Complicated malaria in children and adults from three settings of the Colombian Pacific Coast: A prospective study

Abstract

BackgroundComplicated malaria remains an important public health problem, particularly in endemic settings where access to health services is limited and consequently malaria fatal outcomes occur. Few publications describing the clinical course and outcomes of complicated malaria in Latin America are found in the literature. This prospective study approached the clinical and laboratory characteristics of hospitalized patients with complicated malaria in different endemic areas of the Colombian Pacific Coast with the aim to provide epidemiological knowledge and guide to further reducing malaria severity and mortality.Methods and findingsA prospective, descriptive hospital-based study was conducted in 323 complicated malaria patients (median age 20 years) enrolled in Quibdó, Tumaco and Cali between 2014 and 2016. Clinical evaluation was performed and laboratory parameters were assessed during hospitalization. Plasmodium falciparum was the most common parasite species (70%), followed by P. vivax (28%), and mixed malaria (Pf/Pv; 1.9%). Overall, predominant laboratory complications were severe thrombocytopenia (43%), hepatic dysfunction (40%), and severe anaemia (34%). Severe thrombocytopenia was more common in adults (52%) regardless of parasite species. Severe anaemia was the most frequent complication in children ≤10 years (72%) and was most commonly related to P. vivax infection (p < 0.001); whereas liver dysfunction was more frequent in older patients (54%) with P. falciparum (p < 0.001). Two deaths due to P. vivax and P. falciparum each were registered. Treatment provision before recruitment hindered qPCR confirmation of parasite species in some cases.ConclusionsThe study identified a high prevalence of complicated malaria in the Pacific Coast, together with more frequent severe anaemia in children infected by P. vivax and hepatic dysfunction in adults with P. falciparum. Results indicated the need for earlier diagnosis and treatment to prevent complications development as well as more effective attention at hospital level, in order to rapidly identify and appropriately treat these severe clinical conditions. The study describes epidemiological profiles of the study region and identified the most common complications on which clinicians must focus on to prevent mortality.

IgG Responses to the Plasmodium falciparum Antigen VAR2CSA in Colombia Are Restricted to Pregnancy and Are Not Induced by Exposure to Plasmodium vivax

“…The second set of samples (set 2) was obtained from a passive case detection study conducted from 2011 to 2013 at malaria points of care ( 15 ) and from 2014 to 2016 in hospitals ( 51 ) of Quibdó, Tumaco, and Tierralta. Samples from children (set 2a) and men (set 2b) with acute P. vivax or P. falciparum malaria as well as a set of plasma samples from pregnant women with P. vivax or P. falciparum malaria ( 51 , 52 ) (set 2c) were included.…”

Aspartate aminotransferase-to-platelet ratio index (APRI): A potential marker for diagnosis in patients at risk of severe malaria caused by Plasmodium vivax

“…However, this method was tested without success [44]. More recently, a study conducted in South America showed that thrombocytopenia was one of the most altered hematological parameters in severe infections, regardless of species, with 90% of patients having platelet counts lower than 150,000/ μL and 43% of the population surveyed were < 50,000/ μL [46].…”

Hyperparasitaemia during clinical malaria episodes in infants aged 0–24 months and its association with in utero exposure to Plasmodium falciparum

“…Hyperparasitaemia leads to destruction of host erythrocytes, consumption of host glucose, stimulation of lactate formation through hypoxia and alteration of erythrocyte membrane transport systems [ 23 ]. Thus infants exposed in utero to parasite antigens may be at higher risk of serious complications associated with malaria infection despite the fact that other factors may be at play in influencing levels of parasitaemia.…”