Clinical Features and Outcome of Severe Malaria in Gambian Children

Waller, Deborah; Krishna, Sanjeev; Crawley, Jane; Miller, Kirk D.; Nosten, F; Chapman, David; Kuile, Feiko O. Ter; Craddock, Charles; Berry, C.D.; Holloway, Pah; Brewster, David; Bm, Greenwood; White, Nicholas J.

doi:10.1093/clinids/21.3.577

Cited by 179 publications

(160 citation statements)

References 45 publications

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“…6,12 Renal failure due to acute renal tubular necrosis is reported to be a major cause of death in severe malaria. 6,8,12 Three of our patients who died had ARF in association with other complications.…”

Section: Discussionmentioning

confidence: 76%

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The Clinical Pattern and Complications of Severe Malaria in the Gizan Region of Saudi Arabia

Banzal

et al. 1999

Ann Saudi Med

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Malaria remains a major problem in many parts of the world. Approximately 500 million people are affected annually, and about three million, mostly children, die of falciparum malaria each year. [1][2][3][4][5] In areas of endemic malaria, the most common clinical presentation is that of uncomplicated infection with prompt recovery after treatment.6,7 However, in nonimmune individuals, malaria may present in its most severe forms. 2,5,6,8 Despite a vigorous program of malaria control in the Kingdom of Saudi Arabia, the infection is still endemic in the southwestern area of the country.9 As a result of continued preventive measures, the epidemiology of the disease may be changing, and the proportion of nonimmune individuals may increase. Furthermore, the emergence of chloroquine-resistant malaria in the neighboring country of Yemen has a major implication for the Gizan population.2,4 The frequency and clinical outcome of severe malaria may provide useful, albeit indirect, information on the emergence of antimalarial drug resistance in this region. We describe the clinicopathologic profile and mortality in patients treated for severe malaria in King Fahad Central Hospital (KFCH), Gizan, Saudi Arabia. Materials and MethodsThe Gizan region is one of the 14 administrative provinces of Saudi Arabia. It is located on the Red Sea coast, about 1000 km southwest of Riyadh, and shares its border with Yemen to the east, and the Asir region to the north. The population of about one million is distributed mainly in the rural areas. All serious and complicated cases from the various general hospitals in the region are referred to the KFCH, which is the regional referral center. In addition, the emergency room is open 24 hours each day, allowing self-referral or presentation by those needing emergency care.The medical records of all cases of malaria admitted to the KFCH, from 1995 to 1997 (a three-year period), were analyzed. Malaria was diagnosed by the clinical presentation of fever, positive blood smear for asexual forms of Plasmodium falciparum, and response to antimalarial therapy. After a detailed history was obtained from either the patient or accompanying relatives, the patient was carefully examined. Thick and thin blood films were stained with Giemsa for the detection and characterization of malarial parasites. The parasite load was estimated to range from mild to severe on a scale of 1-4, corresponding approximately to <5%, 5%-10%, 10%-20%, and >20%, respectively. Additional investigations included the determination of hemoglobin level (Hb), white blood cell count (WBC), hematocrit, platelet count, reticulocyte count, mean corpuscular hemoglobin concentration, electrolytes, blood urea nitrogen (BUN), creatinine, blood glucose, bilirubin, aminotransferase, and lactic dehydrogenase in all the patients. Blood cultures, chest x-ray, abdominal ultrasound, urine and stool examination were done where indicated. Cerebrospinal fluid examination and CT scan of the brain were performed in some of the patients, as indicated clin...

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Section: Discussionmentioning

confidence: 76%

“…2,5,6,8 Despite a vigorous program of malaria control in the Kingdom of Saudi Arabia, the infection is still endemic in the southwestern area of the country.…”

mentioning

confidence: 99%

The Clinical Pattern and Complications of Severe Malaria in the Gizan Region of Saudi Arabia

Banzal

et al. 1999

Ann Saudi Med

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“…49 The fatality rate in children was similar to that described by other authors. 29,[50][51][52] Respiratory distress is a predictive factor of high mortality in children. 53,54 Severe malaria is sometimes indistinguishable from sepsis 55 or meningitis.…”

Section: Malaria Casesmentioning

confidence: 99%

Adult and paediatric mortality patterns in a referral hospital in Liberia 1 year after the end of the war

Huerga¹,

Vasset²,

Prados³

2009

Transactions of the Royal Society of Tropical Medicine and Hygi

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“…El estudio se centró en la detección de los signos clínicos fácilmente reconocibles y de los signos parasitológicos detectables en el examen de la gota gruesa, para luego entrenar al personal de diagnóstico en su reconocimiento, puesto que se ha observado que el personal sanitario no médico tiene dificultades en reconocer los signos que se asocian con cuadros clínicos complicados (11,12), y porque se ha observado que su reconocimiento temprano conduce a la instauración de tratamiento (13) y atención hospitalaria temprana, que conlleva la reducción de la mortalidad (14,15).…”

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

2012

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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 acompañe de otros elementos de la atención, como el suministro de un tratamiento antipalúdico adecuado y oportuno. Se proponen los criterios del diagnóstico de complicación moderada. Palabras clave: malaria, signos y síntomas, Plasmodium falciparum, Plasmodium vivax. Prognostic value of clinical and parasitological signs for severe malaria in patients from ColombiaIntroduction. Early recognition of danger signs in patients with malaria can reduce complications and deaths, but little is known about their prognostic value for severe malaria, especially in areas of low transmission and unstable malaria. Objective. To assess the prognostic value for severity of different clinical and parasitological signs in patients with malaria. Materials and methods. A prospective cohort of patients from five municipalities in Colombia with diagnosis of Plasmodium falciparum or P. vivax malaria in whom the association between clinical and parasitological signs with complicated malaria was studied. Results. A predictive model with 47.4% sensitivity, 92.8% specificity, 63.2% positive predictive value and 87.1% negative predictive value was obtained which includes jaundice, dark urine, hyperpyrexia and signs of dehydration. Conclusions. To impact the morbidity of complicated proposed a strategy is proposed for the early recognition of danger signs by non-medical personnel, which could be complemented by other elements of health care, such as providing adequate and appropriate antimalarial treatment. Diagnostic criteria for moderate complication are also proposed.

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Clinical Features and Outcome of Severe Malaria in Gambian Children

Cited by 179 publications

References 45 publications

The Clinical Pattern and Complications of Severe Malaria in the Gizan Region of Saudi Arabia

The Clinical Pattern and Complications of Severe Malaria in the Gizan Region of Saudi Arabia

Adult and paediatric mortality patterns in a referral hospital in Liberia 1 year after the end of the war

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

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