Factors associated with the severity and complication of patients with malaria hospitalized between 2009 and 2013 in three municipalities of Colombia, case control study

Ramirez, Jesica; Porras, Beatriz; Borrero, Elizabeth; Martínez, Sandra

doi:10.1186/s12936-016-1554-5

Cited by 6 publications

(6 citation statements)

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“…Malaria-associated liver damage in uncomplicated malaria, however, has rarely been investigated so far [ 25 ]. Observational studies are often restricted in number and limited to admission samples only [ 15 ], therefore, underestimating incidence and severity. Other studies do not differentiate non-severe from severe disease in their analysis [ 9 , 14 , 26 ].…”

Section: Discussionmentioning

confidence: 99%

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Liver Injury in Uncomplicated Malaria is an Overlooked Phenomenon: An Observational Study

et al. 2018

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BackgroundLiver injury is a known feature of severe malaria, but is only incidentally investigated in uncomplicated disease. In such cases, drug-induced hepatotoxicity is often thought to be the primary cause of the observed liver injury, and this can be a major concern in antimalaria drug development. We investigated liver function test (LFT) abnormalities in patients with imported uncomplicated malaria, and in Controlled Human Malaria Infection (CHMI) studies.MethodsClinical and laboratory data from 484 imported malaria cases and 254 CHMI participants were obtained from the Rotterdam Malaria Cohort database, and the Radboud University Medical Center database (between 2001 and 2017), respectively. Routine clinical LFTs, clinical profiles, parasite densities, hematological, and inflammation parameters were assessed in 217 patients with imported falciparum malaria upon admission, and from longitudinal data of 187 CHMI participants.FindingsUpon admission, the proportion of patients with imported uncomplicated malaria and elevated liver enzymes was 128/186 (69%). In CHMI, 97/187 (52%) participants showed LFT abnormalities, including mild (64%, >1.0 ≤ 2.5× upper limit of normal (ULN)), moderate (20%, >2.5 ≤ 5.0xULN) or severe (16%, >5.0xULN). LFT abnormalities were primarily ALT/AST elevations and to a lesser extent γGT and ALP. LFT abnormalities peaked shortly after initiation of treatment, regardless of drug regimen, and returned to normal within three to six weeks. Positive associations were found with parasite burden and inflammatory parameters, including cumulative inflammatory cytokine responses and oxidative stress markers (r = 0·65, p = 0·008, and r = −0·63, p = 0·001, respectively).InterpretationThis study shows that reversible liver injury is a common feature of uncomplicated falciparum malaria, most likely caused by an enduring pro-inflammatory response post treatment. The recognition of this phenomenon is of clinical relevance for individual patient care as well as clinical development of (new) antimalarial drugs.FundPATH Malaria Vaccine Initiative (MVI)

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Section: Discussionmentioning

confidence: 99%

“…The underlying pathogenesis of liver damage is largely unknown. Furthermore, liver involvement has only been incidentally investigated in uncomplicated malaria [ [14] , [15] , [16] ].…”

Section: Introductionmentioning

confidence: 99%

Liver Injury in Uncomplicated Malaria is an Overlooked Phenomenon: An Observational Study

et al. 2018

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“…vivax ); in whom neurological and hepatic manifestations (impaired consciousness, clinical jaundice, and hepatomegaly) were more common. Moreover, a recent retrospective paired, case–control study (2009–2013) which included 159 clinical records of complicated and non-complicated malaria cases described elevated transaminases (44%), clinical jaundice (37%), elevated bilirubin (25%), and thrombocytopenia (20%) as the main laboratory changes associated with severity; whereas severe anaemia was only found in 8% of the cases [ 25 ]. However, these two studies may present limitations inherent to retrospective studies such as probable misclassification of complicated malaria cases, errors in species diagnosis, i.e.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2017

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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.

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“…Notably, 10.1% (29/287) of the patients presented hepatomegaly. Hepatomegaly has been observed in endemic areas of Colombia (23–25%) [ 28 – 30 ], Indonesia (26.8%) [ 26 ], and previously in the Bolivar state (6.7%) [ 27 ]. The differences between Venezuela and these countries are a matter that requires additional investigation.…”

Section: Discussionmentioning

confidence: 99%

The clinical–epidemiological profile of malaria patients from Southern Venezuela, a critical hotspot in Latin America

Forero‐Peña¹,

Carrión‐Nessi

Chavero³

et al. 2021

Malar J

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Background Venezuela accounted for 55% of the cases and 73% of the malaria deaths in the Americas in 2019. Bolivar state, in the southeast, contributes > 60% of the country's Plasmodium vivax and Plasmodium falciparum cases every year. This study describes the clinical–epidemiological characteristics of clinical malaria patients in this high-transmission area. Methods A prospective study was conducted on patients seeking medical attention in three medical centres in the state capital, Ciudad Bolivar, between June and October 2018. Malaria diagnosis was carried out using microscopy following national standards. Malaria-positive patients were examined for clinical symptoms, and haematological tests were performed at the time of diagnosis. Patients were followed up by telephone to evaluate malaria recurrences. Results Out of 287 patients, 200 (69.7%) were positive for P. vivax, 69 (24%) for P. falciparum, and 18 (6.3%) had mixed (P. vivax/P. falciparum) infections. Patients' median age was 33 years (IQR 20), 168 (69%) were men, and 40% practiced gold mining as the main occupation. Fever (96.5%), chills (91.3%), and headaches (90.6%) were the most frequent symptoms. At least one symptom associated with severe malaria was observed in 69 out of 161 patients with complete clinical evaluation (42.9%). Plasmodium vivax infections were found in 42 out of 69 (60.9%) severe cases; by contrast, P. falciparum and mixed malaria caused 34.8% (24/69) and 4.4% (3/69) of infections, respectively. Two patients died of cerebral malaria. Mean hemoglobin was lower in the patients infected with P. falciparum than those infected with P. vivax. Regardless of the parasite causing the infection, patients presented high levels of total bilirubin, aminotransferases (AST, ALT), and lactate dehydrogenase (LDH). Out of the 142 patients followed up by phone for three months (49.5% of the 287 patients), 35 (24.7%) reported recurrences. Conclusions The high malaria prevalence among young male adults practicing gold mining suggests that this occupation is a significant risk factor. The unexpected high prevalence of P. vivax patients with at least one criteria of severe clinical disease is a matter of concern. Whether it is the result of a lack of timely diagnosis and effective treatment should be explored.

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Factors associated with the severity and complication of patients with malaria hospitalized between 2009 and 2013 in three municipalities of Colombia, case control study

Cited by 6 publications

References 10 publications

Liver Injury in Uncomplicated Malaria is an Overlooked Phenomenon: An Observational Study

Liver Injury in Uncomplicated Malaria is an Overlooked Phenomenon: An Observational Study

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

The clinical–epidemiological profile of malaria patients from Southern Venezuela, a critical hotspot in Latin America

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