Signos de peligro en el paciente con malaria

Clinical features and haematological parameters among malaria patients in Mangaluru city area in the southwestern coastal region of India

The aim of this study was to assess the clinical profile, severity and complications of patients suffering from malaria in Mangaluru, a southwestern coastal city in India. A total of 579 patients, who were treated at the District Wenlock Hospital, Mangaluru, and 168 healthy controls were recruited in this study. The clinical profile, haematological and biochemical parameters, and disease complications were assessed. The majority of patients were treated as outpatients and patients who had severe clinical conditions were admitted to the hospital for treatment and supportive care. Among the total 579 patients recruited in this study, the distribution of P. vivax, P. falciparum and mixed infections were 364 (62.9%), 150 (25.9%) and 65 (11.2%), respectively. Among these, 506 (87.4%) had mild malaria, whereas 73 (12.6%) had severe malaria. Overall, the clinical features and severity of malaria in P. vivax and mixed infection patients were comparable to P. falciparum patients, albeit with some significant differences. The clinical complications in severe malaria cases included thrombocytopenia (50.7%), metabolic acidosis (30.1%), severe anaemia (26.0%), jaundice (21.9%), hepatic dysfunction (15.1%), acute renal failure (6.8%), haematuria (8.2%), hypotension (9.6%), cerebral malaria (1.4%) and acute respiratory distress syndrome (1.4%). All the patients with severe malaria recruited in our study were successfully treated and discharged. Majority of patients had mild malaria, likely due to seeking treatment soon after experiencing symptoms and/or having preexisting immune protection. However, a significant number of patients had severe malaria and required hospital admission indicating that there is a substantial need for creating awareness among vulnerable immigrant population. Implementing effective surveillance and vector control measures in malaria hotspot locations in the city and educating people about preventive measures are likely to reduce the malaria burden in this endemic region.

Severe malaria in pregnant women hospitalized between 2010 and 2014 in the Department of Antioquia (Colombia)

Introduction: Malaria during pregnancy has a negative impact on maternal-neonatal health, with a high risk of clinic complications and mortality. High endemic areas are specially characterized by maternal anaemia and low birth weight. The clinical spectrum is little known in low endemic areas. Objective: To clinically and epidemiologically characterize malaria episodes in hospitalized pregnant women in the Department of Antioquia (Colombia) in the period 2010-2014. Materials and methods: Retrospective, cross-sectional, descriptive study with medical records of pregnant women with P. falciparum and P. vivax malaria. The WHO severe malaria diagnostic criteria and the Colombian Guía para la atención clínica integral del paciente con malaria (guidelines for comprehensive malaria treatment) were used. Results: We analyzed 111 cases, out of which 13.5% were classified as severe malaria according to the WHO criteria. Following the Colombian Guidelines, the proportion increased to 23.4%. Identified complications included hepatic dysfunction, anaemia, acidosis, and severe thrombocytopenia. No difference in the frequency of complications by Plasmodium species was observed; 39.4% of the cases presented general danger signs, pallor and jaundice being the most frequent; 40.5% showed danger signs for pregnancy, such as persistent headache, abdominal pain, and vaginal bleeding. Conclusions: Severe malaria is a highly frequent event in pregnant women, without differences by Plasmodium species. It shows early recognizable dangers signs. Hospital under-reporting was identified in 88% of severe cases as well as a lack of laboratory tests for a more comprehensive diagnosis. A protocol for the clinical diagnosis of pregnant women with malaria is required.

[Complicated Malaria in Chocó: clinical findings and data comparison with the monitoring system]

OBJECTIVES

To describe the epidemiological and clinical cases of complicated malaria and to establish the concordance of this information in the surveillance system.

METHODOLOGY

Information was obtained from medical records of cases reported in 2011 in the surveillance system and the Hospital San Francisco. We selected a clinical sample of 62 stories of 113 cases and health professionals reviewed the information. The presence of positive thick drop with one or more criteria of complication was taken into account to define if the clinical history corresponded to complicated malaria, according to guide national clinic and tab of the surveillance system. Statistical significance was determined with Chi square and the Kappa statistic.

RESULTS

The 37.0% of cases presented a complication, 63.0% had two or more complications. Major complications were thrombocytopenia and severe anemia, followed by hepatic complication, hiperparasitemia, renal insufficiency and cerebral malaria. In 3 of the 54 cases intravenous artesunate was used, quinine was used in 59.2%. Comparison of demographic variables and parasitic species between history and the surveillance system show no significant difference but type of complication was almost nil. The major reported complications do not appear on the notification tab.

DISCUSSION

Further studies need to be continued in order to contribute to the clinical characterization of malaria in the Department and Management interventions. Adjustments to format are recommended to strengthen analysis and decision-making.

Urinalysis and Clinical Correlations in Patients with P. vivax or P. falciparum Malaria from Colombia

BACKGROUND

Urinalysis is a poorly reviewed diagnostic tool in malaria patients; its application can show the presence of severe malaria.

METHODS

Urinalysis was performed in a total of 620 patients diagnosed with malaria by thick blood smear; complications were classified according to WHO major criteria for severity and minor criteria according to the Colombian malaria guideline.

RESULTS

Severe or moderate clinical complications were diagnosed in 31.1% of patients, hepatic dysfunctions were diagnosed in 25.8%, anemia was diagnosed in 9.8%, thrombocytopenia was diagnosed in 7.7%, renal dysfunction was diagnosed in 4.8%, neurological and pulmonary complications were diagnosed in 2.1% and 2.4%, hypoglycemia was diagnosed in 1.1% of patients with blood glucose analysis, and acidosis was diagnosed in 10 of 25. Bilirubinuria was found in 24.3%, associated with urobilinuria, proteinuria, and increased specific gravity; urobilinuria was found in 30.6% associated with elevated serum bilirubin and alanine aminotransferase; 39.2% had proteinuria, associated with higher blood urea nitrogen, serum bilirubin, aspartate, alanine-transaminase, hematuria, and increased specific gravity. Severe or moderate liver and renal complications were associated with proteinuria and bilirubinuria. Urobilinuria was associated with thrombocytopenia and neurological and hepatic dysfunction. Ketonuria was associated with neurological dysfunctions.

CONCLUSIONS

The most frequent alterations in the urinalysis were bilirubinuria, proteinuria, urobilinuria, and increased specific gravity, related to thrombocytopenia and liver, kidney, and neurological alterations.

Factors associated with the severity and complication of patients with malaria hospitalized between 2009 and 2013 in three municipalities of Colombia, case control study

Background

Malaria worldwide annual reported cases range between 250 and 500 million and nearly half a million deaths are reported every year. Colombia has a vast expanse of territory with environmental and social conditions conducive to malaria transmission, which is the reason why it has second place in Latin America for the number of cases of malaria.

Methods

This is a retrospective, paired, case–control study that compares patients with severe malaria and malaria patients without mention of complication. Medical records of patients with confirmed malaria diagnosis were reviewed. The objective of this study was to identify factors associated with complicated malaria in three municipalities of Colombia during the period 2009–2013.

Results

A total sample of 180 medical records was collected, 60 corresponding to cases and 120 to controls following a 1:2 ratio. From the total sample, 88.33 % (159) of subjects were originally from Tumaco, 7.78 %, most of the patients of the study (104) were diagnosed and treated in 2013. Among the laboratory findings, the platelet count was found to have statistically significant differences between cases and controls; this was also true for total bilirubin value and transaminases. The most prevalent severity finding was clinical jaundice, followed by elevated bilirubin (25 %) and elevated transaminases (44.4 %). Thrombocytopenia was found in 11/44 cases (20 %) and only five of 60 patients (8.3 %) presented severe anaemia. The multivariate analysis showed that a platelet count <100,000 and clinical jaundice not associated with organ failure, were the two variables associated with severe malaria in the patients described.

Conclusions

Most of the cases studied, despite meeting criteria of severity, were shown not to be as morbid or severe as in other countries. Clinical jaundice and thrombocytopaenia are associated with severe malaria, and they can be used by general practitioners or primary care physicians to promptly identify patients who may have severe malaria.

Clinical profile of Plasmodium falciparum and Plasmodium vivax infections in low and unstable malaria transmission settings of Colombia

Background

Malaria transmission in Latin America is generally hypoendemic and unstable, with Plasmodium vivax as the most prevalent species. However, only a few studies have been carried out in areas with low and unstable transmission, whereas the clinical profile of malaria has been broadly described in hyperendemic areas. The pattern of clinical manifestations and laboratory findings in low to moderate endemic areas of Colombia is reported here.

Methods

A passive surveillance study was conducted between 2011 and 2013 involving 1,328 patients with Plasmodium falciparum, P. vivax or mixed malaria infections attending malaria points-of-care of four malaria endemic-areas with distinct transmission intensities and parasite distribution. Trained physicians recorded clinical symptoms and signs as well as socio-demographic characteristics of study participants. Haematological, biochemical and urine tests were performed at the time of diagnosis.

Results

Out of 1,328 cases, 673 (50.7%) were caused by P. vivax; 650 (48.9%) were due to P. falciparum; and five (0.4%) patients had mixed infections (P. falciparum/P. vivax). Most patients (92.5%) presented with uncomplicated malaria characterized by fever, chills, headache, sweating, myalgia/arthralgia and parasitaemia ≤ 20,000 parasites/μL. Fever, tachycardia, pallor and abdominal pain on palpation were more frequent in P. falciparum patients, whereas mild hepatomegaly and splenomegaly were mostly observed with P. vivax. Non-severe anaemia (Hb 7.0-10.9 g/dL) was observed in 20% of the subjects, whereas severe anaemia (Hb < 7.0 g/dL) was present in four patients. Half of the patients presented thrombocytopaenia regardless of parasite species. Leukopaenia, neutrophilia and monocytosis were frequently observed in patients infected with P. falciparum. Mild-to-moderate biochemical alterations were present in ~25% of the patients, particularly abnormal bilirubin in those with P. falciparum and abnormal transaminases in P. vivax malaria patients. Proteinuria was present in ~50% of the patients regardless of parasite species, whereas haemoglobinuria was more common in P. vivax infections. Only 7.5% of the cases were classified as clinically severe malaria, caused by both P. vivax and P. falciparum.

Conclusions

The high prevalence of uncomplicated malaria associated with moderate parasitaemia suggests the importance of timely diagnosis and effective treatment and encourages new activities to further decrease complicated malaria cases and mortality.

Maternal clinical findings in malaria in pregnancy in a region of northwestern Colombia

In malaria-endemic regions of Latin America, little is known about malaria in pregnancy. To characterize the clinical and laboratory findings of maternal infection, we evaluated 166 cases of pregnant women infected with Plasmodium spp. in a prospective study conducted in northwestern Colombia during 2005-2006. A total of 89.8% (149 of 166) had fever or a history of fever in the past 48 hours, 9.0% (15 of 166) had severe malaria, of which 66.7% was caused by Plasmodium vivax and 33.3% by P. falciparum. Hepatic dysfunction was the main complication (9 of 15) observed. The proportion of severe cases was similar for both species (P = 0.41). In malaria-endemic areas of Colombia, malaria in pregnancy has a broad clinical spectrum. In pregnant women, P. vivax infection frequently leads to organ-specific complications.

Prognostic value of clinical and parasitological signs for severe malaria in patients from Colombia

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.