scholarly journals IMPORTED PLASMODIUM FALCIPARUM MALARIA: ARE PATIENTS ORIGINATING FROM DISEASE-ENDEMIC AREAS LESS LIKELY TO DEVELOP SEVERE DISEASE? A PROSPECTIVE, OBSERVATIONAL STUDY

2006 ◽  
Vol 75 (6) ◽  
pp. 1195-1199 ◽  
Author(s):  
RICHARD M. JENNINGS ◽  
JUSTIN F. DOHERTY ◽  
MARGARET ARMSTRONG ◽  
JIM E. TODD ◽  
J. BRIAN DE SOUZA ◽  
...  
Keyword(s):  
Plasmodium Falciparum ◽  
Observational Study ◽  
Falciparum Malaria ◽  
Prospective Observational Study ◽  
Severe Disease ◽  
Plasmodium Falciparum Malaria ◽  
Endemic Areas

Hematologic Findings and Transfusion Therapy in Severe Pediatric Plasmodium Falciparum Malaria: Results from a Prospective Observational Study in Uganda

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 3041-3041
Author(s):  
Christine Cserti-Gazdewich ◽  
Aggrey Dhabangi ◽  
Charles Musoke ◽  
Nicolette Nabukeera-Barungi ◽  
Henry Ddungu ◽  
...  
Keyword(s):  
Plasmodium Falciparum ◽  
Observational Study ◽  
Respiratory Distress ◽  
Severe Malaria ◽  
Falciparum Malaria ◽  
Blood Cells ◽  
Prospective Observational Study ◽  
Plasmodium Falciparum Malaria ◽  
Severe Thrombocytopenia ◽  
Severe Anemia

Abstract Background: Plasmodium falciparum malaria is a leading global killer of children and cause for transfusion in endemic areas. Sequestration cytopenias and microvascular insufficiency are pathologic consequences of the acquired cytoadhesivity of P falciparum-infected red blood cells (iRBC). Parasite-derived surface knobs (PfEMP1) expressed on iRBC promote their binding to blood group ligands on non-infected blood cells and the microvascular endothelium. The purpose of the Cytoadherence in Pediatric Malaria Study (clinicaltrials.gov, NCT 00707200) is to study the association between malaria outcomes and host markers of cytoadhesion. Methods: This prospective observational study of children with malaria (age 6 m–12 y, HIV-neg) was launched in October 2007 at Mulago Hospital, Uganda. Patients with severe malaria syndromes, as defined by the WHO, were compared with uncomplicated malaria (UM) patients for presenting hematologic features and transfusion practices. Associations between severe malaria syndromes and mortality were also explored. Results: Over the study’s 1st 7 months, 785 patients were screened, 492 enrolled, and 44 excluded (40 malaria false positives, 4 HIV+). A total of 448 were analyzed (199 severe, 249 UM), including 16 deaths (severe malaria case fatality rate: 8%). Patients were 55% male/45% female. Severe malaria patients were significantly younger than those with UM (2.3 ± 1.9 y, 93% ≤ 5 y, vs 3.5 ± 2.7 y, 76% <5 y), p < 2×10−7. Hematologic features of the patients are summarized in Table 1, illustrating significantly greater derangements in the CBC of severe cases versus UM. In contrast, both groups had a similar sickle trait prevalence and level of parasitemia: Table 1: Hematologic Features in Uncomplicated Malaria (UM) vs Severe Malaria UM (n = 249) Severe (n = 199) signifinance WBC Count, × 10 9/L [mean ± sd] 8.1 ± 3.5 12.8 ± 8.1 p = 2.6 × 10−13 Hemoglobin, g/dL [mean ± sd] 9.3 ± 1.5 5.2 ± 2.1 p = 2.1 × 10−71 Severe Malarial Anemia [number, % ], Hb ≥ 5 g/dL 0 (0 %) 130 (65.3 %) χ2 = 226 Platelet Count, × 10 3/μL, [mean ± sd] 160,000 ± 103,000 129,000 ± 98,000 p =.0015 Severe Thrombocytopenia [n, %], Plt ≥ 50,000/μL 17 (6.8 %) 39 (19.6 %) χ2 = 15.3 Sickle Trait on Screen or History [n, %] 11/157 (7.0 %) 12/118 (10.2 %) χ2 =.51 (NS) Quantitative Parasitemia,/μL [median, range] 80,000 (7–10,638,000) 65,000 (60–2,593,000) p =.8 (NS) Hyperparasitemia [n, % ], Parasites ≥250,000/μL 42 (16.9 %) 44 (22.1 %) χ2 = 1.6 (NS) Among severe cases, severe malarial anemia (SMA) was the most common syndrome (n=130, 65%), followed by lactic acidosis (LA, n=93, 47%), respiratory distress (RD, n=91, 46%), hypoglycaemia (HG, n=22, 23%), cerebral malaria (CM, n=43, 22%), and hypoxia (HO, n=14, 7%). Among fatal cases, RD occurred most commonly (94%), followed by LA (75%), CM (56%), HG (42%), and SMA (only 31%). Overall, RBC transfusions were given to 78% of severe cases, and all but 1 of 130 SMA cases. Despite severe anemia, most received only 1 unit (1.2 ±.5 pediatric units/patient, range 1–3). 83% of transfusions were given for SMA and 10% for RD (without SMA). Significant delays or dose insufficiency of blood products occurred in 5.2% of recipients. ABO non-identical but compatible products were given 10.2% of the time. In unadjusted analysis of severe cases, associations between the hemolytic state of SMA and either hypoxia or respiratory distress (as possible signs of pulmonary hypertension) were not apparent (χ2=.01 and 2.2 respectively). LA was associated with SMA (χ2=4.7, p=.03), but not with the smaller subset of SMA patients with HO (χ2=.61, p=.43). The strongest association occurred between LA and RD (χ2=29.3, p<.0001), tying labored breathing to acidotic respiratory compensation. Conclusions: Hematologic abnormalities are seen across the entire spectrum of severe and uncomplicated pediatric P falciparum malaria in Uganda, and are most striking in the severe syndromes. Among patients with severe malaria, SMA is the most common feature, while severe thrombocytopenia occurs in up to 20%. SMA is not as predictive of death as either RD, LA, or CM. LA in turn occurs even in the absence of severe anemia and/or hypoxia, highlighting the potential contribution of microvascular ischemia from cytoadhesion. Cytoadhesion between infected red cells and host ligands is thus an appealing area of focus for studies of the pathogenesis of malaria morbidity and mortality in children.

scholarly journals TNFα*2 marks high risk of severe disease during Plasmodium falciparum malaria and other infections in Sri Lankans

1999 ◽  
Vol 115 (2) ◽  
pp. 350-355 ◽  
Author(s):  
J. WATTAVIDANAGE ◽  
R. CARTER ◽  
K. L. R. L. PERERA ◽  
A. MUNASINGHA ◽  
S. BANDARA ◽  
...  
Keyword(s):  
Plasmodium Falciparum ◽  
High Risk ◽  
Falciparum Malaria ◽  
Severe Disease ◽  
Plasmodium Falciparum Malaria

scholarly journals A MODEL FOR NATURAL IMMUNITY TO ASEXUAL BLOOD STAGES OF PLASMODIUM FALCIPARUM MALARIA IN ENDEMIC AREAS

2006 ◽  
Vol 75 (2_suppl) ◽  
pp. 19-31 ◽  
Author(s):  
NICOLAS MAIRE ◽  
LOUIS MOLINEAUX ◽  
THOMAS SMITH ◽  
SETH OWUSU-AGYEI ◽  
AMANDA ROSS ◽  
...  
Keyword(s):  
Plasmodium Falciparum ◽  
Falciparum Malaria ◽  
Plasmodium Falciparum Malaria ◽  
Natural Immunity ◽  
Endemic Areas

scholarly journals Epidemiology of Plasmodium falciparum Malaria and Risk Factors for Severe Disease in Hubei Province, China

2020 ◽  
Vol 103 (4) ◽  
pp. 1534-1539
Author(s):  
Jing Xia ◽  
Dongni Wu ◽  
Kai Wu ◽  
Hong Zhu ◽  
Lingcong Sun ◽  
...  
Keyword(s):  
Risk Factors ◽  
Plasmodium Falciparum ◽  
Falciparum Malaria ◽  
Severe Disease ◽  
Plasmodium Falciparum Malaria ◽  
Hubei Province

scholarly journals The effect of blood transfusion on outcomes among African children admitted to hospital with Plasmodium falciparum malaria: a prospective, multicentre observational study

2020 ◽  
Vol 7 (11) ◽  
pp. e789-e797 ◽  
Author(s):  
Hans Ackerman ◽  
Aintzane Ayestaran ◽  
Christopher H O Olola ◽  
Muminatou Jallow ◽  
Tsiri Agbenyega ◽  
...  
Keyword(s):  
Plasmodium Falciparum ◽  
Blood Transfusion ◽  
Observational Study ◽  
Falciparum Malaria ◽  
Plasmodium Falciparum Malaria ◽  
African Children
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