1
|
Yao Z, Liang M, Zhu S. Infectious factors in myocarditis: a comprehensive review of common and rare pathogens. Egypt Heart J 2024; 76:64. [PMID: 38789885 PMCID: PMC11126555 DOI: 10.1186/s43044-024-00493-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 05/13/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Myocarditis is a significant health threat today, with infectious agents being the most common cause. Accurate diagnosis of the etiology of infectious myocarditis is crucial for effective treatment. MAIN BODY Infectious myocarditis can be caused by viruses, prokaryotes, parasites, and fungi. Viral infections are typically the primary cause. However, some rare opportunistic pathogens can also damage heart muscle cells in patients with immunodeficiencies, neoplasms and those who have undergone heart surgery. CONCLUSIONS This article reviews research on common and rare pathogens of infectious myocarditis, emphasizing the complexity of its etiology, with the aim of helping clinicians make an accurate diagnosis of infectious myocarditis.
Collapse
Affiliation(s)
- Zongjie Yao
- School of Health and Life Sciences, University of Health and Rehabilitation Sciences, Qindao, China.
| | - Mingjun Liang
- Department of Intensive Care Medicine, Shanghai Six People's Hospital Affilicated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Simin Zhu
- Wuhan Third Hospital-Tongren Hospital of Wuhan University, Wuhan, China
| |
Collapse
|
2
|
Tiwari A, De A, Sinha A. Increasing blood pressure: could malaria have a role? Lancet Glob Health 2023; 11:e1697. [PMID: 37858581 DOI: 10.1016/s2214-109x(23)00419-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 08/29/2023] [Indexed: 10/21/2023]
Affiliation(s)
- Aparna Tiwari
- ICMR-National Institute of Malaria Research, New Delhi, India; Department of Atomic Energy, Centre for Excellence in Basic Sciences, University of Mumbai, Mumbai, India
| | - Auley De
- ICMR-National Institute of Malaria Research, New Delhi, India; Nirnayan Healthcare, Kolkata, India
| | - Abhinav Sinha
- ICMR-National Institute of Malaria Research, New Delhi, India.
| |
Collapse
|
3
|
Bansal V, Munjal J, Lakhanpal S, Gupta V, Garg A, Munjal RS, Jain R. Epidemiological shifts: the emergence of malaria in America. Proc AMIA Symp 2023; 36:745-750. [PMID: 37829240 PMCID: PMC10566419 DOI: 10.1080/08998280.2023.2255514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 09/01/2023] [Indexed: 10/14/2023] Open
Abstract
Plasmodium is a genus of parasites that comprises different species. The species falciparum, vivax, malariae, ovale, and knowlesi are known to cause a vector-borne illness called malaria, and among these, falciparum is known to cause major complications. The vector, the Anopheles mosquito, is commonly found in warmer regions close to the equator, and hence transmission and numbers of cases tend to be higher in Sub-Saharan Africa, South Asia, and Central America. The number of cases of malaria in the United States has remained stable over the years with low transmission rates, and the disease is mostly seen in the population with a recent travel history to endemic regions. The main reason behind this besides the weather conditions is that economically developed countries have eliminated mosquitos. However, there have been reports of locally reported cases with Plasmodium vivax in areas such as Florida and Texas in patients with no known travel history. This paper aims to familiarize US physicians with the pathophysiology, clinical features, and diagnostic modalities of malaria, as well as available treatment options.
Collapse
Affiliation(s)
- Vasu Bansal
- Internal Medicine, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Jaskaran Munjal
- Internal Medicine, Shri Ram Murti Smarak Institute of Medical Sciences, Bareilly, Uttar Pradesh, India
| | | | - Vasu Gupta
- Department of Internal Medicine, Cleveland Clinic Akron General, Akron, OhioUSA
| | - Ashwani Garg
- Penn State Milton S. Hershey Medical Center, Hershey, PennsylvaniaUSA
| | | | - Rohit Jain
- Penn State Milton S. Hershey Medical Center, Hershey, PennsylvaniaUSA
| |
Collapse
|
4
|
Bhattacharjee S, Ghosh D, Saha R, Sarkar R, Kumar S, Khokhar M, Pandey RK. Mechanism of Immune Evasion in Mosquito-Borne Diseases. Pathogens 2023; 12:pathogens12050635. [PMID: 37242305 DOI: 10.3390/pathogens12050635] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 04/20/2023] [Accepted: 04/21/2023] [Indexed: 05/28/2023] Open
Abstract
In recent decades, mosquito-borne illnesses have emerged as a major health burden in many tropical regions. These diseases, such as malaria, dengue fever, chikungunya, yellow fever, Zika virus infection, Rift Valley fever, Japanese encephalitis, and West Nile virus infection, are transmitted through the bite of infected mosquitoes. These pathogens have been shown to interfere with the host's immune system through adaptive and innate immune mechanisms, as well as the human circulatory system. Crucial immune checkpoints such as antigen presentation, T cell activation, differentiation, and proinflammatory response play a vital role in the host cell's response to pathogenic infection. Furthermore, these immune evasions have the potential to stimulate the human immune system, resulting in other associated non-communicable diseases. This review aims to advance our understanding of mosquito-borne diseases and the immune evasion mechanisms by associated pathogens. Moreover, it highlights the adverse outcomes of mosquito-borne disease.
Collapse
Affiliation(s)
| | - Debanjan Ghosh
- Department of Biotechnology, Pondicherry University, Puducherry 605014, India
| | - Rounak Saha
- Department of Biochemistry and Molecular Biology, Pondicherry University, Puducherry 605014, India
| | - Rima Sarkar
- DBT Rajiv Gandhi Centre for Biotechnology, Thiruvananthapuram 695014, India
| | - Saurav Kumar
- DBT Rajiv Gandhi Centre for Biotechnology, Thiruvananthapuram 695014, India
| | - Manoj Khokhar
- Department of Biochemistry, AIIMS, Jodhpur 342005, India
| | - Rajan Kumar Pandey
- Department of Medical Biochemistry and Biophysics, Karolinska Institute, 171 77 Solna, Sweden
| |
Collapse
|
5
|
Brainin P, Gomes LC, Holm AE, Matos LO, Wegener A, Lima KO, Kaagaard MD, Vieira IVM, de Souza RM, Olsen FJ, Marinho CRF, Biering-Sørensen T, Silvestre OM. Left ventricular function by strain in uncomplicated malaria: a prospective study from the Brazilian Amazon. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2023; 39:595-606. [PMID: 36460878 DOI: 10.1007/s10554-022-02763-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 11/19/2022] [Indexed: 12/04/2022]
Abstract
We hypothesized that adults with uncomplicated malaria have lower left ventricular contractile function compared to the general population and that this improves after antimalarial treatment. We examined uncomplicated malaria and the general population from the Western part of the Brazilian Amazon Basin. All persons underwent an echocardiographic examination and peripheral blood smears. Left ventricular function was assessed by speckle tracking analysis of global longitudinal strain (GLS). Logistic regression models were used to assess the association between malaria status (yes/no) and GLS and improvement in GLS by follow-up was assessed using a paired T-test. We enrolled 99 adults with uncomplicated malaria (mean age 40 years, 46% female) of whom 75 had Plasmodium vivax, 22 Plasmodium falciparum and two had both species [median 1595 (528 to 6585) parasites/mm3]. Seventy adults completed a follow-up examination after standard malaria treatment (median 31 days). We examined 486 from the general population (mean age 41 years, 63% female). In persons with malaria at baseline, GLS was lower compared to the general population (18.7% vs. 19.4%, P = 0.002) and GLS improved at follow-up (19.2%, P = 0.032). In multivariable models adjusted for clinical, socioeconomic and echocardiographic confounders, baseline GLS remained significantly associated with malaria status [odds ratio 2.45 (95%CI 1.00 to 7.25), P = 0.023 per 1% increase]. Parasite density was associated with worsening in GLS [+ 16% (+ 0% to + 34%), P = 0.047 per 1 unit increase in GLS]. Adults with uncomplicated malaria had lower GLS compared to the general population and this improved after completed antimalarial treatment. Our results suggest that malaria infection may affect left ventricular contractile function, however, further studies are needed to fully elucidate such a relationship.
Collapse
Affiliation(s)
- Philip Brainin
- Multidisciplinary Center, Federal University of Acre, Câmpus Floresta, Cruzeiro do Sul, Acre, Brazil. .,Department of Cardiology, Herlev-Gentofte University Hospital, Hospitalsvej 8, post 835, 2900, Hellerup, Denmark.
| | - Laura Cordeiro Gomes
- Department of Parasitology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Anna E Holm
- Multidisciplinary Center, Federal University of Acre, Câmpus Floresta, Cruzeiro do Sul, Acre, Brazil.,Department of Cardiology, Herlev-Gentofte University Hospital, Hospitalsvej 8, post 835, 2900, Hellerup, Denmark
| | - Luan O Matos
- Multidisciplinary Center, Federal University of Acre, Câmpus Floresta, Cruzeiro do Sul, Acre, Brazil
| | - Alma Wegener
- Multidisciplinary Center, Federal University of Acre, Câmpus Floresta, Cruzeiro do Sul, Acre, Brazil.,Department of Cardiology, Herlev-Gentofte University Hospital, Hospitalsvej 8, post 835, 2900, Hellerup, Denmark
| | - Karine O Lima
- Multidisciplinary Center, Federal University of Acre, Câmpus Floresta, Cruzeiro do Sul, Acre, Brazil
| | - Molly D Kaagaard
- Multidisciplinary Center, Federal University of Acre, Câmpus Floresta, Cruzeiro do Sul, Acre, Brazil.,Department of Cardiology, Herlev-Gentofte University Hospital, Hospitalsvej 8, post 835, 2900, Hellerup, Denmark
| | - Isabelle V M Vieira
- Multidisciplinary Center, Federal University of Acre, Câmpus Floresta, Cruzeiro do Sul, Acre, Brazil
| | - Rodrigo Medeiros de Souza
- Multidisciplinary Center, Federal University of Acre, Câmpus Floresta, Cruzeiro do Sul, Acre, Brazil
| | - Flemming Javier Olsen
- Department of Cardiology, Herlev-Gentofte University Hospital, Hospitalsvej 8, post 835, 2900, Hellerup, Denmark
| | | | - Tor Biering-Sørensen
- Department of Cardiology, Herlev-Gentofte University Hospital, Hospitalsvej 8, post 835, 2900, Hellerup, Denmark.,Faculty of Biomedical Sciences, Copenhagen University, Copenhagen, Denmark
| | - Odilson M Silvestre
- Health and Sport Science Center, Federal University of Acre, Rio Branco, Acre, Brazil
| |
Collapse
|
6
|
Thomford NE, Anyanful A, Ateko RO, Blackhurst D, Biney RP, Boadi D, Nyarko SB, Ekor M, Kyei GB. Apolipoprotein E genetic variation, atherogenic index and cardiovascular disease risk assessment in an African population: An analysis of HIV and malaria patients in Ghana. PLoS One 2023; 18:e0284697. [PMID: 37134097 PMCID: PMC10155972 DOI: 10.1371/journal.pone.0284697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 04/05/2023] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND Apolipoprotein E is involved in lipid transport and clearance of lipoprotein through low-density lipoprotein receptors (LDLR). ApoE variation has been linked to cardiovascular disease (CVD) risk. There are 3 isoforms of ApoE which originate from two non-synonymous single nucleotide polymorphisms denoted as ε2, ε3 and ε4. The ε2 isoform is implicated in higher levels of atherogenic lipoprotein with the ε4 isoform causing LDLR downregulation. This leads to variable effects and differential CVD risk. Malaria and HIV are life-threatening diseases affecting several countries globally especially in sub-Saharan Africa. Parasite and viral activities have been implicated in lipid dysregulation leading to dyslipidaemia. This study examined ApoE variation and CVD risk assessment in malaria and HIV patients. METHODS We compared 76 malaria-only, 33 malaria-HIV coinfected, 21-HIV-only and 31 controls from a tertiary health facility in Ghana. Fasting venous blood samples were taken for ApoE genotyping and lipid measurements. Clinical and laboratory data were collected with ApoE genotyping performed using Iplex Gold microarray and PCR-RFLP. Cardiovascular disease risk was calculated using the Framingham BMI and cholesterol risk and Qrisk3 tools. RESULTS The frequency of C/C genotype for rs429358 was 9.32%, whiles T/T genotype for rs7412 was found in 2.48% of all participants. ε3/ε3 was the most distributed ApoE genotype accounting for 51.55% of the total participants whiles ε2/ε2 was found in 2.48% of participants, with 1 in malaria-only and 3 in HIV-only patients. There was a significant association between ε4+ and high TG (OR = 0.20, CI; 0.05-0.73; p = 0.015), whiles ε2+ was significantly associated with higher BMI (OR; 0.24, CI; 0.06-0.87; p = 0.030) and higher Castelli Risk Index II in females (OR = 11.26, CI; 1.37-92.30; p = 0.024). A higher proportion of malaria-only participants had a moderate to high 10-year CVD risk. CONCLUSION Overall malaria patients seem to have a higher CVD risk though the means through which this occurs may be poorly understood. ε2/ε2 genotypes was observed in our population at a lower frequency. Further studies are vital to determine CVD risk in malaria and how this occurs.
Collapse
Affiliation(s)
- Nicholas Ekow Thomford
- Department of Medical Biochemistry, Pharmacogenomics and Genomic Medicine Group, School of Medical Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
- Division of Human Genetics, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Akwasi Anyanful
- Division of Human Genetics, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Richmond Owusu Ateko
- Department of Chemical Pathology, University of Ghana Medical School University of Ghana, Legon, Accra, Ghana
- Division of Chemical Pathology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Dee Blackhurst
- Division of Chemical Pathology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Robert Peter Biney
- Department of Pharmacology, School of Medical Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Dennis Boadi
- Division of Human Genetics, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Samuel Badu Nyarko
- Department of Medical Biochemistry, Pharmacogenomics and Genomic Medicine Group, School of Medical Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Martins Ekor
- Department of Pharmacology, School of Medical Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
| | - George Boateng Kyei
- Department of Virology, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
- Department of Medicine, Washington University School of Medicine, St. Louis, MO, United States of America
| |
Collapse
|
7
|
Tropical diseases and risk of hypertension in the Amazon Basin: a cross-sectional study. J Hum Hypertens 2022; 36:1121-1127. [PMID: 34775497 DOI: 10.1038/s41371-021-00633-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 10/23/2021] [Accepted: 10/29/2021] [Indexed: 12/14/2022]
Abstract
Although infectious diseases have been associated with cardiovascular conditions, little is known about tropical disease burden and hypertension. We hypothesized that a history of tropical infections was associated with hypertension. We examined participants from outpatient clinics in the Amazon Basin who were interviewed about prior exposure to tropical diseases, including dengue, malaria hospitalization, and leishmaniasis. Hypertension was defined as a prior physician diagnosis of hypertension, treatment with anti-hypertensive medication, or a systolic blood pressure ≥140 mmHg and/or a diastolic blood pressure ≥90 mmHg. We used logistic regression models to examine the relationship between tropical infectious disease and hypertension. We included 556 participants (mean age 41 ± 15 years, 61% women) of whom 214 (38%) had hypertension and 354 (64%) had a history of tropical infectious disease. The distribution of tropical diseases was: dengue 270 (76%), malaria hospitalization 104 (29%) and leishmaniasis 48 (14%). Any prior tropical infection was significantly associated with prevalent hypertension (odds ratio 1.76 [95% CI 1.22-2.54], P = 0.003) and the association remained significant after adjusting for age, sex, body mass index, diabetes, hypercholesterolemia, socioeconomic status, smoking, vegetable intake and serum creatinine. Persons with a history of ≥2 tropical infections (n = 64) had the greatest risk of hypertension (odds ratio 2.04 [95% CI 1.15-3.63], P = 0.015). In adjusted models, prior infection with dengue was associated with hypertension (P = 0.006), but no associations were found with malaria hospitalization (P = 0.39) or leishmaniasis (P = 0.98). In conclusion, a history of tropical infectious disease was associated with hypertension. This finding supports the idea that pathogen burden may be related to cardiovascular conditions.
Collapse
|
8
|
Langdon A, Abdlaziz I, Rhodes K, Clarke J. Case of myocarditis secondary to severe Plasmodium falciparum infection. BMJ Case Rep 2022; 15:e249363. [PMID: 36423944 PMCID: PMC9693649 DOI: 10.1136/bcr-2022-249363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Malaria remains one of the most prevalent infectious diseases globally. Despite targets set out by the WHO in 2015, there has been a rise in the number of cases since 2019 as an indirect effect of the COVID-19 pandemic.Cardiac complications are very rarely witnessed with severe malaria. Of the cardiac sequelae, myocarditis is one of the most frequently observed with a handful of case reports in the literature. We report a case of a man in his 50s who developed myocarditis while being managed for severe Plasmodium falciparum malaria in an intensive care unit in the UK and review the literature relevant to this case. This is the second reported case of this condition in the UK.
Collapse
Affiliation(s)
- Angharad Langdon
- Department of Anaesthetics and Intensive Care Medicine, Lewisham and Greenwich NHS Trust, London, UK
| | - Ihab Abdlaziz
- Department of Anaesthetics and Intensive Care Medicine, Lewisham and Greenwich NHS Trust, London, UK
| | - Kim Rhodes
- Department of Anaesthetics and Intensive Care Medicine, Lewisham and Greenwich NHS Trust, London, UK
| | - Jayson Clarke
- Department of Anaesthetics and Intensive Care Medicine, Lewisham and Greenwich NHS Trust, London, UK
| |
Collapse
|
9
|
Vidusa L, Kalejs O, Maca-Kaleja A, Strumfa I. Role of Endomyocardial Biopsy in Diagnostics of Myocarditis. Diagnostics (Basel) 2022; 12:diagnostics12092104. [PMID: 36140505 PMCID: PMC9497694 DOI: 10.3390/diagnostics12092104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 07/29/2022] [Accepted: 08/25/2022] [Indexed: 11/19/2022] Open
Abstract
Endomyocardial biopsy as the cornerstone of diagnostics has been re-evaluated throughout the years, leaving unanswered questions on the precedence of it. The reported incidence of myocarditis has increased during the pandemic of coronavirus disease 2019 (COVID-19), reinforcing discussions on appropriate diagnostics of myocarditis. By analysis of evidence-based literature published within the last demi-decade, we aimed to summarize the most recent information in order to evaluate the current role of endomyocardial biopsy in diagnostics and management of myocarditis. For the most part, research published over the last five years showed ongoing uncertainty regarding the use, informativeness, safety and necessity of performing a biopsy. Special circumstances, such as fulminant clinical course or failure to respond to empirical treatment, were reconfirmed as justified indications, with a growing applicability of non-invasive diagnostic approaches for most other cases. We concluded that endomyocardial biopsy, if performed properly and with adjunct diagnostic methods, holds a critical role for treatment correction in specific histological subtypes of myocarditis and for differential diagnosis between immune-mediated myocarditis and secondary infections due to immunosuppressive treatment. A high level of possible misdiagnosing was detected, indicating the need to review terminology used to describe findings of myocardial inflammation that did not meet Dallas criteria.
Collapse
Affiliation(s)
- Liga Vidusa
- Department of Pathology, Riga Stradins University, 16 Dzirciema Street, LV-1007 Riga, Latvia
| | - Oskars Kalejs
- Department of Internal Medicine, Riga Stradins University, 16 Dzirciema Street, LV-1007 Riga, Latvia
- Latvian Centre of Cardiology, Pauls Stradins Clinical University Hospital, 13 Pilsonu Street, LV-1002 Riga, Latvia
| | - Aija Maca-Kaleja
- Department of Internal Medicine, Riga Stradins University, 16 Dzirciema Street, LV-1007 Riga, Latvia
- Latvian Centre of Cardiology, Pauls Stradins Clinical University Hospital, 13 Pilsonu Street, LV-1002 Riga, Latvia
| | - Ilze Strumfa
- Department of Pathology, Riga Stradins University, 16 Dzirciema Street, LV-1007 Riga, Latvia
- Correspondence:
| |
Collapse
|
10
|
Namazzi R, Opoka R, Datta D, Bangirana P, Batte A, Berrens Z, Goings MJ, Schwaderer AL, Conroy AL, John CC. Acute Kidney Injury Interacts With Coma, Acidosis, and Impaired Perfusion to Significantly Increase Risk of Death in Children With Severe Malaria. Clin Infect Dis 2022; 75:1511-1519. [PMID: 35349633 PMCID: PMC9617576 DOI: 10.1093/cid/ciac229] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Mortality in severe malaria remains high in children treated with intravenous artesunate. Acute kidney injury (AKI) is a common complication of severe malaria, but the interactions between AKI and other complications on the risk of mortality in severe malaria are not well characterized. METHODS Between 2014 and 2017, 600 children aged 6-48 months to 4 years hospitalized with severe malaria were enrolled in a prospective clinical cohort study evaluating clinical predictors of mortality in children with severe malaria. RESULTS The mean age of children in this cohort was 2.1 years (standard deviation, 0.9 years) and 338 children (56.3%) were male. Mortality was 7.3%, and 52.3% of deaths occurred within 12 hours of admission. Coma, acidosis, impaired perfusion, AKI, elevated blood urea nitrogen (BUN), and hyperkalemia were associated with increased mortality (all P < .001). AKI interacted with each risk factor to increase mortality (P < .001 for interaction). Children with clinical indications for dialysis (14.4% of all children) had an increased risk of death compared with those with no indications for dialysis (odds ratio, 6.56; 95% confidence interval, 3.41-12.59). CONCLUSIONS AKI interacts with coma, acidosis, or impaired perfusion to significantly increase the risk of death in severe malaria. Among children with AKI, those who have hyperkalemia or elevated BUN have a higher risk of death. A better understanding of the causes of these complications of severe malaria, and development and implementation of measures to prevent and treat them, such as dialysis, are needed to reduce mortality in severe malaria.
Collapse
Affiliation(s)
- Ruth Namazzi
- Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda,Global Health Uganda, Kampala, Uganda
| | - Robert Opoka
- Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda,Global Health Uganda, Kampala, Uganda
| | - Dibyadyuti Datta
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Paul Bangirana
- Global Health Uganda, Kampala, Uganda,Department of Psychiatry, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Anthony Batte
- Child Development Centre, Makerere University, Kampala, Uganda
| | - Zachary Berrens
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Michael J Goings
- Indiana University Center for Global Health, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Andrew L Schwaderer
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Andrea L Conroy
- Correspondence: A. L. Conroy, Department of Pediatrics, Indiana University School of Medicine, 1044 W Walnut St, Indianapolis, IN 46202 ()
| | | |
Collapse
|
11
|
Kaagaard MD, Matos LO, Holm AE, Gomes LC, Wegener A, Lima KO, Vieira IV, de Souza RM, Marinho CRF, Hviid L, Vestergaard LS, Dominguez H, Biering-Sørensen T, Silvestre OM, Brainin P. Frequency of Electrocardiographic Alterations and Pericardial Effusion in Patients With Uncomplicated Malaria. Am J Cardiol 2022; 165:116-123. [PMID: 34906368 DOI: 10.1016/j.amjcard.2021.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 11/01/2021] [Accepted: 11/05/2021] [Indexed: 11/25/2022]
Abstract
Studies have proposed that malaria may lead to electrocardiographic (ECG) changes and pericardial inflammation. We aimed to investigate the frequency of ECG alterations, determined by ECG and Holter monitoring, and pericardial effusion in patients with malaria infection. We performed a prospective observational study of adult patients with uncomplicated malaria in Amazonas, Brazil. Peripheral blood smears, ECG, and bedside echocardiography were conducted before antimalarial treatment and repeated at follow-up after completed treatment. We evaluated the diagnostic value of PR-segment depression, PR-segment elevation, and Spodick's sign for detecting pericardial effusion. A subset of patients underwent Holter monitoring at baseline. Among 98 cases of uncomplicated malaria (55% men; mean age 40 years; median parasite density 1,774/µl), 75 had Plasmodium vivax, 22 Plasmodium falciparum, and 1 had mixed infection. At baseline, 17% (n = 17) had PR-segment depression, 12% (n = 12) PR-segment elevation, 3% (n = 2) Spodick's sign, and the prevalence of pericardial effusion was 9% (n = 9). ECG alterations had sensitivities of 22% to 89% and specificities of 88% to 100% for detecting pericardial effusion at baseline. PR-segment depression had the best accuracy (sensitivity 89%, specificity 90%). Of the 25 patients, 4 patients who did not have pericardial effusion, displayed nonsustained ventricular tachycardia, determined by Holter monitoring (median duration 43 hours). Follow-up examination data were obtained for 71 patients (median 31 days), for whom PR-segment depression, elevation, and pericardial effusion had reduced significantly (p <0.05). In conclusion, our findings suggest that ECG alterations may be useful to detect pericardial effusion in malaria and that these findings decrease after completed antimalarial treatment.
Collapse
|
12
|
Brainin P, Mohr GH, Modin D, Claggett B, Silvestre OM, Shah A, Vestergaard LS, Jensen JUS, Hviid L, Torp‐Pedersen C, Køber L, Solomon S, Schou M, Gislason GH, Biering‐Sørensen T. Heart failure associated with imported malaria: a nationwide Danish cohort study. ESC Heart Fail 2021; 8:3521-3529. [PMID: 34313024 PMCID: PMC8497340 DOI: 10.1002/ehf2.13441] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 04/18/2021] [Accepted: 05/12/2021] [Indexed: 11/29/2022] Open
Abstract
AIMS Despite adequate treatment, recent studies have hypothesized that malaria may affect long-term cardiovascular function. We aimed to investigate the long-term risk of cardiovascular events and death in individuals with a history of imported malaria in Denmark. METHODS Using nationwide Danish registries, we followed individuals with a history of malaria for the risk of incident heart failure (HF), myocardial infarction (MI), cardiovascular death and all-cause death (1 January 1994 to 1 January 2017). The population was age- and sex-matched with individuals without a history of malaria from the Danish population (ratio 1:9). We excluded patients with known HF and ischaemic heart disease at inclusion. RESULTS We identified 3912 cases with a history of malaria (mean age 33 ± 17 years, 57% male, 41% Plasmodium falciparum infections). The median follow-up was 9.8 years (interquartile range 3.9-16.4 years). Event rates per 1000 person-years for individuals with a history vs. no history of malaria were HF: 1.84 vs. 1.32; MI: 1.28 vs. 1.30; cardiovascular death: 1.40 vs. 1.77; and all-cause death: 5.04 vs. 5.28. In Cox proportional hazards models adjusted for cardiovascular risk factors, concomitant pharmacotherapy, region of origin, household income and educational level, malaria was associated with HF (HR: 1.59 [1.21-2.09], P = 0.001), but not MI (HR: 1.00 [0.72-1.39], P = 1.00), cardiovascular death (HR: 1.00 [0.74-1.35], P = 0.98) or all-cause death (HR 1.11 [0.94-1.30], P = 0.21). Specifically, P. falciparum infection was associated with increased risk of HF (HR: 1.64 [1.14-2.36], P = 0.008). CONCLUSION Individuals with a history of imported malaria, specifically P. falciparum, may have an increased risk of incident HF.
Collapse
Affiliation(s)
- Philip Brainin
- Department of CardiologyHerlev and Gentofte HospitalHerlevDenmark
- Department of CardiologyFederal University of Acre, Câmpus FlorestaCruzeiro do SulBrazil
| | - Grimur Høgnason Mohr
- Department of CardiologyHerlev and Gentofte HospitalHerlevDenmark
- Centre for Neuropsychiatric Schizophrenia Research, CNSR, Mental Health Centre GlostrupUniversity of CopenhagenGlostrupMADenmark
| | - Daniel Modin
- Department of CardiologyHerlev and Gentofte HospitalHerlevDenmark
| | - Brian Claggett
- Division of Cardiovascular Medicine, Brigham and Women's HospitalHarvard Medical SchoolBostonMAUSA
| | - Odilson M. Silvestre
- Department of CardiologyFederal University of Acre, Câmpus FlorestaCruzeiro do SulBrazil
| | - Amil Shah
- Division of Cardiovascular Medicine, Brigham and Women's HospitalHarvard Medical SchoolBostonMAUSA
| | - Lasse S. Vestergaard
- National Malaria Reference Laboratory, Department of Bacteria, Parasites and FungiStatens Serum InstitutCopenhagenDenmark
| | - Jens Ulrik Stæhr Jensen
- Department of Internal Medicine, Respiratory Medicine SectionCopenhagen UniversityCopenhagenDenmark
- PERSIMUNE, Department of Infectious Diseases, RigshospitaletCopenhagen UniversityCopenhagenDenmark
- Department of Clinical MedicineUniversity of CopenhagenCopenhagenDenmark
| | - Lars Hviid
- Department of Immunology and MicrobiologyCopenhagen UniversityCopenhagenDenmark
- Department of Infectious Diseases, RigshospitaletCopenhagen UniversityCopenhagenDenmark
| | - Christian Torp‐Pedersen
- Department of Cardiology and Clinical ResearchNordsjaellands HospitalHillerødDenmark
- Department of CardiologyAalborg University HospitalAalborgDenmark
| | - Lars Køber
- Department of Clinical MedicineUniversity of CopenhagenCopenhagenDenmark
- Department of Cardiology, RigshospitaletCopenhagen UniversityCopenhagenDenmark
| | - Scott Solomon
- Division of Cardiovascular Medicine, Brigham and Women's HospitalHarvard Medical SchoolBostonMAUSA
| | - Morten Schou
- Department of CardiologyHerlev and Gentofte HospitalHerlevDenmark
- Department of Clinical MedicineUniversity of CopenhagenCopenhagenDenmark
| | - Gunnar H. Gislason
- Department of CardiologyHerlev and Gentofte HospitalHerlevDenmark
- Department of Clinical MedicineUniversity of CopenhagenCopenhagenDenmark
- The Danish Heart FoundationCopenhagenDenmark
| | - Tor Biering‐Sørensen
- Department of CardiologyHerlev and Gentofte HospitalHerlevDenmark
- Department of Biomedical SciencesCopenhagen UniversityCopenhagenDenmark
| |
Collapse
|
13
|
Wegener A, Lima KO, Holm AE, Gomes LC, Matos LO, Vieira IVM, Souza RM, Marinho CRF, Vestergaard LS, Biering-Sørensen T, Silvestre OM, Brainin P. Cardiopulmonary alterations by ultrasound in a patient with uncomplicated mixed malaria infection: a case report from the Amazon Basin. Malar J 2021; 20:330. [PMID: 34321001 PMCID: PMC8316880 DOI: 10.1186/s12936-021-03861-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 07/20/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Information on cardiopulmonary complications in clinical malaria is sparse and diagnosis may be difficult in resource-limited areas due to lack of proper diagnostic tools and access to medical care. A case of pericardial effusion and pulmonary alterations assessed by ultrasound in a patient with uncomplicated mixed malaria infection is described. CASE PRESENTATION A previously healthy 23-year-old male from the Amazon Basin was diagnosed with mixed infection of Plasmodium vivax and Plasmodium falciparum by peripheral blood smear. The patient presented with mild malaria symptoms without signs of severe malaria, but reported moderate chest pain and shortness of breath. Laboratory analyses revealed thrombocytopenia and anemia. The electrocardiogram had PR depressions and bedside ultrasound of the cardiopulmonary system showed pericardial effusion (18 mm) accompanied by multiple B-lines in the lungs, identified as vertical artifacts extending from the pleural line. Cardiac biomarkers were normal. The patient was treated according to national guidelines for malaria and suspected pericarditis, respectively. At follow-up on day 5, the pericardial effusion (9mm) and B-lines had markedly decreased. By day 21 the patient was asymptomatic, had completed the treatment, and the electrocardiogram and ultrasound findings had normalized. CONCLUSIONS This case report highlight the usefulness of bedside ultrasound to identify cardiopulmonary involvement in patients with uncomplicated malaria and relevant symptoms.
Collapse
Affiliation(s)
- Alma Wegener
- Multidisciplinary Centre, Federal University of Acre, Câmpus Floresta, Cruzeiro do Sul, Acre, Brazil. .,Department of Cardiology, Herlev and Gentofte Hospital, Cardiovascular Non-Invasive Imaging Research Laboratory, University of Copenhagen, Hospitalsvej 8, Post 835, 2900, Copenhagen, Denmark.
| | - Karine O Lima
- Multidisciplinary Centre, Federal University of Acre, Câmpus Floresta, Cruzeiro do Sul, Acre, Brazil
| | - Anna E Holm
- Multidisciplinary Centre, Federal University of Acre, Câmpus Floresta, Cruzeiro do Sul, Acre, Brazil.,Department of Cardiology, Herlev and Gentofte Hospital, Cardiovascular Non-Invasive Imaging Research Laboratory, University of Copenhagen, Hospitalsvej 8, Post 835, 2900, Copenhagen, Denmark
| | - Laura C Gomes
- Department of Parasitology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Luan O Matos
- Multidisciplinary Centre, Federal University of Acre, Câmpus Floresta, Cruzeiro do Sul, Acre, Brazil
| | - Isabelle V M Vieira
- Multidisciplinary Centre, Federal University of Acre, Câmpus Floresta, Cruzeiro do Sul, Acre, Brazil
| | - Rodrigo Medeiros Souza
- Multidisciplinary Centre, Federal University of Acre, Câmpus Floresta, Cruzeiro do Sul, Acre, Brazil
| | | | - Lasse S Vestergaard
- National Malaria Reference Laboratory, Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark
| | - Tor Biering-Sørensen
- Department of Cardiology, Herlev and Gentofte Hospital, Cardiovascular Non-Invasive Imaging Research Laboratory, University of Copenhagen, Hospitalsvej 8, Post 835, 2900, Copenhagen, Denmark.,Faculty of Biomedical Sciences, Copenhagen University, Copenhagen, Denmark
| | - Odilson M Silvestre
- Health and Sport Science Center, Federal University of Acre, Rio Branco, Acre, Brazil
| | - Philip Brainin
- Multidisciplinary Centre, Federal University of Acre, Câmpus Floresta, Cruzeiro do Sul, Acre, Brazil.,Department of Cardiology, Herlev and Gentofte Hospital, Cardiovascular Non-Invasive Imaging Research Laboratory, University of Copenhagen, Hospitalsvej 8, Post 835, 2900, Copenhagen, Denmark
| |
Collapse
|