scholarly journals Differential kinetics of plasma procalcitonin levels in cerebral malaria in urban Senegalese patients according to disease outcome

2011 ◽  
Vol 2 (1) ◽  
pp. 22 ◽  
Author(s):  
Babacar Mbengue ◽  
Bacary Diatta ◽  
Birahim Niang ◽  
Ngor Diagne ◽  
Mamadou Ndiaye ◽  
...  
Keyword(s):  
Cerebral Malaria ◽  
Severe Malaria ◽  
Fatal Outcome ◽  
Care Facility ◽  
Threshold Level ◽  
Serum Levels ◽  
Sub Saharan Africa ◽  
Serial Killer ◽  
Sub Saharan ◽  
Hôpital Principal

<em>P. falciparum</em> malaria continues as the serial killer of over a million lives yearly, mainly for children in sub-Saharan Africa. For severe malaria, we are still on the quest for a prognostic marker of fatal outcome. We analysed the association between serum levels of Procalcitonin (PCT), a marker of septic inflammation, and clinical outcome in Senegalese patients admitted with confirmed cerebral malaria in the intensive care facility of Hopital Principal. A total of 98 patients living in the hypoendemic urban area of Dakar, Senegal, were enrolled during transmission seasons. Levels of PCT were compared between surviving vs the 26.5 % fatal cases in blood samples of the 3 days following hospitalisation. Mean PCT levels were elevated in patients with active infection, with a large range of values (0.1 to 280 nanog per mL), significantly higher on day 0 in fatal cases than in surviving (53.6 vs 27.3; P=0.01). No exact individual threshold level could indicate occurrence of fatality, however mortality could be most accurately predicted by PCT level above 69 nanog per ML and there was a very clear different profile of evolution of PCT levels on the 3 days of observation decreasing early from day 1 in surviving patients (P&lt;10–3), contrary to fatal cases. These results indicate that PCT kinetic rather than intrinsic level could be of use to predict a reduced risk of fatality in patient with cerebral malaria and could serve as potential predicting marker for severe malaria.

scholarly journals Severe Case of Plasmodium falciparum Malaria in a Pregnant Woman from Nigeria

2019 ◽  
Vol 2019 ◽  
pp. 1-3
Author(s):  
Kruti Yagnik ◽  
Bilal Farooqi ◽  
Molly W. Mandernach ◽  
Anthony P. Cannella ◽  
Gautam Kalyatanda
Keyword(s):  
Pregnant Women ◽  
Severe Malaria ◽  
Plasmodium Falciparum Malaria ◽  
Severe Case ◽  
Pregnant Patient ◽  
Sub Saharan Africa ◽  
Blood Parasites ◽  
Intrauterine Pregnancy ◽  
Drug Of Choice ◽  
Sub Saharan

Human malaria has arguably affected more of human history than any other pathogen. Pregnant women have a higher risk of developing severe malaria as well as the risk of severe complications. We present a case of severe malaria in a pregnant patient from sub-Saharan Africa who was treated successfully with artesunate. A 28-year-old Nigerian woman with a 20-week intrauterine pregnancy presented with a five-day history of fever and diffuse joint pains. Evaluation of peripheral thin blood smear demonstrated a parasitemia of 9.8%. The patient was admitted to the intensive care unit, and oral clindamycin/quinine was initiated until intravenous artesunate was obtained. The patient completed four doses of IV artesunate, and after the 4th dose of artesunate, no blood parasites were seen on peripheral smear. The patient was discharged home and, upon clinic follow-up, did not have any further complications associated with either her disease or therapy. A review on the treatment of severe malaria in all trimesters of pregnancy supports the WHO recommendation for intravenous artesunate as the drug of choice. This case illustrates the importance of recognizing malaria in pregnant women from endemic countries and shows that artesunate compounds can be used safely in pregnancy, particularly with high parasitemia.

scholarly journals Plasmodium vivax cerebral malaria in an adult patient in Sudan

2019 ◽  
Vol 18 (1) ◽  
Author(s):  
Maowia M. Mukhtar ◽  
Omer A. Eisawi ◽  
Seth A. Amanfo ◽  
Elwaleed M. Elamin ◽  
Zeinab S. Imam ◽  
...  
Keyword(s):  
Plasmodium Vivax ◽  
Cerebral Malaria ◽  
Blood Film ◽  
Sub Saharan Africa ◽  
Measured Temperature ◽  
Neck Stiffness ◽  
The Pacific ◽  
High Parasitaemia ◽  
Brain Ct Scan ◽  
Sub Saharan

Abstract Background Plasmodium vivax infection is rising in sub-Saharan Africa, where Plasmodium falciparum is responsible for more than 90% of malaria cases. While P. vivax is identified as a major cause of severe and cerebral malaria in South east Asia, the Pacific and South America, most of the severe and cerebral cases in Africa were attributed to P. falciparum. Cases of severe malaria due to P. vivax are emerging in Africa. A few severe P. vivax cases were reported in Eastern Sudan and they were underestimated due to the lack of accurate diagnosis, low parasitaemia and seldom use of rapid diagnostic tests (RDTs). Case presentation A 60-year-old Sudanese male presented to the Al Kuwaiti hospital in the Sudan capital Khartoum. On admission, the patient was complaining of fever (measured temperature was 38 °C), sweating, chills, vomiting and confusion in the past 2 days prior to his admission. He rapidly deteriorated into a coma state within 48 h of the admission, with significant neck stiffness. He was admitted to the intensive care unit and was suspected of meningitis. Lumbar puncture was not performed since the patient was suffering from spinal cord disc. Brain CT scan was unremarkable. Several biochemical, haematological tests, and blood film for malaria were performed. The results of the laboratory tests were within the normal range except of mild elevation of the total white blood cell count and a significant decrease in the platelets count. Malaria parasites were seen in the blood film with high parasitaemia (quantified as 3 +++). The patient was diagnosed as P. vivax cerebral malaria based on the positive blood film and the amplification of P. vivax specific 499 bp amplicon using Plasmodium multi-species multiplex Polymerase Chain Reaction (PCR). The patient was treated with quinine 10 mg/kg body weight for 10 days followed by primaquine 15 mg/days PO for 2 weeks. The symptoms subsided within 48 h and the patients was cured and released from the hospital. Conclusions Plasmodium vivax is an emerging cause of cerebral malaria in adults in Sudan and should be considered in the differential diagnosis of cerebral malaria for proper management of patients.

scholarly journals The age patterns of severe malaria syndromes in sub-Saharan Africa across a range of transmission intensities and seasonality settings

2010 ◽  
Vol 9 (1) ◽  
Author(s):  
Arantxa Roca-Feltrer ◽  
Ilona Carneiro ◽  
Lucy Smith ◽  
Joanna RM Armstrong Schellenberg ◽  
Brian Greenwood ◽  
...  
Keyword(s):  
Severe Malaria ◽  
Sub Saharan Africa ◽  
Age Patterns ◽  
Sub Saharan

scholarly journals Lipidome profiles of plasma microvesicles differ in experimental cerebral malaria, compared to malaria without neurological complications

2020 ◽  
Author(s):  
Amani M Batarseh ◽  
Fatemeh Vafaee ◽  
Elham Hosseini-Beheshti ◽  
Alex Chen ◽  
Amy Cohen ◽  
...  
Keyword(s):  
Cerebral Malaria ◽  
Neurological Complications ◽  
Sub Saharan Africa ◽  
South East Asia ◽  
Fatal Complication ◽  
Experimental Cerebral Malaria ◽  
Lipid Species ◽  
Experimental Mouse Model ◽  
Experimental Mouse ◽  
Sub Saharan

ABSTRACTCerebral malaria (CM), a fatal complication of Plasmodium infection that affects children in sub-Saharan Africa and adults in South-East Asia, results from incompletely understood pathogenetic mechanisms, which include an excessive release of microvesicles (MV). Plasma MV levels have been found elevated in CM patients and in the experimental mouse model.We compared lipid profiles in circulating MV purified from CBA mice infected with P. berghei ANKA (PbA), which causes CM, to those from P. yoelii (Py), which does not. Here we show that plasma MV produced at the time of CM differed dramatically from those from non-CM mice, in spite of identical levels of parasitaemia. Using high-resolution LCMS, we identified over 300 lipid species within 12 lipid classes. Total lysophosphatidylethanolamine (LPE) levels were significantly lower in PbA infection compared to uninfected mice, while they were unchanged in Py MV, and lysophosphatidylcholine (LPC) was more significantly reduced in PbA mice compared to the other two groups. These results suggest, for the time, that experimental CM is characterised by specific changes in lipid composition of circulating MV, pointing towards triglycerides (TG) especially docosahexaenoic acid (DHA 22:6) containing species, phosphatidylethanolamine (PE), LPC, LPE, and diacylglycerol (DG) as potential important players in CM pathogenesis.

scholarly journals Evaluating kidney function using a point-of-care creatinine test in Ugandan children with severe malaria: a prospective cohort study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Anthony Batte ◽  
Kristin J. Murphy ◽  
Ruth Namazzi ◽  
Katrina Co ◽  
Robert O. Opoka ◽  
...  
Keyword(s):  
Severe Malaria ◽  
Point Of Care ◽  
Isotope Dilution Mass Spectrometry ◽  
Kidney Injury ◽  
Sub Saharan Africa ◽  
Middle Income ◽  
Middle Income Countries ◽  
Point Of Care Test ◽  
Care Assessment ◽  
Sub Saharan

Abstract Background Acute kidney injury (AKI) disproportionately affects individuals in low-and middle-income countries (LMIC). However, LMIC—particularly countries in sub-Saharan Africa— are under-represented in global AKI research. A critical barrier in diagnosing AKI is access to reliable serum creatinine results. We evaluated the utility of a point-of-care test to measure creatinine and diagnose AKI in Ugandan children with malaria. Methods Paired admission creatinine was assessed in 539 Ugandan children 6 months to 4 years of age hospitalized with severe malaria based on blood smear or rapid diagnostic test. Creatinine levels were measured using isotope dilution mass spectrometry (IDMS)-traceable methods. The reference creatinine was measured using the modified Jaffe method by a certified laboratory and the point-of-care testing was conducted using an i-STAT blood analyzer (i-STAT1, with and without adjustment for the partial pressure of carbon dioxide). AKI was defined and staged using the Kidney Disease: Improving Global Outcomes criteria. Results The mean age of children was 2.1 years, and 21.6% of children were stunted. Mortality was 7.6% in-hospital. Over the entire range of measured creatinine values (<0.20mg/dL-8.4mg/dL), the correlation between the reference creatinine and adjusted and unadjusted point-of-care creatinine was high with R2 values of 0.95 and 0.93 respectively; however, the correlation was significantly lower in children with creatinine values <1mg/dL (R2 of 0.44 between the reference and adjusted and unadjusted i-STAT creatinine). The prevalence of AKI was 45.5% using the reference creatinine, and 27.1 and 32.3% using the unadjusted and adjusted point-of-care creatinine values, respectively. There was a step-wise increase in mortality across AKI stages, and all methods were strongly associated with mortality (p<0.0001 for all). AKI defined using the reference creatinine measure was the most sensitive to predict mortality with a sensitivity of 85.4% compared to 70.7 and 63.4% with the adjusted and unadjusted point-of-care creatinine values, respectively. Conclusions Point-of-care assessment of creatinine in lean Ugandan children <4 years of age underestimated creatinine and AKI compared to the clinical reference. Additional studies are needed to evaluate other biomarkers of AKI in LMIC to ensure equitable access to AKI diagnostics globally.

scholarly journals Cost-effectiveness of parenteral artesunate for treating children with severe malaria in sub-Saharan Africa

2011 ◽  
Vol 89 (7) ◽  
pp. 504-512 ◽  
Author(s):  
Yoel Lubell ◽  
Arthorn Riewpaiboon ◽  
Arjen M Dondorp ◽  
Lorenz von Seidlein ◽  
Olugbenga A Mokuolu ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Severe Malaria ◽  
Sub Saharan Africa ◽  
Sub Saharan

scholarly journals Marked elevation in plasma osteoprotegerin constitutes an early and consistent feature of cerebral malaria

2016 ◽  
Vol 115 (04) ◽  
pp. 773-780 ◽  
Author(s):  
Kristina Gegenbauer ◽  
Jamie M. O’Sullivan ◽  
Alain Chion ◽  
Owen P. Smith ◽  
Roger J. S. Preston ◽  
...  
Keyword(s):  
Cerebral Malaria ◽  
Severe Malaria ◽  
Critical Role ◽  
Fatal Outcome ◽  
Prognostic Significance ◽  
Clinical Signs ◽  
Marked Elevation ◽  
Consistent Feature ◽  
Lactate Levels

SummaryAdherence of infected erythrocytes to vascular endothelium causes acute endothelial cell (EC) activation during Plasmodium falciparum infection. Consequently, proteins stored in Weibel-Palade (WP) bodies within EC are secreted into the plasma. Osteoprotegerin (OPG) binds to VWF and consequently is stored within WP bodies. Given the critical role of EC activation in the pathogenesis of severe malaria, we investigated plasma OPG levels in children with P. falciparum malaria. At presentation, plasma OPG levels were significantly elevated in children with cerebral malaria (CM) compared to healthy controls (means 16.0 vs 0.8 ng/ml; p<0.01). Importantly, OPG levels were also significantly higher in children with CM who had a fatal outcome, compared to children with CM who survived. Finally, in children with CM, plasma OPG levels correlated with other established prognostic indices (including plasma lactate levels and peripheral parasite density). To further investigate the relationship between severe malaria and OPG, we utilised a murine model of experimental CM in which C57BL/6J mice were infected with P. berghei ANKA. Interestingly, plasma OPG levels were increased 4.6 fold within 24 hours following P. berghei inoculation. This early marked elevation in OPG levels was observed before any objective clinical signs were apparent, and preceded the development of peripheral blood parasitaemia. As the mice became increasingly unwell, plasma OPG levels progressively increased. Collectively, these data suggest that OPG constitutes a novel biomarker with prognostic significance in patients with severe malaria. In addition, further studies are required to determine whether OPG plays a role in modulating malaria pathogenesis.

scholarly journals Demography, social contact patterns and the COVID-19 burden in different settings of Ethiopia: a modeling study

2020 ◽  
Author(s):  
Filippo Trentini ◽  
Giorgio Guzzetta ◽  
Margherita Galli ◽  
Agnese Zardini ◽  
Fabio Manenti ◽  
...  
Keyword(s):  
Fatal Outcome ◽  
Social Contact ◽  
Demographic Factors ◽  
School Closure ◽  
Sub Saharan Africa ◽  
School Closures ◽  
Mixing Patterns ◽  
Access To Primary Care ◽  
Sub Saharan ◽  
Socio Demographic Factors

AbstractBackgroundCOVID-19 spread may have a dramatic impact in countries with vulnerable economies and limited availability of, and access to, healthcare resources and infrastructures. However, in sub-Saharan Africa a low prevalence and mortality have been observed so far.MethodsWe collected data on individuals’ social contacts in Ethiopia across geographical contexts characterized by heterogeneous population density, work and travel opportunities, and access to primary care. We assessed how socio-demographic factors and observed mixing patterns can influence the COVID-19 disease burden, by simulating SARS-CoV-2 transmission in remote settlements, rural villages, and urban neighborhoods, under the current school closure mandate.ResultsFrom national surveillance data, we estimated a net reproduction number of 1.62 (95%CI 1.55-1.70). We found that, at the end of an epidemic mitigated by school closure alone, 10-15% of the overall population would have been symptomatic and 0.3-0.4% of the population would require mechanical ventilation and/or possibly result in a fatal outcome. Higher infection attack rates are expected in more urbanized areas, but the highest incidence of critical disease is expected in remote subsistence farming settlements.ConclusionsThe relatively low burden of COVID-19 in Ethiopia can be explained by the estimated mixing patterns, underlying demography and the enacted school closures. Socio-demographic factors can also determine marked heterogeneities across different geographical contexts within the same country. Our findings can contribute to understand why sub-Saharan Africa is experiencing a relatively lower attack rate of severe cases compared to high income countries.

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