56 (16%) cases had nephropathy. One-hundred-forty cases (40%) were aged between 5 and 10 years. Serious renal involvement was observed in 14 (25%) children who were 10-14 years old. Oligo-anuria was found in 40 (71.4%) cases, and generalized oedema was found in 33 (58.9%) children from the onset of malaria. Approximately 47 cases showed associated multi-organ dysfunction, and 9 cases had isolated renal failure. Malaria-induced hepatopathy and nephropathy had a higher risk of death than nephropathy alone. Conclusion The spectrum of malarial nephropathy in children is highly variable, ranging from asymptomatic proteinuria to advanced stages of AKI. Renal involvement is more common and severe in P. falciparum. Children aged between 5 and 14 years and those with oligo-anuria, symptomatic azotaemia, electrolyte abnormalities and hepatopathy are more likely to develop advanced stage AKI and subsequently have an increased risk of mortality.
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Affiliation(s)
- Debasmita Rath
- Department of Paediatrics, Institute of Medical Science and SUM Hospital, Siksha O Anusandhan University, Bhubaneswar, India
| | - Mahesh C Sahu
- Institute of Medical Science and SUM Hospital, Siksha O Anusandhan University, K8, Kalinga Nagar, Bhubaneswar, Odisha, India
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Barennes H, Sayavong E, Pussard E. High Mortality Risk in Hypoglycemic and Dysglycemic Children Admitted at a Referral Hospital in a Non Malaria Tropical Setting of a Low Income Country. PLoS One 2016; 11:e0150076. [PMID: 26910320 PMCID: PMC4766095 DOI: 10.1371/journal.pone.0150076] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 02/09/2016] [Indexed: 01/30/2023] Open
Abstract
INTRODUCTION Hypoglycemia is a recognized feature of severe malaria but its diagnosis and management remain problematic in resource-limited settings. There is limited data on the burden and prognosis associated with glycemia dysregulation in non-neonate children in non-malaria areas. We prospectively assessed the abnormal blood glucose prevalence and the outcome and risk factors of deaths in critically ill children admitted to a national referral hospital in Laos. METHODS Consecutive children (1 month-15 years) admitted to the pediatric ward of Mahosot hospital, were categorized using the integrated management of childhood illness (IMCI). Blood glucose was assessed once on admission through a finger prick using a bedside glucometer. Glycemia levels: hypoglycemia: < 2.2 mmol/L (< 40 mg⁄ dl), low glycemia: 2.2-4.4 mmol/L (40-79 mg⁄ dl), euglycemia: 4.4-8.3 mmol/L (80-149 mg⁄ dl), and hyperglycemia: > 8.3 mmol/L (≥150 mg⁄ dl), were related to the IMCI algorithm and case fatality using univariate and multivariate analysis. RESULTS Of 350 children, 62.2% (n = 218) were severely ill and 49.1% (n = 172) had at least one IMCI danger sign. A total of 15 (4.2%, 95%CI: 2.4-6.9) had hypoglycemia, 99 (28.2%, 95%CI: 23.6-33.3) low glycemia, 201 (57.4%, 95% CI: 52.0-62.6) euglycemia and 35 (10.0%, 95% CI: 7.0-13.6) hyperglycemia. Hypoglycemia was associated with longer fasting (p = 0.001) and limited treatment before admission (p = 0.09). Hypoglycemia and hyperglycemia were associated with hypoxemia (SaO2) (p = 0.001). A total of 21 (6.0%) of the children died: 66.6% with hypoglycemic, 6.0% with low glycemic, 5.7% with hyperglycemic and 1.4% with euglycemic groups. A total of 9 (2.5%) deaths occurred during the first 24 hours of admission and 5 (1.7%) within 3 days of hospital discharge. Compared to euglycemic children, hypoglycemic and low glycemic children had a higher rate of early death (20%, p<0.001 and 5%, p = 0.008; respectively). They also had a higher risk of death (OR: 132; 95%CI: 29.0-596.5; p = 0.001; and OR: 4.2; 95%CI: 1.1-15.6; p = 0.02; respectively). In multivariate analyses, hypoglycemia (OR: 197; 95%CI: 33-1173.9), hypoxemia (OR: 5.3; 95%CI: 1.4-20), presence of hepatomegaly (OR: 8.7; 95%CI: 2.0-37.6) and having an illiterate mother (OR: 25.9; 95%CI: 4.2-160.6) were associated with increased risk of death. CONCLUSION Hypoglycemia is linked with a high risk of mortality for children in non malaria tropical settings. Blood sugar should be monitored and treatment provided for sick children, especially with danger signs and prolonged fasting. Further evaluations of intervention using thresholds including low glycemia is recommended in resource-limited settings. Research is also needed to determine the significance, prognosis and care of hyperglycemia.
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Affiliation(s)
- Hubert Barennes
- Institut de la Francophonie pour la Médecine Tropicale, Vientiane, Lao PDR
- Agence Nationale de Recherche sur le VIH et les Hépatites, Phnom Penh, Cambodia
- Epidemiologie-Biostatistique, ISPED, Centre INSERM U897, Bordeaux University, F-Bordeaux, France
- Epidemiology Unit, Pasteur Institute, Phnom Penh, Cambodia
| | - Eng Sayavong
- Institut de la Francophonie pour la Médecine Tropicale, Vientiane, Lao PDR
| | - Eric Pussard
- Génétique Moléculaire, Pharmacogénétique et Hormonologie, Kremlin Bicêtre University Hospital, Paris, France
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Ephraim RKD, Tashie W, Agbodzakey H, Sakyi SA, Essien-Baidoo S, Adoba P, Adu P, Ampong J. Dipstick urinalysis findings in children with Plasmodium falciparum in the South Tongu District: A case-control study. Niger Med J 2016; 56:292-6. [PMID: 26759517 PMCID: PMC4697220 DOI: 10.4103/0300-1652.169748] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background: Malaria ranks among the major health and developmental challenges facing some of the poorest countries in tropical and sub-tropical regions across the globe. We determined urinary abnormalities and its relationship with parasite density in children ≤12 years with Plasmodium falciparum infection. Materials and Methods: From December 2013 to March 2014, we randomly recruited 116 participants comprising 58 malaria patients (cases) and 58 healthy controls from the Comboni Mission and the Sogakope District Hospitals both in the South Tongu district. Blood was collected for the estimation of hemoglobin and total white blood cells; thick and thin blood films were used for the determination of malaria parasite density. Urine was collected for the measurement of the various biochemical components using the automated urine analyzer. A pretested questionnaire was used to obtain demographic and clinical data. Results: Urine protein (P < 0.001), blood (P < 0.001), bilirubin (P < 0.001), urobilinogen (P < 0.001), and ketones (P = 0.001) were significantly higher in individuals with P. falciparum infection than in healthy controls. Proteinuria (P = 0.247; r = 0.155), hematuria (P = 0.142; r = 0.195), bilirubinuria (P = 0.001; r = 0.438), urobilinogenuria (P = 0.876; r = 0.021), and ketonuria (P = 0.136; r = 0.198) were positively correlated with malaria parasite density; however, only bilirubinuria was significantly higher at higher parasitemia. Conclusion: Malaria has a significant effect on the chemical composition of urine with bilirubin positively correlated with parasite density. Dipstick urinalysis can be used together with light microscopy in resource-limited malaria-endemic areas to accurately diagnose falciparum malaria infection.
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Affiliation(s)
- Richard K D Ephraim
- Department of Medical Laboratory Technology, University of Cape Coast, Cape Coast, Ghana
| | - Worlanyo Tashie
- Department of Medical Laboratory Technology, University of Cape Coast, Cape Coast, Ghana
| | - Hope Agbodzakey
- Department of Medical Laboratory Technology, University of Cape Coast, Cape Coast, Ghana
| | - Samuel Asamoah Sakyi
- Department of Molecular Medicine, School of Medical Science, Kwame Nkrumah University of Science and Technology, Kumasi, Legon, Ghana; Department of Bacteriology, Noguchi Memorial Institute for Medical Research, Legon, Ghana
| | - Samuel Essien-Baidoo
- Department of Medical Laboratory Technology, University of Cape Coast, Cape Coast, Ghana
| | - Prince Adoba
- Department of Medical Laboratory Technology, University of Cape Coast, Cape Coast, Ghana
| | - Patrick Adu
- Department of Medical Laboratory Technology, University of Cape Coast, Cape Coast, Ghana
| | - Joyce Ampong
- Department of Medical Laboratory Technology, University of Cape Coast, Cape Coast, Ghana
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Mendonça VRR, Souza LCL, Garcia GC, Magalhães BML, Gonçalves MS, Lacerda MVG, Barral-Netto M. Associations between hepcidin and immune response in individuals with hyperbilirubinaemia and severe malaria due to Plasmodium vivax infection. Malar J 2015; 14:407. [PMID: 26466783 PMCID: PMC4607001 DOI: 10.1186/s12936-015-0930-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 10/05/2015] [Indexed: 11/20/2022] Open
Abstract
Background Hyperbilirubinaemia (bilirubin >51.3 μmol/L) alone is not indicative of severe malaria, and the immune response underlying hyperbilirubinaemia remains largely unexplored. Liver damage associated with hyperbilirubinaemia may alter the expression of hepcidin, which regulates systemic iron by degrading ferroportin. For this study, the association between hepcidin and the levels of cytokines and chemokines in the serum of individuals with mild and severe vivax malaria and subjects with malaria with isolated hyperbilirubinaemia was evaluated. Methods Cytokines/chemokines and hepcidin were measured in individuals with mild (n = 72) and severe (n = 17) vivax malaria, as well as in the serum of subjects with vivax malaria with isolated hyperbilirubinaemia (n = 14) from the Brazilian Amazon between 2009 and 2013 by multiplex assay and ELISA, respectively. The polymorphism 744 G > T in the ferroportin gene was identified by restriction fragment-length polymorphism analysis and the restriction enzyme PvuII. Results The polymorphism at position 744 G > T in the ferroportin gene was typed and no differences in the distributions of genotypes or alleles were observed between the study groups. Subjects with severe malaria had higher levels of interleukin (IL)-2 and IL-13 than subjects with hyperbilirubinaemia. No differences in the expression of immune markers were observed between subjects with mild malaria and those with hyperbilirubinaemia. However, hepcidin levels were higher in individuals with severe malaria and hyperbilirubinaemia than those with mild malaria (p = 0.0002 and p = 0.0004, respectively) and cut-off values of hepcidin differentiated these groups from subjects with mild malaria. Hepcidin was positively associated with IL-6 and IL-10 levels and with parasitaemia in subjects with mild malaria and with IFN-γ in subjects with severe malaria. Conclusions Malaria in the presence of hyperbilirubinaemia produces a less robust inflammatory response compared to severe cases of malaria. Hepcidin levels are positively associated with immune markers in vivax malaria outcomes. Electronic supplementary material The online version of this article (doi:10.1186/s12936-015-0930-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Vitor R R Mendonça
- Laboratório Integrado de Microbiogia e Imunoregulação (LIMI), Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz (FIOCRUZ), Salvador, Brazil. .,Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Brazil.
| | - Ligia C L Souza
- Laboratório Integrado de Microbiogia e Imunoregulação (LIMI), Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz (FIOCRUZ), Salvador, Brazil. .,Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Brazil.
| | - Gabriela C Garcia
- Laboratório Integrado de Microbiogia e Imunoregulação (LIMI), Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz (FIOCRUZ), Salvador, Brazil. .,Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Brazil.
| | - Belisa M L Magalhães
- Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Brazil. .,Universidade do Estado do Amazonas, Manaus, Brazil.
| | - Marilda S Gonçalves
- Laboratório Integrado de Microbiogia e Imunoregulação (LIMI), Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz (FIOCRUZ), Salvador, Brazil.
| | - Marcus V G Lacerda
- Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Brazil. .,Universidade do Estado do Amazonas, Manaus, Brazil.
| | - Manoel Barral-Netto
- Laboratório Integrado de Microbiogia e Imunoregulação (LIMI), Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz (FIOCRUZ), Salvador, Brazil. .,Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Brazil. .,Instituto de Investigação em Imunologia, Instituto Nacional de Ciência e Tecnologia, São Paulo, Brazil.
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Asma UE, Taufiq F, Khan W. Prevalence and clinical manifestations of malaria in Aligarh, India. THE KOREAN JOURNAL OF PARASITOLOGY 2014; 52:621-9. [PMID: 25548413 PMCID: PMC4277024 DOI: 10.3347/kjp.2014.52.6.621] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 08/04/2014] [Accepted: 09/29/2014] [Indexed: 12/04/2022]
Abstract
Malaria is one of the most widespread infectious diseases of tropical countries with an estimated 207 million cases globally. In India, there are endemic pockets of this disease, including Aligarh. Hundreds of Plasmodium falciparum and P. vivax cases with severe pathological conditions are recorded every year in this district. The aim of this study is to find out changes in liver enzymes and kidney markers. Specific diagnosis for P. falciparum and P. vivax was made by microscopic examination of Giemsa stained slides. Clinical symptoms were observed in both of these infections. Liver enzymes, such as AST, ALT, and ALP, and kidney function markers, such as creatinine and urea, were estimated by standard biochemical techniques. In Aligarh district, P. vivax, P. falciparum, and mixed infections were 64%, 34%, and 2%, respectively. In case of P. falciparum infection, the incidences of anemia, splenomegaly, renal failure, jaundice, and neurological sequelae were higher compared to those in P. vivax infection. Recrudescence and relapse rates were 18% and 20% in P. falciparum and P. vivax infections, respectively. Liver dysfunctions and renal failures were more common in P. falciparum patients, particularly in elderly patients. Artesunate derivatives must, therefore, be introduced for the treatment of P. falciparum as they resist to chloroquine as well as sulfadoxine-pyrimethamine combinations.
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Affiliation(s)
- Umm-e Asma
- Department of Zoology, Aligarh Muslim University, Aligarh 202002, India
| | - Farha Taufiq
- Department of Zoology, Aligarh Muslim University, Aligarh 202002, India
| | - Wajihullah Khan
- Department of Zoology, Aligarh Muslim University, Aligarh 202002, India
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Jain V, Basak S, Bhandari S, Bharti PK, Thomas T, Singh MP, Singh N. Burden of complicated malaria in a densely forested Bastar region of Chhattisgarh State (Central India). PLoS One 2014; 9:e115266. [PMID: 25531373 PMCID: PMC4274025 DOI: 10.1371/journal.pone.0115266] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2014] [Accepted: 11/20/2014] [Indexed: 11/21/2022] Open
Abstract
Background A prospective study on severe and complicated malaria was undertaken in the tribal dominated area of Bastar division, Chhattisgarh (CG), Central India, with an objective to understand the clinical epidemiology of complicated malaria in patients attending at a referral hospital. Methods Blood smears, collected from the general medicine and pediatric wards of a government tertiary health care facility located in Jagdalpur, CG, were microscopically examined for malaria parasite from July 2010 to December 2013. The Plasmodium falciparum positive malaria cases who met enrollment criteria and provided written informed consent were enrolled under different malaria categories following WHO guidelines. PCR was performed to reconfirm the presence of P.falciparum mono infection among enrolled cases. Univariate and multivariate logistic regression analysis was done to identify different risk factors using STATA 11.0. Results A total of 40,924 cases were screened for malaria. The prevalence of malaria and P.falciparum associated complicated malaria (severe and cerebral both) in the hospital was 6% and 0.81%, respectively. P.falciparum malaria prevalence, severity and associated mortality in this region peaked at the age of>4–5 years and declined with increasing age. P.falciparum malaria was significantly more prevalent in children than adults (P<0.00001). Among adults, males had significantly more P.falciparum malaria than females (P<0.00001). Case fatality rate due to cerebral malaria and severe malaria was, respectively, 32% and 9% among PCR confirmed mono P.falciparum cases. Coma was the only independent predictor of mortality in multivariate regression analysis. Mortality was significantly associated with multi-organ complication score (P = 0.0003). Conclusion This study has revealed that the pattern of morbidity and mortality in this part of India is very different from earlier reported studies from India. We find that the peak morbidity and mortality in younger children regardless of seasonality. This suggests that this age group needs special care for control and clinical management.
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Affiliation(s)
- Vidhan Jain
- Regional Medical Research Centre for Tribals (RMRCT), ICMR, Garha, Jabalpur, Madhya Pradesh, India
| | - Sanjay Basak
- District Malaria Office, Maharani Hospital and associated Medical College Jagdalpur, Chhattisgarh, India
| | - Sneha Bhandari
- Regional Medical Research Centre for Tribals (RMRCT), ICMR, Garha, Jabalpur, Madhya Pradesh, India
| | - Praveen K. Bharti
- Regional Medical Research Centre for Tribals (RMRCT), ICMR, Garha, Jabalpur, Madhya Pradesh, India
| | - Trilok Thomas
- Regional Medical Research Centre for Tribals (RMRCT), ICMR, Garha, Jabalpur, Madhya Pradesh, India
| | - Mrigendra P. Singh
- National Institute of Malaria Research, Field Unit, Jabalpur, Madhya Pradesh, India
| | - Neeru Singh
- Regional Medical Research Centre for Tribals (RMRCT), ICMR, Garha, Jabalpur, Madhya Pradesh, India
- * E-mail:
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Barennes H, Pussard E. Improving the management of dysglycemia in children in the developing world. Am J Trop Med Hyg 2014; 92:6-8. [PMID: 25311692 DOI: 10.4269/ajtmh.14-0212] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Improving the availability of point-of-care (POC) diagnostics for glucose is crucial in resource-constrained settings (RCS). Both hypo and hyperglycemia have an appreciable frequency in the tropics and have been associated with increased risk of deaths in pediatrics units. However, causes of dysglycemia, including hyperglycemia, are numerous and insufficiently documented in RCS. Effective glycemic control with glucose infusion and/or intensive insulin therapy can improve clinical outcomes in western settings. A non-invasive way for insulin administration is not yet available for hyperglycemia. We documented a few causes and developed simple POC treatment of hypoglycemia in RCS. We showed the efficacy of sublingual sugar in two clinical trials. Dextrose gel has been recently tested for neonate mortality. This represents an interesting alternative that should be compared with sublingual sugar in RCS. New studies had to be done to document dysglycemia mechanism, frequency and morbid-mortality, and safe POC treatment in the tropics.
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Affiliation(s)
- Hubert Barennes
- INSERM, ISPED, Centre INSERM U897-Epidemiologie-Biostatistique, F-33000 Bordeaux, France; Agence Nationale de Recherche sur le VIH et Hépatite, ANRS Phnom Penh, Cambodia; Epidemiology Unit, Pasteur Institute, Phnom Penh, Cambodia; Génétique Moléculaire, Pharmacogénétique et Hormonologie CHU Bicêtre, Kremlin Bicêtre, Paris, France
| | - Eric Pussard
- INSERM, ISPED, Centre INSERM U897-Epidemiologie-Biostatistique, F-33000 Bordeaux, France; Agence Nationale de Recherche sur le VIH et Hépatite, ANRS Phnom Penh, Cambodia; Epidemiology Unit, Pasteur Institute, Phnom Penh, Cambodia; Génétique Moléculaire, Pharmacogénétique et Hormonologie CHU Bicêtre, Kremlin Bicêtre, Paris, France
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Miranda-Arboleda AF, Martínez-Salazar EL, Tobón-Castaño A. El riñón en la malaria: de la patogénesis a las manifestaciones clínicas. INFECTIO 2014. [DOI: 10.1016/j.infect.2014.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
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Clinico-pathological studies of Plasmodium falciparum and Plasmodium vivax - malaria in India and Saudi Arabia. Acta Parasitol 2014; 59:206-12. [PMID: 24827088 DOI: 10.2478/s11686-014-0227-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Revised: 10/10/2013] [Accepted: 01/28/2014] [Indexed: 11/20/2022]
Abstract
Malaria is one of the most devastating diseases of tropical countries with clinical manifestations such as anaemia, splenomegaly, thrombocytopenia, hepatomegaly and acute renal failures. In this study, cases of thrombocytopenia and haemoglobinemia were more prominent in subjects infected with Plasmodium falciparum (Welch, 1897) than those with Plasmodium vivax (Grassi et Feletti, 1890). However, anaemia, jaundice, convulsions and acute renal failure were significantly high (3-4 times) in subjects infected with P. falciparum than those infected with P. vivax. The incidence of splenomegaly and neurological sequelae were 2 and 6 times higher in P. falciparum infections compared to the infections of P. vivax. Both in P. vivax and P. falciparum malaria, the cases of splenomegaly, jaundice and neurological sequelae were almost double in children (<10 years) compared to older patients. The liver enzymes were generally in normal range in cases of low and mild infections. However, the AST, ALT, ALP activities and serum bilirubin, creatinine, and the urea content were increased in P. falciparum and P. vivax malaria patients having high parasitaemia, confirming liver dysfunction and renal failures in few cases of severe malaria both in India and Saudi Arabia.
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Invasive bacterial co-infection in African children with Plasmodium falciparum malaria: a systematic review. BMC Med 2014; 12:31. [PMID: 24548672 PMCID: PMC3928319 DOI: 10.1186/1741-7015-12-31] [Citation(s) in RCA: 127] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Accepted: 01/21/2014] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Severe malaria remains a major cause of pediatric hospital admission across Africa. Invasive bacterial infection (IBI) is a recognized complication of Plasmodium falciparum malaria, resulting in a substantially worse outcome. Whether a biological relationship exists between malaria infection and IBI susceptibility remains unclear. We, therefore, examined the extent, nature and evidence of this association. METHODS We conducted a systematic search in August 2012 of three major scientific databases, PubMed, Embase and Africa Wide Information, for articles describing bacterial infection among children with P. falciparum malaria using the search string '(malaria OR plasmodium) AND (bacteria OR bacterial OR bacteremia OR bacteraemia OR sepsis OR septicaemia OR septicemia).' Eligiblity criteria also included studies of children hospitalized with malaria or outpatient attendances in sub-Saharan Africa. RESULTS A total of 25 studies across 11 African countries fulfilled our criteria. They comprised twenty cohort analyses, two randomized controlled trials and three prospective epidemiological studies. In the meta-analysis of 7,208 children with severe malaria the mean prevalence of IBI was 6.4% (95% confidence interval (CI) 5.81 to 6.98%). In a further meta-analysis of 20,889 children hospitalised with all-severity malaria and 27,641 children with non-malarial febrile illness the mean prevalence of IBI was 5.58 (95% CI 5.5 to 5.66%) in children with malaria and 7.77% (95% CI 7.72 to 7.83%) in non-malaria illness. Ten studies reported mortality stratified by IBI. Case fatality was higher at 81 of 336, 24.1% (95% CI 18.9 to 29.4) in children with malaria/IBI co-infection compared to 585 of 5,760, 10.2% (95% CI 9.3 to 10.98) with malaria alone. Enteric gram-negative organisms were over-represented in malaria cases, non-typhoidal Salmonellae being the most commonest isolate. There was weak evidence indicating IBI was more common in the severe anemia manifestation of severe malaria. CONCLUSIONS The accumulated evidence suggests that children with recent or acute malaria are at risk of bacterial infection, which results in an increased risk of mortality. Characterising the exact nature of this association is challenging due to the paucity of appropriate severity-matched controls and the heterogeneous data. Further research to define those at greatest risk is necessary to target antimicrobial treatment.
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Manning L, Laman M, Davis WA, Davis TME. Clinical features and outcome in children with severe Plasmodium falciparum malaria: a meta-analysis. PLoS One 2014; 9:e86737. [PMID: 24516538 PMCID: PMC3916300 DOI: 10.1371/journal.pone.0086737] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Accepted: 12/14/2013] [Indexed: 11/29/2022] Open
Abstract
Background Although global malaria mortality is declining, estimates may not reflect better inpatient management of severe malaria (SM) where reported case fatality rates (CFRs) vary from 1–25%. Methods A meta-analysis of prospective studies of SM was conducted to examine i) whether hypothesized differences between clinical features and outcome in Melanesian compared with African or Asian children really exist, and ii) to explore temporal changes in overall and complication-specific CFRs. The proportions of different SM complications and, overall and complication-specific CFRs were incorporated into the meta-analysis. Adjustments were made for study-level covariates including geographic region, SM definition, artemisinin treatment, median age of participants and time period. Findings Sixty-five studies were included. Substantial heterogeneity (I2>80%) was demonstrated for most outcomes. SM definition contributed to between-study heterogeneity in proportions of cerebral malaria (CM), metabolic acidosis (MA), severe anemia and overall CFR, whilst geographic region was a significant moderator in for CM and hypoglycemia (HG) rates. Compared with their African counterparts, Melanesian children had lower rates of HG (10% [CI95 7–13%] versus 1% [0–3%], P<0.05), lower overall CFR (2% [0–4%] versus 7% [6–9%], P<0.05) and lower CM-specific CFR (8% [0–17%] versus 19% [16–21%], P<0.05). There was no temporal trend for overall CFR and CM-specific CFR but declining HG- and MA- specific CFRs were observed. Interpretation These data highlight that recent estimates of declining global malaria mortality are not replicated by improved outcomes for children hospitalized with SM. Significant geographic differences in the complication rates and subsequent CFRs exist and provide the first robust confirmation of lower CFRs in Melanesian children, perhaps due to less frequent HG.
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Affiliation(s)
- Laurens Manning
- School of Medicine and Pharmacology, University of Western Australia, Fremantle Hospital, Fremantle, Western Australia, Australia
- * E-mail:
| | - Moses Laman
- School of Medicine and Pharmacology, University of Western Australia, Fremantle Hospital, Fremantle, Western Australia, Australia
| | - Wendy A. Davis
- School of Medicine and Pharmacology, University of Western Australia, Fremantle Hospital, Fremantle, Western Australia, Australia
| | - Timothy M. E. Davis
- School of Medicine and Pharmacology, University of Western Australia, Fremantle Hospital, Fremantle, Western Australia, Australia
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Nayak N P, Nayak RP, Soans ST, Alva S, Ahamed Z, Kotinakanot S. A study of the clinical profile and management of malaria in pediatric age group in a tertiary care hospital in Mangalore. ASIAN PACIFIC JOURNAL OF TROPICAL DISEASE 2014. [DOI: 10.1016/s2222-1808(14)60432-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Cabrales P, Martins YC, Ong PK, Zanini GM, Frangos JA, Carvalho LJM. Cerebral tissue oxygenation impairment during experimental cerebral malaria. Virulence 2013; 4:686-97. [PMID: 24128424 DOI: 10.4161/viru.26348] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Ischemia and hypoxia have been implicated in cerebral malaria (CM) pathogenesis, although direct measurements of hypoxia have not been conducted. C57BL/6 mice infected with Plasmodium berghei ANKA (PbA) develop a neurological syndrome known as experimental cerebral malaria (ECM), whereas BALB/c mice are resistant to ECM. In this study, intravital microscopy methods were used to quantify hemodynamic changes, vascular/tissue oxygen (O₂) tension (PO₂), and perivascular pH in vivo in ECM and non-ECM models, employing a closed cranial window model. ECM mice on day 6 of infection showed marked decreases in pial blood flow, vascular (arteriolar, venular), and perivascular PO₂, perivascular pH, and systemic hemoglobin levels. Changes were more dramatic in mice with late-stage ECM compared with mice with early-stage ECM. These changes led to drastic decreases in O₂ delivery to the brain tissue. In addition, ECM animals required a greater PO₂ gradient to extract the same amount of O₂ compared with non-infected animals, as the pial tissues extract O₂ from the steepest portion of the blood O₂ equilibrium curve. ECM animals also showed increased leukocyte adherence in postcapillary venules, and the intensity of adhesion was inversely correlated with blood flow and O₂ extraction. PbA-infected BALB/c mice displayed no neurological signs on day 6 and while they did show changes similar to those observed in C57BL/6 mice (decreased pial blood flow, vascular/tissue PO₂, perivascular pH, hemoglobin levels), non-ECM animals preserved superior perfusion and oxygenation compared with ECM animals at similar anemia and parasitemia levels, resulting in better O₂ delivery and O₂ extraction by the brain tissue. In conclusion, direct quantitative assessment of pial hemodynamics and oxygenation in vivo revealed that ECM is associated with severe progressive brain tissue hypoxia and acidosis.
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Affiliation(s)
- Pedro Cabrales
- Center for Malaria Research; La Jolla Bioengineering Institute; San Diego, CA USA; Department of Bioengineering; University of California; San Diego, CA USA
| | - Yuri C Martins
- Center for Malaria Research; La Jolla Bioengineering Institute; San Diego, CA USA
| | - Peng Kai Ong
- Center for Malaria Research; La Jolla Bioengineering Institute; San Diego, CA USA
| | - Graziela M Zanini
- Center for Malaria Research; La Jolla Bioengineering Institute; San Diego, CA USA; Parasitology Service; Evandro Chagas Clinical Research Institute; Fiocruz; Rio de Janeiro, Brazil
| | - John A Frangos
- Center for Malaria Research; La Jolla Bioengineering Institute; San Diego, CA USA
| | - Leonardo J M Carvalho
- Center for Malaria Research; La Jolla Bioengineering Institute; San Diego, CA USA; Laboratory of Malaria Research; Oswaldo Cruz Institute; Fiocruz; Rio de Janeiro, Brazil
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Sambany E, Pussard E, Rajaonarivo C, Raobijaona H, Barennes H. Childhood dysglycemia: prevalence and outcome in a referral hospital. PLoS One 2013; 8:e65193. [PMID: 23741481 PMCID: PMC3669285 DOI: 10.1371/journal.pone.0065193] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2011] [Accepted: 04/26/2013] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Hypoglycemia is a defining feature of severe malaria and several other infectious diseases in children but the prevalence, significance, and prognosis of abnormal blood glucose, including hyperglycemia, have rarely been addressed in severely ill children in non-malaria endemic areas. METHODS In Madagascar, consecutive children (1 month-15 years) admitted to the pediatric ward of a referral hospital, were categorized using the integrated management of childhood illness (IMCI). Samples were taken once on admission for measuring blood glucose concentration. Glycemia levels (hypoglycemia <2.2 mmol/l; low glycemia: 2.2-4.4 mmol/l; normoglycemia >4.4-8.3 mmol/l; and hyperglycemia >8.3 mmol/l) were related to the IMCI algorithm and case fatality. Factors associated with blood glucose concentration and case fatality were analysed using univariate and multivariate analysis. RESULTS Of 420 children, 48.1% (n = 202) were severely ill; 3.1% (n = 13) had hypoglycemia; 20.0% (n = 84) low glycemia; 65.9% (n = 277) normoglycemia; and 10.9% (n = 46) hyperglycemia. In univariate analysis, hypoglycemia and hyperglycemia both showed significant increase in the risk of death, as compared to normal blood glucose (RR: 12.2, 95% CI: 6.2-23.7 and RR: 2.5, 95% CI: 1.0-6.2, respectively). Children with low glycemia had no increased risk of death (RR: 1.2, 95% CI: 0.4-3.2) despite a poorer IMCI status on admission. After logistic regression, hypoglycemia (RR: 19.4, 95% CI: 5.0-.74.7, hepatomegaly (RR: 12.2, 95% CI: 3.3-44.9) and coma (RR: 4.8, 95% CI: 1.3-17.6) were the features on admission associated with an increased risk of death. CONCLUSIONS Dysglycemia in non-neonates is associated with increased mortality. These findings underline the need for the use of rapid screening tests to initiate early treatment. Alternative treatments such as oral or sublingual administration of glucose should be developed in structures with limited resources.
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Affiliation(s)
- Emercia Sambany
- Institut Francophone pour la Médecine Tropicale, Vientiane, Lao PDR
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Abstract
Malaria, diarrhea, respiratory infections, and cutaneous larva migrans are common travel-related infections observed in children and adolescents returning from trips to developing countries. Children visiting friends and relatives are at the highest risk because few visit travel clinics before travel, their stays are longer, and the sites they visit are more rural. Clinicians must be able to prepare their pediatric-age travelers before departure with preventive education, prophylactic and self-treating medications, and vaccinations. Familiarity with the clinical manifestations and treatment of travel-related infections will secure prompt and effective therapy.
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Ossou-Nguiet PM, Okoko AR, Ekouya Bowassa G, Oko AP, Mabiala-Babela JR, Ndjobo Mamadoud IC, Moyen G. [Determinants of cerebral malaria in Congolese children]. Rev Neurol (Paris) 2013; 169:510-4. [PMID: 23394850 DOI: 10.1016/j.neurol.2012.11.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Revised: 11/01/2012] [Accepted: 11/07/2012] [Indexed: 10/27/2022]
Abstract
Malaria still constitutes a worrying problem of public health. It remains an important cause of infant mortality. To determine the determinants of severe malaria a case control study was carried out from July to December 2011 in the pediatric intensive care department of the university hospital of Brazzaville. The group included 230 children hospitalised for severe malaria, and the control group consisted of children followed up for non-severe malaria. Cases and controls were compared using statistical tests for matched group. The young age of the mother (OR=4.13), her poor education level (OR=2.36), the low socioeconomic level of parents (OR=5.90), the malnutrition (OR=2.67), the delay of consultation (OR=13.69) and parasitemia were associated with significantly higher risk of severe malaria. The importance of identified determinants imposes the implementation of primary prevention measures, which pass through the amelioration of socioeconomic and cultural conditions of populations, the reinforcement of sanitary education, and also a secondary prevention consisting of an early and accurate management of ordinary malaria.
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Affiliation(s)
- P M Ossou-Nguiet
- Service de neurologie, université de Brazzaville, CHU de Brazzaville, 13, boulevard Maréchal-Lyautey, BP 32, Brazzaville, Congo.
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McMorran BJ, Wieczorski L, Drysdale KE, Chan JA, Huang HM, Smith C, Mitiku C, Beeson JG, Burgio G, Foote SJ. Platelet factor 4 and Duffy antigen required for platelet killing of Plasmodium falciparum. Science 2012; 338:1348-51. [PMID: 23224555 DOI: 10.1126/science.1228892] [Citation(s) in RCA: 122] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Platelets restrict the growth of intraerythrocytic malaria parasites by binding to parasitized cells and killing the parasite within. Here, we show that the platelet molecule platelet factor 4 (PF4 or CXCL4) and the erythrocyte Duffy-antigen receptor (Fy) are necessary for platelet-mediated killing of Plasmodium falciparum parasites. PF4 is released by platelets on contact with parasitized red cells, and the protein directly kills intraerythrocytic parasites. This function for PF4 is critically dependent on Fy, which binds PF4. Genetic disruption of Fy expression inhibits binding of PF4 to parasitized cells and concomitantly prevents parasite killing by both human platelets and recombinant human PF4. The protective function afforded by platelets during a malarial infection may therefore be compromised in Duffy-negative individuals, who do not express Fy.
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Affiliation(s)
- Brendan J McMorran
- Australian School of Advanced Medicine, Macquarie University, Sydney, NSW 2109, Australia.
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Sharma R, Gohain S, Chandra J, Kumar V, Chopra A, Chatterjee S, Aneja S, Dutta AK. Plasmodium vivax malaria admissions and risk of mortality in a tertiary-care children's hospital in North India. Paediatr Int Child Health 2012; 32:152-7. [PMID: 22824663 DOI: 10.1179/2046905512y.0000000012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND In 2010, there was an increase in the severity of malaria admissions to Kalawati Saran Children's Hospital, New Delhi and this report describes the morbidity and mortality profile. METHOD A retrospective chart review of patients admitted with parasitologically confirmed malaria between January and December 2010. RESULTS There were 156 cases: P. vivax 105 (67.3%), P. falciparum 39 (25%) and mixed infections 12 (7.7%). Thrombocytopenia (platelet count <150×10(9)/L) was present in 90 (85.7%) patients with P. vivax mono-infection. There were 91 (58.3%) patients with severe malaria: P. vivax mono-infection 46 (50.5%), P. falciparum mono-infection 35 (38.5%) and mixed 10 (11%). Severe anaemia and severe thrombocytopenia (platelet count <20×10(9)/L) were detected significantly more often in P. falciparum and P. vivax mono-infection, respectively. Complications including cerebral malaria, acute renal failure, shock, acute respiratory distress syndrome (ARDS) and multiple-organ dysfunction syndrome (MODS) were similar in both groups. The mortality rate of around 20% was similar in severe P. vivax and P. falciparum mono-infection. Risk of mortality in vivax malaria was highest in patients with ARDS followed by MODS and shock. CONCLUSION Increased morbidity owing to P. vivax malaria was observed and risk of mortality was highest in patients with ARDS and MODS.
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Affiliation(s)
- Rajni Sharma
- Department of Pediatrics, Lady Hardinge Medical College and Kalawati Saran Children's Hospital, New Delhi, India.
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Prognostic value of clinical and parasitological signs for severe malaria in patients from Colombia. BIOMEDICA 2012. [DOI: 10.7705/biomedica.v32i0.613] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Introducción. El pronto reconocimiento de los signos de peligro en los pacientes con malaria puede reducir las complicaciones y muertes. Sin embargo, se conoce poco sobre su valor pronóstico para la malaria complicada, especialmente en las zonas de transmisión baja e inestable de la enfermedad.Objetivo. Estimar el valor pronóstico de gravedad que tienen diversos signos clínicos y parasitológicos en los pacientes con malaria.Materiales y métodos. Se hizo un estudio en una cohorte prospectiva con pacientes de cinco municipios de Colombia, con diagnóstico de malaria por Plasmodium falciparum y P. vivax, en quienes se estudió la asociación de los signos clínicos y los parasitológicos con la malaria complicada.Resultados. Se obtuvo un modelo de predicción con una sensibilidad de 47,4 % y especificidad de 92,8 %, valor pronóstico positivo de 63,2 % y valor pronóstico negativo de 87,1 %, el cual incluye ictericia, orina oscura, hiperpirexia y signos de deshidratación.Conclusiones. Con el fin de causar un impacto en la morbilidad complicada de la malaria, se propone una estrategia de reconocimiento de los signos de peligro por el personal no médico, que se acompañede otros elementos de la atención, como el suministro de un tratamiento antipalúdico adecuado y oportuno. Se proponen los criterios del diagnóstico de complicación moderada.
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Tangpukdee N, Krudsood S, Kano S, Wilairatana P. Falciparum malaria parasitemia index for predicting severe malaria. Int J Lab Hematol 2012; 34:320-7. [PMID: 22221310 DOI: 10.1111/j.1751-553x.2011.01398.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION While hyperparasitemia is considered an important indicator for the development of severe malaria, there is currently no consensus on the quantitative definition of hyperparasitemia. This study was conducted to establish a cutoff point for peripheral parasitemia among patients with Plasmodium falciparum malaria, to define severe malaria. METHODS The clinical presentations of 200 uncomplicated P. falciparum malaria, and 189 severe P. falciparum malaria, patients, admitted to the Hospital for Tropical Diseases, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand, were analyzed. RESULTS A peripheral parasitemia of 0.5% was found to be the optimal cutoff point for defining severe malaria, demonstrating highest sensitivity (85.1%), specificity (62.0%), and accuracy (73.2%). CONCLUSION Symptoms of severe falciparum malaria depend on many factors. For the definition of hyperparasitemia in areas of low or seasonal transmission, peripheral parasitemia of 0.5% might be considered a cutoff point for discrimination between severity levels. This value might be useful for the clinical management of malaria, particularly in hypo-endemic areas, unstable transmission areas, and other areas with similar transmission patterns.
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Affiliation(s)
- N Tangpukdee
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
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Mohapatra MK, Dash LK, Mishra NR, Agrawala RK. Profile of seizures in adult falciparum malaria and the clinical efficacy of phenytoin sodium for control of seizures. ASIAN PACIFIC JOURNAL OF TROPICAL DISEASE 2012. [DOI: 10.1016/s2222-1808(12)60220-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Malaria and National Vector Borne Disease Control Programme. Indian J Pediatr 2011; 78:1527-35. [PMID: 21909781 DOI: 10.1007/s12098-011-0554-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2011] [Accepted: 08/02/2011] [Indexed: 10/17/2022]
Abstract
Malaria is a major vector borne disease in India with significant morbidity and mortality. The official figure of 1.5 million cases annually is a gross under-estimation of the true incidence and the actual figures are estimated to be 10-100 times higher. The National Vector Borne Disease Control Programme (NVBDCP) directorate is the main body responsible for malaria control in India. Newer strategies including insecticide treated bednets, longlasting insecticidal bednets and rapid diagnostic tests have been used for malaria control in the last decade. Global assistance has come from the World Bank and Global fund in the form of Enhanced Malaria Control Programme(EMCP) and Intensified Malaria Control Programme(IMCP) respectively. Despite years of concerted global and national efforts, control of malaria continues to be a challenge. The emergence of drug resistance to anti-malarial drugs has been a major hurdle in its control. The NVBDCP has formulated new treatment guidelines for malaria in 2010 which recommend artemisinin based combination therapy (ACT) as the first-line drugs for P. falciparum malaria in the country. The article discusses the recent national drug policy for malaria and the rationale for its use.
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Sowunmi A, Okuboyejo TM, Gbotosho GO, Happi CT. Risk factors for Plasmodium falciparum hyperparasitaemia in malarious children. BMC Infect Dis 2011; 11:268. [PMID: 21982211 PMCID: PMC3199259 DOI: 10.1186/1471-2334-11-268] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Accepted: 10/09/2011] [Indexed: 11/10/2022] Open
Abstract
Background Hyperparasitaemia is a feature of childhood severe malaria but there is little information on the risk factors for hyperparasitaemia in malarious children Methods The risk factors associated with Plasmodium falciparum hyperparasitaemia, defined as asexual parasitaemia > 250,000/μl, at presentation were evaluated in 3338 malarious children enrolled prospectively between 2008 and 2010 in an endemic area of southwestern Nigeria. Results At enrolment, 97 (3%) of 3338 malarious children had hyperparasitaemia. In a multiple regression model, 3 factors were found to be independent risk factors for the presence of hyperparasitaemia at enrolment: an age ≤ 11 years (Adjusted odds ratio [AOR] = 2.85, 95% confidence interval [CI] 1.23-6.61, P = 0.014), fever (AOR = 2.02, 95% CI 1.23-3.29, P = 0.005), and enrolment after year 2008 (AOR = 0.42, 95% CI 0.24-0.73, P = 0.002). Duration of illness ≤ 3 d was associated with increased risk of hyperparasitaemia. There was no association between season and hyperparasitaemia. Compared to non-hyperparasitaemia, hyperparasitaemia was associated with an increased risk of progression to cerebral malaria (P < 0.0001). The risk of progression in hyperparasitaemic children was higher in < 5-year olds (P = 0.02). Conclusion Young age and presence of fever are independent risk factors for hyperparasitaemia which is associated with an increased risk of progression to cerebral malaria. The findings have implications for case and community management of childhood hyperparasitaemia and for malaria control efforts in sub-Saharan Africa where severe malaria is relatively common.
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Affiliation(s)
- Akintunde Sowunmi
- Department of Pharmacology & Therapeutics and Institute for Medical Research and Training, University of Ibadan, Ibadan, Nigeria.
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Costenaro P, Benedetti P, Facchin C, Mengoli C, Pellizzer G. Fatal Myocarditis in Course of Plasmodium falciparum Infection: Case Report and Review of Cardiac Complications in Malaria. Case Rep Med 2011; 2011:202083. [PMID: 21541220 PMCID: PMC3085333 DOI: 10.1155/2011/202083] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2011] [Accepted: 02/21/2011] [Indexed: 11/17/2022] Open
Abstract
We describe a fatal case of imported malaria where the sole finding revealed at the postmortem evaluation was an acute lymphocytic myocarditis with myocardiolysis. This case recalls the potential importance of myocardial injury in the prognosis of malaria and prompts a reevaluation of current perspectives on the pathogenesis of severe falciparum infection. In the light of this, we have reviewed the cases of cardiac complications in malaria published to date.
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Affiliation(s)
- Paola Costenaro
- Scuola di Specializzazione in Malattie Infettive, Università degli Studi di Padova, Via Giustiniani, 35122 Padova, Italy
| | - Paolo Benedetti
- Unità Operativa di Malattie infettive e Tropicali, Ospedale S. Bortolo, Viale F. Rodolfi 37, 36100 Vicenza, Italy
| | - Chiara Facchin
- Unità Operativa di Malattie infettive e Tropicali, Ospedale S. Bortolo, Viale F. Rodolfi 37, 36100 Vicenza, Italy
| | - Carlo Mengoli
- Scuola di Specializzazione in Malattie Infettive, Università degli Studi di Padova, Via Giustiniani, 35122 Padova, Italy
| | - Giampietro Pellizzer
- Unità Operativa di Malattie infettive e Tropicali, Ospedale S. Bortolo, Viale F. Rodolfi 37, 36100 Vicenza, Italy
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Nanda NC, Rath P, Acharya J, Mishra P, Mishra SK. Falciparum malaria in children-a brief report of 305 patients from rourkela, eastern India. Indian J Pediatr 2011; 78:475-7. [PMID: 21088935 DOI: 10.1007/s12098-010-0287-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2010] [Accepted: 10/21/2010] [Indexed: 11/25/2022]
Abstract
Most of the studies on malaria in children are reported from Africa, but only a few are from India. A retrospective study of 305 children with slide positive malaria was conducted at Rourkela, Orissa. 5.2% children were below 1 year of age. 34.1% were between 1 and 5 years and 60.7% were above 5 years. 63.9% were boys. The presenting symptoms were fever (98.4%), vomiting (52%), and headache (22%). 121 patients had one or more complications viz., cerebral malaria (n = 56), severe anemia (39), jaundice (31), convulsions (20), hypoglycemia (10) and only one with acute renal failure. 22 patients died.
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Affiliation(s)
- Nimai C Nanda
- Ispat General Hospital, Rourkela, 769005, Orissa, India
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Peter G, Manuel AL, Shetty A. Study comparing the clinical profile of complicated cases of Plasmodium falciparum malaria among adults and children. ASIAN PACIFIC JOURNAL OF TROPICAL DISEASE 2011. [DOI: 10.1016/s2222-1808(11)60008-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
This study describes 977 children with imported malaria in England and Wales between 2004 and 2008, focusing on 29 (3.0%) patients admitted to intensive care, of whom 10 had cerebral malaria, 4 required inotropes, and 1 had concurrent septicemia. The remaining 14 were admitted for monitoring only. None died, but 1 child developed cerebellar infarction.
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Kochar DK, Tanwar GS, Khatri PC, Kochar SK, Sengar GS, Gupta A, Kochar A, Middha S, Acharya J, Saxena V, Pakalapati D, Garg S, Das A. Clinical features of children hospitalized with malaria--a study from Bikaner, northwest India. Am J Trop Med Hyg 2010; 83:981-9. [PMID: 21036824 DOI: 10.4269/ajtmh.2010.09-0633] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Severe Plasmodium vivax malaria in adults has been reported from Bikaner (northwestern India) but the reports on children are scanty. This prospective study was done on 303 admitted children of malaria. The diagnosis was done by peripheral blood smear and rapid diagnostic test. Further confirmation of severe P. vivax monoinfection was done by polymerase chain reaction (PCR). The proportion of P. falciparum, P. vivax, and mixed (P. falciparum and P. vivax) infection was 61.01%, 33.99%, and 4.95%, respectively. Severe disease was present in 49.5% (150/303) children with malaria, with the risk greatest among P. vivax monoinfection (63.1% [65/103]) compared with P. falciparum, either alone (42.7% [79/185]; odds ratio [OR] = 2.3 [95% confidence interval (CI) = 1.40-3.76], P = 0.001) or mixed infections (40% [6/15]; OR = 2.57 [95% CI = 0.88-7.48]). In children < 5 years of age, the proportion of severe malaria attributable to P. vivax rose to 67.4% (31/46) compared with 30.4% (14/46) of P. falciparum (OR = 4.7 [95% CI = 2.6-8.6], P < 0.0001) and 2.2% (1/46) of mixed infection (OR = 92 [95% CI = 24.6-339.9], P < 0.0001). The proportion of patients having severe manifestations, which included severe anemia, thrombocytopenia, cerebral malaria, acute respiratory distress syndrome, hepatic dysfunction, renal dysfunction, abnormal bleeding was significantly high in association with P. vivax monoinfection in 0-5 year age group, while the same was significantly high in association with P. falciparum monoinfection in 5-10 year age group. Similarly P. vivax monoinfection had greatest propensity to cause multiorgan dysfunction in 0-5 year age group (34.1% [17/41], P < 0.0001) in comparison to P. falciparum monoinfection, which had similar propensity in 5-10 year age group (36.8% [35/95], P = 0.039). Plasmodium vivax monoinfection was almost equally serious to cause significant mortality in comparison to P. falciparum (case fatality rate of severe P. vivax was 3.9% versus 3.2% of severe P. falciparum malaria; P = 1.0). This study reaffirms the evidence of severe P. vivax malaria in children in Bikaner.
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Affiliation(s)
- Dhanpat Kumar Kochar
- Department of Medicine, Kothari Medical and Research Institute, Bikaner, Rajasthan, India.
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Dhingra N, Jha P, Sharma VP, Cohen AA, Jotkar RM, Rodriguez PS, Bassani DG, Suraweera W, Laxminaryan R, Peto R. Adult and child malaria mortality in India: a nationally representative mortality survey. Lancet 2010; 376:1768-74. [PMID: 20970179 PMCID: PMC3021416 DOI: 10.1016/s0140-6736(10)60831-8] [Citation(s) in RCA: 178] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND National malaria death rates are difficult to assess because reliably diagnosed malaria is likely to be cured, and deaths in the community from undiagnosed malaria could be misattributed in retrospective enquiries to other febrile causes of death, or vice-versa. We aimed to estimate plausible ranges of malaria mortality in India, the most populous country where the disease remains common. METHODS Full-time non-medical field workers interviewed families or other respondents about each of 122,000 deaths during 2001-03 in 6671 randomly selected areas of India, obtaining a half-page narrative plus answers to specific questions about the severity and course of any fevers. Each field report was sent to two of 130 trained physicians, who independently coded underlying causes, with discrepancies resolved either via anonymous reconciliation or adjudication. FINDINGS Of all coded deaths at ages 1 month to 70 years, 2681 (3·6%) of 75,342 were attributed to malaria. Of these, 2419 (90%) were in rural areas and 2311 (86%) were not in any health-care facility. Death rates attributed to malaria correlated geographically with local malaria transmission ratesderived independently from the Indian malaria control programme. The adjudicated results show 205,000 malaria deaths per year in India before age 70 years (55,000 in early childhood, 30,000 at ages 5-14 years, 120,000 at ages 15-69 years); 1·8% cumulative probability of death from malaria before age 70 years. Plausible lower and upper bounds (on the basis of only the initial coding) were 125,000-277,000. Malaria accounted for a substantial minority of about 1·3 million unattended rural fever deaths attributed to infectious diseases in people younger than 70 years. INTERPRETATION Despite uncertainty as to which unattended febrile deaths are from malaria, even the lower bound greatly exceeds the WHO estimate of only 15,000 malaria deaths per year in India (5000 early childhood, 10 000 thereafter). This low estimate should be reconsidered, as should the low WHO estimate of adult malaria deaths worldwide. FUNDING US National Institutes of Health, Canadian Institute of Health Research, Li Ka Shing Knowledge Institute.
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Affiliation(s)
- Neeraj Dhingra
- National AIDS Control Organization, New Delhi 100110, India
- Centre for Global Health Research (CGHR), Li Ka Shing Knowledge Institute, St. Michael's Hospital and Dalla Lana School of Public Health, University of Toronto, Ontario M5B 2C5, Canada
| | - Prabhat Jha
- Centre for Global Health Research (CGHR), Li Ka Shing Knowledge Institute, St. Michael's Hospital and Dalla Lana School of Public Health, University of Toronto, Ontario M5B 2C5, Canada
- Correspondence: or
| | - Vinod P Sharma
- Centre for Rural Development and Technology, Indian Institute of Technology, New Delhi 110016
| | - Alan A Cohen
- Centre for Global Health Research (CGHR), Li Ka Shing Knowledge Institute, St. Michael's Hospital and Dalla Lana School of Public Health, University of Toronto, Ontario M5B 2C5, Canada
| | - Raju M Jotkar
- Centre for Global Health Research (CGHR), Li Ka Shing Knowledge Institute, St. Michael's Hospital and Dalla Lana School of Public Health, University of Toronto, Ontario M5B 2C5, Canada
- St. John's Research Institute, Bangalore, Karnataka 560034, India
| | - Peter S Rodriguez
- Centre for Global Health Research (CGHR), Li Ka Shing Knowledge Institute, St. Michael's Hospital and Dalla Lana School of Public Health, University of Toronto, Ontario M5B 2C5, Canada
| | - Diego G Bassani
- Centre for Global Health Research (CGHR), Li Ka Shing Knowledge Institute, St. Michael's Hospital and Dalla Lana School of Public Health, University of Toronto, Ontario M5B 2C5, Canada
| | - Wilson Suraweera
- Centre for Global Health Research (CGHR), Li Ka Shing Knowledge Institute, St. Michael's Hospital and Dalla Lana School of Public Health, University of Toronto, Ontario M5B 2C5, Canada
| | | | - Richard Peto
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), University of Oxford, OX3 7LF, UK
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Lal S, Lahariya C, Saxena VK. Insecticide treated nets, antimalarials and child survival in India. Indian J Pediatr 2010; 77:425-30. [PMID: 20422322 DOI: 10.1007/s12098-010-0051-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2010] [Accepted: 01/27/2010] [Indexed: 11/27/2022]
Abstract
Malaria has been a complex public health problem affecting mainly the poor and the rural communities in India. Insecticide treated nets (ITN) and antimalarials are the two proven interventions for prevention and control of malaria. ITN has been amply demonstrated to be an effective intervention to protect children from malaria, and in preventing deaths due to falciparum malaria. Antimalarials are a therapeutic intervention for management of malaria, and prevention of complications due to Plasmodium falciparum infection. However, implementation of these interventions is fraught with problems of complex and multidimensional nature at the periphery. These can be addressed by optimizing the use of the 2 interventions, the insecticide treated nets and antimalarials, for area specific application and country specific needs, determined by the eco-epidemiological diversity of malaria in India. This article reviews the significant role of ITN in reducing child mortality, and the judicious use of antimalarials in the management of malaria patient, and the problems associated with the use of these interventions in protecting children against malaria in India.
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Affiliation(s)
- Shiv Lal
- National Centre for Disease Control (National Institute of Communicable Diseases), Sham Nath Marg, Delhi, India
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Abstract
Severe malaria causes multiorgan dysfunction, which is the predominant reason for mortality in these children. Cardiac enzymes have been elevated and cardiac involvement has been suspected in some of these children, however, clear cut echocardiographic evidence for it was not possible. There were isolated reports of myocardial dysfunction in malaria in adults but none in children. We present two such children with cardiac involvement and myocardial dysfunction.
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Willcox ML, Forster M, Dicko MI, Graz B, Mayon-White R, Barennes H. Blood glucose and prognosis in children with presumed severe malaria: is there a threshold for 'hypoglycaemia'? Trop Med Int Health 2009; 15:232-40. [PMID: 19961563 DOI: 10.1111/j.1365-3156.2009.02444.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Hypoglycaemia (glucose <2.2 mmol/l) is a defining feature of severe malaria, but the significance of other levels of blood glucose has not previously been studied in children with severe malaria. METHODS A prospective study of 437 consecutive children with presumed severe malaria was conducted in Mali. We defined hypoglycaemia as <2.2 mmol/l, low glycaemia as 2.2-4.4 mmol/l and hyperglycaemia as >8.3 mmol/l. Associations between glycaemia and case fatality were analysed for 418 children using logistic regression models and a receiver operator curve (ROC). RESULTS There was a significant difference between blood glucose levels in children who died (median 4.6 mmol/l) and survivors (median 7.6 mmol/l, P < 0.001). Case fatality declined from 61.5% of the hypoglycaemic children to 46.2% of those with low glycaemia, 13.4% of those with normal glycaemia and 7.6% of those with hyperglycaemia (P < 0.001). Logistic regression showed an adjusted odds ratio (AOR) of 0.75 (0.64-0.88) for case fatality per 1 mmol/l increase in baseline blood glucose. Compared to a normal blood glucose, hypoglycaemia and low glycaemia both significantly increased the odds of death (AOR 11.87, 2.10-67.00; and 5.21, 1.86-14.63, respectively), whereas hyperglycaemia reduced the odds of death (AOR 0.34, 0.13-0.91). The ROC [area under the curve at 0.753 (95% CI 0.684-0.820)] indicated that glycaemia had a moderate predictive value for death and identified an optimal threshold at glycaemia <6.1 mmol/l, (sensitivity 64.5% and specificity 75.1%). CONCLUSIONS If there is a threshold of blood glucose which defines a worse prognosis, it is at a higher level than the current definition of 2.2 mmol/l.
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Affiliation(s)
- Merlin L Willcox
- Department of Primary Health Care, University of Oxford, Oxford, UK.
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