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Velavan TP, Fleischmann WA, Kremsner PG. A severe case of Plasmodium falciparum malaria in a traveler returning from Kazakhstan, a malaria-free country. Int J Infect Dis 2024; 143:107026. [PMID: 38583823 DOI: 10.1016/j.ijid.2024.107026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 03/20/2024] [Accepted: 03/25/2024] [Indexed: 04/09/2024] Open
Abstract
Following a 2-week trip to Kazakhstan, a 42-year-old woman presented at the emergency department in Germany with fever, headache, nausea, and neurological symptoms. An infection with Plasmodium falciparum was rapidly diagnosed. The patient was immediately treated with intravenous artesunate and transferred to an intensive care unit. The initial parasite density was as high as 30% infected erythrocytes with 845,880 parasites/µL. Since Kazakhstan was declared malaria-free in 2012, molecular testing for Plasmodium has been initiated to identify a possible origin. Genotyping of the msp-1 gene and microsatellite markers showed that the parasites are of African origin, with two different alleles indicating a polyclonal infection. After a hospitalization of 10 days, the patient was discharged in good health. Overall, our results emphasize that malaria must be on the list of differential diagnoses for patients with fever of unknown origin, even if they come from countries where malaria does not commonly occur.
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Affiliation(s)
- Thirumalaisamy P Velavan
- Institute for Tropical Medicine, University of Tübingen, Tübingen, Germany; Vietnamese-German Center for Medical Research, VG-CARE, Hanoi, Vietnam; Faculty of Medicine, Duy Tan University, Da Nang, Vietnam.
| | - Wim A Fleischmann
- Institute for Tropical Medicine, University of Tübingen, Tübingen, Germany
| | - Peter G Kremsner
- Institute for Tropical Medicine, University of Tübingen, Tübingen, Germany; Centre de Recherches Médicales de Lambaréné, Lambarene, Gabon
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Recker M, Fleischmann WA, Nghia TH, Truong NV, Nam LV, Duc Anh D, Song LH, The NT, Anh CX, Hoang NV, My Truong N, Toan NL, Kremsner PG, Velavan TP. Markers of prolonged hospitalisation in severe dengue. PLoS Negl Trop Dis 2024; 18:e0011922. [PMID: 38289968 PMCID: PMC10857710 DOI: 10.1371/journal.pntd.0011922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 02/09/2024] [Accepted: 01/15/2024] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND Dengue is one of the most common diseases in the tropics and subtropics. Whilst mortality is a rare event when adequate supportive care can be provided, a large number of patients get hospitalised with dengue every year that places a heavy burden on local health systems. A better understanding of the support required at the time of hospitalisation is therefore of critical importance for healthcare planning, especially when resources are limited during major outbreaks. METHODS Here we performed a retrospective analysis of clinical data from over 1500 individuals hospitalised with dengue in Vietnam between 2017 and 2019. Using a broad panel of potential biomarkers, we sought to evaluate robust predictors of prolonged hospitalisation periods. RESULTS Our analyses revealed a lead-time bias, whereby early admission to hospital correlates with longer hospital stays - irrespective of disease severity. Importantly, taking into account the symptom duration prior to hospitalisation significantly affects observed associations between hospitalisation length and previously reported risk markers of prolonged stays, which themselves showed marked inter-annual variations. Once corrected for symptom duration, age, temperature at admission and elevated neutrophil-to-lymphocyte ratio were found predictive of longer hospitalisation periods. CONCLUSION This study demonstrates that the time since dengue symptom onset is one of the most significant predictors for the length of hospital stays, independent of the assigned severity score. Pre-hospital symptom durations need to be accounted for to evaluate clinically relevant biomarkers of dengue hospitalisation trajectories.
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Affiliation(s)
- Mario Recker
- Institute for Tropical Medicine, University Hospital Tübingen, Tübingen, Germany
- Centre for Ecology and Conservation, University of Exeter, Penryn Campus, Penryn, United Kingdom
| | - Wim A. Fleischmann
- Institute for Tropical Medicine, University Hospital Tübingen, Tübingen, Germany
| | - Trinh Huu Nghia
- 103 Military Hospital, Vietnam Military Medical University, Hanoi, Vietnam
| | - Nguyen Van Truong
- 103 Military Hospital, Vietnam Military Medical University, Hanoi, Vietnam
| | - Le Van Nam
- 103 Military Hospital, Vietnam Military Medical University, Hanoi, Vietnam
| | - Do Duc Anh
- Institute for Tropical Medicine, University Hospital Tübingen, Tübingen, Germany
- Vietnamese-German Center for Medical Research, VG-CARE, Hanoi, Vietnam
| | - Le Huu Song
- Vietnamese-German Center for Medical Research, VG-CARE, Hanoi, Vietnam
- 108 Military Central Hospital, Hanoi, Vietnam
| | - Nguyen Trong The
- Vietnamese-German Center for Medical Research, VG-CARE, Hanoi, Vietnam
- 108 Military Central Hospital, Hanoi, Vietnam
| | | | | | - Nhat My Truong
- Vietnamese-German Center for Medical Research, VG-CARE, Hanoi, Vietnam
- 108 Military Central Hospital, Hanoi, Vietnam
| | - Nguyen Linh Toan
- Vietnamese-German Center for Medical Research, VG-CARE, Hanoi, Vietnam
- Department of Pathophysiology, Vietnam Military Medical University, Hanoi, Vietnam
| | - Peter G. Kremsner
- Institute for Tropical Medicine, University Hospital Tübingen, Tübingen, Germany
- Centre de Recherches Médicales de Lambaréné (CERMEL), Gabon
| | - Thirumalaisamy P. Velavan
- Institute for Tropical Medicine, University Hospital Tübingen, Tübingen, Germany
- Vietnamese-German Center for Medical Research, VG-CARE, Hanoi, Vietnam
- Faculty of Medicine, Duy Tan University, Da Nang, Vietnam
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