Malaria-Related Anemia in Patients from Unstable Transmission Areas in Colombia

Lopez-Perez, Mary; Álvarez, Álvaro; Gutiérrez, Juan B.; Moreno, Alberto; Herrera, Sócrates; Arévalo‐Herrera, Myriam

doi:10.4269/ajtmh.14-0345

Cited by 10 publications

(6 citation statements)

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“…As in previous reports [ 16 , 14 , 44 ], anaemia was only present as mild-to-moderate in ~20% of the cases, and severe in only four patients. Because there is an inverse correlation between Hb levels and days of illness [ 45 ], results would support a short duration of infection and possibly the presence of iron deficiency as previously reported [ 46 ]. While most patients had a low-to-moderate parasitaemia, higher median parasitaemia was found in P. vivax -infected patients (3,314 parasites/μL) than in those infected with P. falciparum (1,482 parasites/μL).…”

Section: Discussionsupporting

confidence: 78%

Clinical profile of Plasmodium falciparum and Plasmodium vivax infections in low and unstable malaria transmission settings of Colombia

Arévalo‐Herrera

Lopez-Perez

Medina³

et al. 2015

Malar J

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BackgroundMalaria transmission in Latin America is generally hypoendemic and unstable, with Plasmodium vivax as the most prevalent species. However, only a few studies have been carried out in areas with low and unstable transmission, whereas the clinical profile of malaria has been broadly described in hyperendemic areas. The pattern of clinical manifestations and laboratory findings in low to moderate endemic areas of Colombia is reported here.MethodsA passive surveillance study was conducted between 2011 and 2013 involving 1,328 patients with Plasmodium falciparum, P. vivax or mixed malaria infections attending malaria points-of-care of four malaria endemic-areas with distinct transmission intensities and parasite distribution. Trained physicians recorded clinical symptoms and signs as well as socio-demographic characteristics of study participants. Haematological, biochemical and urine tests were performed at the time of diagnosis.ResultsOut of 1,328 cases, 673 (50.7%) were caused by P. vivax; 650 (48.9%) were due to P. falciparum; and five (0.4%) patients had mixed infections (P. falciparum/P. vivax). Most patients (92.5%) presented with uncomplicated malaria characterized by fever, chills, headache, sweating, myalgia/arthralgia and parasitaemia ≤ 20,000 parasites/μL. Fever, tachycardia, pallor and abdominal pain on palpation were more frequent in P. falciparum patients, whereas mild hepatomegaly and splenomegaly were mostly observed with P. vivax. Non-severe anaemia (Hb 7.0-10.9 g/dL) was observed in 20% of the subjects, whereas severe anaemia (Hb < 7.0 g/dL) was present in four patients. Half of the patients presented thrombocytopaenia regardless of parasite species. Leukopaenia, neutrophilia and monocytosis were frequently observed in patients infected with P. falciparum. Mild-to-moderate biochemical alterations were present in ~25% of the patients, particularly abnormal bilirubin in those with P. falciparum and abnormal transaminases in P. vivax malaria patients. Proteinuria was present in ~50% of the patients regardless of parasite species, whereas haemoglobinuria was more common in P. vivax infections. Only 7.5% of the cases were classified as clinically severe malaria, caused by both P. vivax and P. falciparum.ConclusionsThe high prevalence of uncomplicated malaria associated with moderate parasitaemia suggests the importance of timely diagnosis and effective treatment and encourages new activities to further decrease complicated malaria cases and mortality.

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Section: Discussionsupporting

confidence: 78%

Clinical profile of Plasmodium falciparum and Plasmodium vivax infections in low and unstable malaria transmission settings of Colombia

Arévalo‐Herrera

Lopez-Perez

Medina³

et al. 2015

Malar J

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“…Complications during malaria caused by P. vivax is an increasingly reported phenomenon for which we lack understanding of its etiology [28,29]. Anemia is one of most reported complications associated with P. vivax malaria, but little is understood about the mechanism leading to it [7,30,31]. In this study, we focused on characterizing the autoimmune B-cell response and its relation to malarial anemia in two different cohorts of malaria patients from Colombia, who suffered mostly from P. vivax malaria: one longitudinal in uncomplicated patients and one cross-sectional comparing uncomplicated and complicated patients.…”

Section: Discussionmentioning

confidence: 99%

“…Anemia is one of most reported complications associated with P . vivax malaria, but little is understood about the mechanism leading to it [ 7 , 30 , 31 ]. In this study, we focused on characterizing the autoimmune B-cell response and its relation to malarial anemia in two different cohorts of malaria patients from Colombia, who suffered mostly from P .…”

Section: Discussionmentioning

confidence: 99%

Atypical memory B-cells and autoantibodies correlate with anemia during Plasmodium vivax complicated infections

Rivera-Correa¹,

Yasnot²,

Tovar³

et al. 2020

PLoS Negl Trop Dis

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Malaria caused by Plasmodium vivax is a highly prevalent infection worldwide , that was previously considered mild, but complications such as anemia have been highly reported in the past years. In mice models of malaria, anti-phosphatidylserine (anti-PS) autoantibodies, produced by atypical B-cells, bind to uninfected erythrocytes and contribute to anemia. In human patients with P. falciparum malaria, the levels of anti-PS, atypical B-cells and anemia are strongly correlated to each other. In this study, we focused on assessing the relationship between autoantibodies, different B-cell populations and hemoglobin levels in two different cohorts of P. vivax patients from Colombia, South America. In a first longitudinal cohort, our results show a strong inverse correlation between different IgG autoantibodies tested (anti-PS, anti-DNA and anti-erythrocyte) and atypical memory B-cells (atMBCs) with hemoglobin in both P. vivax and P. falciparum patients over time. In a second cross-sectional cohort, we observed a stronger relation between hemoglobin levels, atMBCs and autoantibodies in complicated P. vivax patients compared to uncomplicated ones. Altogether, these data constitute the first evidence of autoimmunity associating with anemia and complicated P. vivax infections, suggesting a role for its etiology through the expansion of autoantibody-secreting atMBCs.

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“…Notably, a diagnosis delay (>72 h after symptoms onset) was found in most patients, possibly due to either limited access to healthcare services (less developed on the Pacific Coast) or health staff failure to identify complicated malaria manifestations. Moreover, this delayed diagnosis increases the risk of anaemia [ 41 ]. Although a re-infection or relapse cannot be ruled out in patients reporting previous malaria episodes in the last month, which was significantly more common in cases with mixed infection, it suggests therapeutic failure or low adherence to anti-malarial treatment.…”

Section: Discussionmentioning

confidence: 99%

Clinical and epidemiological aspects of complicated malaria in Colombia, 2007–2013

Chaparro-Narváez¹,

Lopez-Perez

Rengifo

et al. 2016

Malar J

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BackgroundDuring the last decade, Colombia presented a significant decrease in malaria clinical cases and associated mortality. However, there is a lack of reliable information about the prevalence and characteristics of complicated malaria cases as well as its association with different Plasmodium species. A description of the epidemiological and clinical aspects of complicated malaria in Colombia is presented here.MethodsA descriptive study was conducted using data collected between 2007 and 2013 by the Public Health Surveillance System (SIVIGILA). Demographic and clinical features were described. Frequency of complicated malaria cases, annual parasite index (API) and annual percent change (APC) for trend modelling by gender and age were also calculated.ResultsA total of 547,542 malaria cases were recorded by SIVIGILA during the study period, of which 2553 (0.47 %) corresponded to complicated cases with similar distribution by Plasmodium vivax and Plasmodium falciparum species. Mixed infections were found in 153 cases (6.0 %). Trend modelling of the API for complicated malaria for all parasite species showed a non-significant increase throughout the years (APC 14.4 %; 95 % CI −4.3 to 36.6 %). Complicated malaria individuals were mostly males (62.2 %) and young adults (median age of 23 years). Notably, 72.4 % of the patients attended for malaria diagnosis >72 h after symptoms onset and 17 % reported malaria episodes in the last 30 days. All patients received anti-malarial treatment, but only 40 % received the first-line as recommended by the Colombian guidelines. Overall, hepatic and renal complications were the most common severe manifestations (63.6 %). Whereas hepatic and pulmonary complications were more common in P. vivax infections, renal and cerebral complications were significantly more frequent in patients with P. falciparum. In contrast with mono-infected patients, severe anaemia and shock were more frequent in patients with mixed infection.ConclusionIn contrast with the malaria-decreasing trend over the last years, the complicated malaria trend showed a non-significant annual increase. Therefore, in addition to existing national policies on early diagnosis and prompt anti-malarial treatment, more efforts have to be committed addressing the delayed diagnosis and inadequate treatment found in this study. Improving malaria notification forms, medical assistance skills, and capacity should be prioritized.Electronic supplementary materialThe online version of this article (doi:10.1186/s12936-016-1323-5) contains supplementary material, which is available to authorized users.

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Malaria-Related Anemia in Patients from Unstable Transmission Areas in Colombia

Cited by 10 publications

References 46 publications

Clinical profile of Plasmodium falciparum and Plasmodium vivax infections in low and unstable malaria transmission settings of Colombia

Clinical profile of Plasmodium falciparum and Plasmodium vivax infections in low and unstable malaria transmission settings of Colombia

Atypical memory B-cells and autoantibodies correlate with anemia during Plasmodium vivax complicated infections

Clinical and epidemiological aspects of complicated malaria in Colombia, 2007–2013

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