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Hodson DZ, Mbarga Etoundi Y, Mbatou Nghokeng N, Mohamadou Poulibe R, Magne Djoko S, Goodwin J, Cheteug Nguesta G, Nganso T, Armstrong JN, Andrews JJ, Zhang E, Wade M, Eboumbou Moukoko CE, Boum Y, Parikh S. Clinical characteristics of Plasmodium falciparum infection among symptomatic patients presenting to a major urban military hospital in Cameroon. Malar J 2022; 21:298. [PMID: 36273147 PMCID: PMC9588226 DOI: 10.1186/s12936-022-04315-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 10/10/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Urban malaria has received insufficient attention in the literature. The prevalence and clinical characteristics of Plasmodium falciparum infection amongst patients presenting with suspected malaria were investigated at a major urban hospital in Douala, Cameroon with a particular focus on anaemia. METHODS A cross-sectional, 18-week demographic and clinical survey was conducted of patients presenting to the Emergency Department of Douala Military Hospital with suspected malaria, largely defined by the presence or recent history of fever. Venous samples were tested for P. falciparum using rapid diagnostic tests and PCR, and anaemia was defined by haemoglobin level according to WHO definitions. Likelihood ratios (LR), odds ratios (OR), and population attributable risk percent (PARP) were calculated. RESULTS Participants were ages 8 months to 86 years, 51% were women (257/503), and all districts of Douala were represented. Overall, 38.0% (n = 189/497) were anaemic, including 5.2% (n = 26/497) with severe anaemia. Anaemia prevalence was significantly higher (OR: 2.20, 95% CI 1.41-3.45) among children < 15 years (53.1%, n = 52/98) compared to adults (34%, n = 133/392). Plasmodium falciparum was detected in 37.2% by nested PCR. Among all participants, several factors were associated with clinically significant LR for P. falciparum infection, including age 10-14 years (positive LR: 3.73), living in the island district of Douala VI (positive LR: 3.41), travel to any of three northern regions (positive LR: 5.11), and high fever > 40 °C at presentation (positive LR: 4.83). Among all participants, 8.7% of anaemia was associated with P. falciparum infection, while the PARP was 33.2% among those < 15 years of age and 81.0% among 10-14-year-olds. CONCLUSIONS The prevalence of P. falciparum infection in the urban hospital was high. Mirroring trends in many rural African settings, older children had the highest positivity rate for P. falciparum infection. Anaemia was also common in all age groups, and for those 10-14 years of age, 80% of the risk for anaemia was associated with P. falciparum infection. Malaria rates in major urban population centres can be high, and more research into the multifactorial causes of anaemia across the age spectrum are needed.
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Affiliation(s)
| | - Yannick Mbarga Etoundi
- Douala Military Hospital, Douala, Cameroon
- Douala Military Hospital School of Nursing, Douala, Cameroon
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | | | | | | | - Justin Goodwin
- Yale School of Medicine, New Haven, USA
- Yale School of Public Health, New Haven, USA
| | - Glwadys Cheteug Nguesta
- Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon
- Malaria Research Service, Centre Pasteur of Cameroon, Yaoundé, Cameroon
| | - Tatiana Nganso
- Malaria Research Service, Centre Pasteur of Cameroon, Yaoundé, Cameroon
| | | | | | | | | | - Carole Else Eboumbou Moukoko
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
- Malaria Research Service, Centre Pasteur of Cameroon, Yaoundé, Cameroon
| | - Yap Boum
- Epicentre, Yaoundé, Cameroon
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé, Yaoundé, Cameroon
| | - Sunil Parikh
- Yale School of Medicine, New Haven, USA.
- Yale School of Public Health, New Haven, USA.
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Antonio-Nkondjio C, Ndo C, Njiokou F, Bigoga JD, Awono-Ambene P, Etang J, Ekobo AS, Wondji CS. Review of malaria situation in Cameroon: technical viewpoint on challenges and prospects for disease elimination. Parasit Vectors 2019; 12:501. [PMID: 31655608 PMCID: PMC6815446 DOI: 10.1186/s13071-019-3753-8] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 10/18/2019] [Indexed: 11/30/2022] Open
Abstract
Malaria still has a devastating impact on public health and welfare in Cameroon. Despite the increasing number of studies conducted on disease prevalence, transmission patterns or treatment, there are to date, not enough studies summarising findings from previous works in order to identify gaps in knowledge and areas of interest where further evidence is needed to drive malaria elimination efforts. The present study seeks to address these gaps by providing a review of studies conducted so far on malaria in Cameroon since the 1940s to date. Over 250 scientific publications were consulted for this purpose. Although there has been increased scale-up of vector control interventions which significantly reduced the morbidity and mortality to malaria across the country from a prevalence of 41% of the population reporting at least one malaria case episode in 2000 to a prevalence of 24% in 2017, the situation is not yet under control. There is a high variability in disease endemicity between epidemiological settings with prevalence of Plasmodium parasitaemia varying from 7 to 85% in children aged 6 months to 15 years after long-lasting insecticidal nets (LLINs) scale-up. Four species of Plasmodium have been recorded across the country: Plasmodium falciparum, P. malariae, P. ovale and P. vivax. Several primate-infecting Plasmodium spp. are also circulating in Cameroon. A decline of artemisinin-based combinations therapeutic efficacy from 97% in 2006 to 90% in 2016 have been reported. Several mutations in the P. falciparum chloroquine resistance (Pfcrt) and P. falciparum multidrug resistance 1 (Pfmdr1) genes conferring resistance to either 4-amino-quinoleine, mefloquine, halofanthrine and quinine have been documented. Mutations in the Pfdhfr and Pfdhps genes involved in sulfadoxine-pyrimethamine are also on the rise. No mutation associated with artemisinin resistance has been recorded. Sixteen anopheline species contribute to malaria parasite transmission with six recognized as major vectors: An. gambiae, An. coluzzii, An. arabiensis, An. funestus, An. nili and An. moucheti. Studies conducted so far, indicated rapid expansion of DDT, pyrethroid and carbamate resistance in An. gambiae, An. coluzzii, An. arabiensis and An. funestus threatening the performance of LLINs. This review highlights the complex situation of malaria in Cameroon and the need to urgently implement and reinforce integrated control strategies in different epidemiological settings, as part of the substantial efforts to consolidate gains and advance towards malaria elimination in the country.
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Affiliation(s)
- Christophe Antonio-Nkondjio
- Laboratoire de Recherche sur le Paludisme, Organisation de Coordination pour la lutte contre les Endémies en Afrique Centrale (OCEAC), B. P.288 Yaoundé, Cameroun
- Centre for Research in Infectious Disease (CRID), P.O. Box 13591, Yaoundé, Cameroon
- Vector Biology Liverpool School of Tropical medicine Pembroke Place, Liverpool, UK
| | - Cyrille Ndo
- Department of Biological Sciences, Faculty of Medicine and Pharmaceutical Sciences, University of Douala, P.O. Box 24157, Douala, Cameroon
- Centre for Research in Infectious Disease (CRID), P.O. Box 13591, Yaoundé, Cameroon
| | - Flobert Njiokou
- Centre for Research in Infectious Disease (CRID), P.O. Box 13591, Yaoundé, Cameroon
- Faculty of Sciences, University of Yaoundé I, P.O. Box 337, Yaoundé, Cameroon
| | - Jude D. Bigoga
- Laboratory for Vector Biology and control, National Reference Unit for Vector Control, The Biotechnology Center, Nkolbisson-University of Yaounde I, P.O. Box 3851, Messa, Yaounde, Cameroon
- Department of Biochemistry, Faculty of Science, University of Yaounde I, Yaounde, Cameroon
| | - Parfait Awono-Ambene
- Laboratoire de Recherche sur le Paludisme, Organisation de Coordination pour la lutte contre les Endémies en Afrique Centrale (OCEAC), B. P.288 Yaoundé, Cameroun
| | - Josiane Etang
- Laboratoire de Recherche sur le Paludisme, Organisation de Coordination pour la lutte contre les Endémies en Afrique Centrale (OCEAC), B. P.288 Yaoundé, Cameroun
- Department of Biological Sciences, Faculty of Medicine and Pharmaceutical Sciences, University of Douala, P.O. Box 24157, Douala, Cameroon
- Institute for Insect Biotechnology, Justus Liebig University Gießen, Winchester Str. 2, 35394 Gießen, Germany
| | - Albert Same Ekobo
- Faculty of Sciences, University of Yaoundé I, P.O. Box 337, Yaoundé, Cameroon
| | - Charles S. Wondji
- Centre for Research in Infectious Disease (CRID), P.O. Box 13591, Yaoundé, Cameroon
- Vector Biology Liverpool School of Tropical medicine Pembroke Place, Liverpool, UK
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Sakwe N, Bigoga J, Ngondi J, Njeambosay B, Esemu L, Kouambeng C, Nyonglema P, Seumen C, Gouado I, Oben J. Relationship between malaria, anaemia, nutritional and socio-economic status amongst under-ten children, in the North Region of Cameroon: A cross-sectional assessment. PLoS One 2019; 14:e0218442. [PMID: 31226133 PMCID: PMC6588222 DOI: 10.1371/journal.pone.0218442] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 05/21/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Despite malaria, malnutrition and anaemia being major public-health challenges in Cameroon, very little has been reported on the interaction between these interconnected health determinants. This study therefore sought to investigate the relationship between malaria, anaemia, nutritional and socio-economic status amongst under-ten children living in six localities within two health districts in the North Region of Cameroon. METHODS Accordingly, a cross- sectional survey was conducted during the peak malaria season in November 2014, in Pitoa and Mayo-Oulo Health Districts. Three hundred and sixty eight children aged 6months-10 years were enrolled. Structured questionnaires were used to assess socio-economic status. Anthropometric indices were taken using standard methods and nutritional status assessed by calculating Height for Age (HA), Weight for Age (WA) and Weight for Height (WH) z-scores to determine stunting, underweight and wasting respectively. Finger-prick blood samples were used to prepare thin and thick blood smears for microscopy. Whole blood was collected to determine the PCV and blood spots on filter paper were used to extract plasmodium DNA for speciation by PCR. RESULTS Overall prevalence rates of malaria, malnutrition and anaemia were 32.9%, 54.1% and 20.6% respectively. Stunting, underweight and wasting were detected in 56.9%, 63.5% and 34.8% of the children respectively. There was a significant association between malaria and malnutrition [OR = 1.89, (95% CI: 1.12-3.19); (p = 0.017)]. Malnutrition was also strongly associated with malaria status [OR = 2.07, (95% CI: 1.22-3.53); (p = 0.007)]. The prevalence rates of mild, moderate and severe anaemia were 8.1%, 9.2% and 3.3% respectively. Both malaria status and anaemia correlated with development index [OR = 0.75, (95% CI: 0.58-0.99); (p = 0.042)] and [OR = 1.45, (95% CI: 1.05-2.00); (p = 0.023)] respectively. CONCLUSION Our findings show a synergistic relationship between malaria and malnutrition. Effective collaboration between malaria control and nutrition intervention programmes is essential for proper case management and improved socio-economic status.
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Affiliation(s)
- Nobelle Sakwe
- Laboratory of Nutrition and Nutritional Biochemistry, Department of Biochemistry, University of Yaounde I, Yaounde, Cameroon
- Molecular Parasitology and Disease Vector Research Laboratory, the Biotechnology Center, University of Yaounde I, Yaounde, Cameroon
| | - Jude Bigoga
- Molecular Parasitology and Disease Vector Research Laboratory, the Biotechnology Center, University of Yaounde I, Yaounde, Cameroon
- National Malaria Control Programme, Yaounde, Cameroon
| | - Judith Ngondi
- Laboratory of Nutrition and Nutritional Biochemistry, Department of Biochemistry, University of Yaounde I, Yaounde, Cameroon
| | - Boris Njeambosay
- Molecular Parasitology and Disease Vector Research Laboratory, the Biotechnology Center, University of Yaounde I, Yaounde, Cameroon
| | - Livo Esemu
- Molecular Parasitology and Disease Vector Research Laboratory, the Biotechnology Center, University of Yaounde I, Yaounde, Cameroon
| | | | | | - Clovis Seumen
- Molecular Parasitology and Disease Vector Research Laboratory, the Biotechnology Center, University of Yaounde I, Yaounde, Cameroon
| | - Inocent Gouado
- Laboratory of Nutrition and Food Sciences, Department of Biochemistry, University of Douala, Douala, Cameroon
| | - Julius Oben
- Laboratory of Nutrition and Nutritional Biochemistry, Department of Biochemistry, University of Yaounde I, Yaounde, Cameroon
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Antonio-Nkondjio C, Demanou M, Etang J, Bouchite B. Impact of cyfluthrin (Solfac EW050) impregnated bed nets on malaria transmission in the city of Mbandjock : lessons for the nationwide distribution of long-lasting insecticidal nets (LLINs) in Cameroon. Parasit Vectors 2013; 6:10. [PMID: 23311927 PMCID: PMC3556121 DOI: 10.1186/1756-3305-6-10] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Accepted: 01/08/2013] [Indexed: 11/24/2022] Open
Abstract
Background Insecticide treated materials remain the mainstay for malaria prevention. The current study reports on the entomological impact of cyfluthrin impregnated bed nets on malaria transmission in Mbandjock, a semi urban locality in southern Cameroon. Several findings pertaining to the recent distribution of LLINs across Cameroon are discussed. Methods Malaria transmission and vector bionomics were monitored before and after impregnated net coverage. Bed nets were distributed in Mbandjock, whereas the locality of Nkoteng was free of bed nets during the entire study period. January to June 1997 represented the period before bed net coverage and September 1997 to September 1998 was the period after bed net coverage. Adult mosquitoes were collected by human landing catches. Mosquito genus and species were identified with morphological and molecular diagnostic tools. Anopheline salivary glands and ovaries were dissected to determine female infectious status and parity rates respectively. Results A total of 6959 anophelines corresponding to 6029 in Mbandjock and 930 in Nkoteng were collected in the course of the study. Seven species were recorded in both cities : Anopheles coustani, An. funestus, An. gambiae sl, An. moucheti, An. ziemanni, An. nili and An. paludis. An. gambiae s.l. (>95% An. gambiae S molecular form) was the most abundant species representing 75.6% and 86.6% of the total anophelines caught in Mbandjock before and after bed net coverage respectively. The human biting rate (HBR) in Mbandjock decreased from 17 bites/human/night before bed net coverage to less than 4 bites/human/night during the first 7 months following impregnated bed net coverage. A significant decrease of mosquito parity rate was recorded when comparing the period before (52%) and after (46.5%) bed net distribution. The average infection rate of malaria vectors significantly decreased from 5.3% before to 1.8% after bed net coverage (p < 0.0001). The entomological inoculation rate in Mbandjock was reduced by 74% varying from 124.1 infected bites/human/year before bed net distribution, to 32.5 infected bites/human/year after bed net coverage. All entomological indexes were relatively stable in Nkoteng and no reduction of malaria transmission was recorded in this locality. Conclusion The study confirms the effectiveness of cyfluthrin impregnated nets in reducing malaria transmission. Lessons from this study could be essential to draw guidelines for the management of the recent nationwide distribution of LLINs across Cameroon in 2011.
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Affiliation(s)
- Christophe Antonio-Nkondjio
- Laboratoire de Recherche sur le Paludisme, Organisation de Coordination pour la lutte Contre les Endémies en Afrique Centrale (OCEAC), P.O. Box 288, Yaoundé, Cameroon.
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Antonio-Nkondjio C, Defo-Talom B, Tagne-Fotso R, Tene-Fossog B, Ndo C, Lehman LG, Tchuinkam T, Kengne P, Awono-Ambene P. High mosquito burden and malaria transmission in a district of the city of Douala, Cameroon. BMC Infect Dis 2012; 12:275. [PMID: 23106909 PMCID: PMC3532071 DOI: 10.1186/1471-2334-12-275] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Accepted: 10/29/2012] [Indexed: 11/24/2022] Open
Abstract
Background Rapid demographic growth in Douala city, Cameroon, has resulted in profound ecological and environmental changes. Although demographic changes can affect anopheline mosquito breeding sites, there is a lack of understanding about the epidemiological impact that such changes might have on vector ecology and malaria transmission. Methods A 12-month entomological study was conducted in a highly populated district of Douala called Ndogpassi. Adult mosquitoes were collected using two methods: 1) human landing catches (HLC); and 2) Centers for Disease Control and Prevention (CDC) light traps; these methods were used twice monthly from January to December 2011. Mosquito genus and species were identified with morphological and molecular diagnostic tools. The sampling efficiency of the CDC light trap and HLC were compared. Anopheles gambiae infection with Plasmodium falciparum was detected using ELISA. Susceptibility to DDT, permethrin, and deltamethrin insecticides were also determined. Results A total of 6923 mosquitoes were collected by HLC (5198) and CDC light traps (1725). There was no equivalence in the sampling efficiency between light traps and human landing catches (P > 0.01). With 51% of the total, Culex was the most common, followed by Anopheles (26.14%), Mansonia (22.7%) and Aedes (0.1%). An. gambiae ss (M form) comprised ~98% of the total anophelines collected. An. gambiae had a biting rate of 0.25 to 49.25 bites per human per night, and was the only species found to be infected with P. falciparum. A P. falciparum infection rate of 0.5% was calculated (based on enzyme-linked immunosorbent assays using the circumsporozoite surface protein). The entomological inoculation rate was estimated at 31 infective bites per annum. Insecticide susceptibility tests on An. gambiae females revealed a mortality rate of 33%, 76% and 98% for DDT, permethrin and deltamethrin, respectively. The West African kdr allele (L1014F) was detected in 38 of the 61 An. gambiae analyzed (62.3%). Conclusions The present study revealed seasonal malaria transmission in Douala. High levels of An. gambiae were detected along with a high prevalence of insecticide resistance in this vector population. These findings highlight the need to promote use of insecticide-impregnated bed nets in Douala.
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Affiliation(s)
- Christophe Antonio-Nkondjio
- Laboratoire de Recherche sur le Paludisme, Organisation de Coordination pour la lutte Contre les Endémies en Afrique Centrale (OCEAC), P.O. Box 288, Yaoundé, Cameroun.
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Msangeni HA, Kamugisha ML, Sembuche SH, Malecela EK, Akida JA, Temba FF, Mmbando BP, Lemnge MM. Prospective study on severe malaria among in-patients at Bombo regional hospital, Tanga, north-eastern Tanzania. BMC Infect Dis 2011; 11:256. [PMID: 21958391 PMCID: PMC3224364 DOI: 10.1186/1471-2334-11-256] [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: 01/04/2011] [Accepted: 09/29/2011] [Indexed: 11/11/2022] Open
Abstract
Background In Tanzania, malaria is the major cause of morbidity and mortality, accounting for about 30% of all hospital admissions and around 15% of all hospital deaths. Severe anaemia and cerebral malaria are the two main causes of death due to malaria in Tanga, Tanzania. Methods This was a prospective observational hospital-based study conducted from October 2004 to September 2005. Consent was sought from study participants or guardians in the wards. Finger prick blood was collected from each individual for thick and thin smears, blood sugar levels and haemoglobin estimations by Haemocue machine after admission. Results A total of 494 patients were clinically diagnosed and admitted as cases of severe malaria. Majority of them (55.3%) were children below the age of 5 years. Only 285 out of the total 494 (57.7%) patients had positive blood smears for malaria parasites. Adults aged 20 years and above had the highest rate of cases with fever and blood smear negative for malaria parasites. Commonest clinical manifestations of severe malaria were cerebral malaria (47.3%) and severe anaemia (14.6%), particularly in the under-fives. Case fatality was 3.2% and majority of the deaths occurred in the under-fives and adults aged 20 years and above with negative blood smears. Conclusion Proper laboratory diagnosis is crucial for case management and reliable data collection. The non-specific nature of malaria symptomatologies limits the use of clinical diagnosis and the IMCI strategy. Strengthening of laboratory investigations to guide case management is recommended.
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Affiliation(s)
- Hamisi A Msangeni
- National Institute for Medical Research, Tanga Medical Research Centre, P.O. Box 5004, Tanga, Tanzania.
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Pankoui Mfonkeu JB, Gouado I, Fotso Kuaté H, Zambou O, Amvam Zollo PH, Grau GER, Combes V. Elevated cell-specific microparticles are a biological marker for cerebral dysfunctions in human severe malaria. PLoS One 2010; 5:e13415. [PMID: 20976232 PMCID: PMC2954805 DOI: 10.1371/journal.pone.0013415] [Citation(s) in RCA: 117] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2010] [Accepted: 09/16/2010] [Indexed: 11/21/2022] Open
Abstract
Cerebral malaria (CM) and severe anemia (SA) are the most severe complications of Plasmodium falciparum infections. Although increased release of endothelial microparticles (MP) correlates with malaria severity, the full extent of vascular cell vesiculation remains unknown. Here, we characterize the pattern of cell-specific MP in patients with severe malaria. We tested the hypothesis that systemic vascular activation contributes to CM by examining origins and levels of plasma MP in relation to clinical syndromes, disease severity and outcome. Patients recruited in Douala, Cameroon, were assigned to clinical groups following WHO criteria. MP quantitation and phenotyping were carried out using cell-specific markers by flow cytometry using antibodies recognizing cell-specific surface markers. Platelet, erythrocytic, endothelial and leukocytic MP levels were elevated in patients with cerebral dysfunctions and returned to normal by discharge. In CM patients, platelet MP were the most abundant and their levels significantly correlated with coma depth and thrombocytopenia. This study shows for the first time a widespread enhancement of vesiculation in the vascular compartment appears to be a feature of CM but not of SA. Our data underpin the role of MP as a biomarker of neurological involvement in severe malaria. Therefore, intervention to block MP production in severe malaria may provide a new therapeutic pathway.
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Affiliation(s)
| | - Inocent Gouado
- Department of Biochemistry, Faculty of Science, University of Douala, Douala, Cameroon
| | | | - Odile Zambou
- Pediatric service, Deido district Hospital, Douala, Cameroon
| | | | | | - Valéry Combes
- Department of Pathology, The University of Sydney, Sydney, New South Wales, Australia
- * E-mail:
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Abstract
To investigate the part played by undernutrition in malaria severity, some biomarkers of nutritional status were assessed in children with severe malarial anaemia (MA) and cerebral malaria (CM) in comparison with healthy children or those with uncomplicated malaria. Undernutrition was assessed using the weight-for-age Z score (WAZ). Retinol was determined by HPLC; lipid profile, Ca, Mg and albumin were determined by spectrophotometry. Severe and moderate undernutritions were more prevalent in children with MA and those with the combined symptoms of CM and MA, but not in those with CM alone. Some perturbations were noticed in the lipid profile, but most of the values remained within the normal ranges. The risk of vitamin A deficiency, as assessed by plasma retinol concentration, was noteworthy in children with severe malaria: 0.48 × 10(-6) and 0.50 × 10(-6) mol/l, respectively, in children with MA and CM (reference value: >0.7 × 10(-6) mol/l). A significant difference was obtained for retinol values after an ANOVA of all the groups (P = 0.0029), with the value in the MA group being significantly low than that in the control group (P < 0.05); likewise, a significant difference was obtained after comparison of all the groups for Mg and albumin (P = 0.0064 and 0.0082, respectively). Despite their low number (n 6), fatal cases of CM had a normal mean WAZ on admission, but low values of retinol, albumin and HDL:LDL ratio. Despite these associations, undernutrition itself did not appear to be a primary factor associated with fatal outcome.
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Kanda Y, Kawamura H, Matsumoto H, Kobayashi T, Kawamura T, Abo T. Identification and characterization of autoantibody-producing B220low B (B-1) cells appearing in malarial infection. Cell Immunol 2010; 263:49-54. [DOI: 10.1016/j.cellimm.2010.02.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2009] [Revised: 02/17/2010] [Accepted: 02/22/2010] [Indexed: 01/07/2023]
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Abstract
OBJECTIVES We evaluated plasma creatinine, urea, bilirubin, lactic acid, and nitric oxide values in children with malaria to identify indices of disease severity and predictors of fatal outcomes. METHODS Children 0 to 15 years old were recruited, clinical data recorded, and blood samples collected. Plasma creatinine, urea, bilirubin, lactic acid, and nitric oxide (NO) values were determined by spectrophotometry. RESULTS Values of creatinine, urea, and bilirubin were normal in all the groups except for urea in some groups (55.30 +/- 5.508 mg/dL and 60.45 +/- 15.56 mg/dL in anemia patients and those with the combined symptoms of cerebral malaria and anemia, respectively). The mean lactate values were high in severe malaria groups (0.57 +/- 0.05 g/L and 0.48 +/- 0.05 g/L in cerebral malaria and anemia patients, respectively). As for the mean NO values, they were above the normal range in all the groups, except the controls, but particularly in the severe malaria groups (68.66 +/- 7.85, 84.52 +/- 8.17, 99.57 +/- 10.48, 87.25 +/- 12.57, and 93.48 +/- 7.09 micromol/L for the control, uncomplicated malaria, anemia, cerebral malaria patients and those with the combined symptoms of cerebral malaria and anemia, respectively; P = 0.643). CONCLUSIONS In this setting, lactate and NO were indicators of poor prognosis. Though the impact of creatinine, urea, and bilirubin were not found to be significant, they can still be useful to assess improvement in severe malaria cases.
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