Severe malaria in Battambang Referral Hospital, an area of multidrug resistance in Western-Cambodia: a retrospective analysis of cases from 2006–2009

Abstract

BackgroundDespite recent malaria containment and control efforts leading to reduced incidence, Cambodia remains endemic for both Plasmodium vivax and multidrug-resistant Plasmodium falciparum malaria. Little has been reported in the peer-reviewed literature regarding the burden of severe malaria (SM) in Cambodia.MethodsMedical records for all patients admitted to the Battambang Referral Hospital (BRH) with an admitting or discharge diagnosis of SM from 2006 to 2009 (suspected SM cases) were reviewed. Those meeting the case definition of SM according to retrospective chart review and investigator assessment of probable cases, based on published national guidelines available at the time, were analysed for trends in demographics, mortality and referral patterns.ResultsOf the 537 suspected SM cases at BRH during the study period, 393 (73%) met published WHO criteria for SM infection. Despite limited diagnostic and treatment facilities, overall mortality was 14%, with 7% mortality in children 14 and under, but 19% in adults (60% of cases). Cerebral malaria with coma was relatively rare (17%), but mortality was disproportionately high at 35%. Mean time to hospital presentation was five days (range one to 30 days) after onset of symptoms. While patients with delays in presentation had worse outcomes, there was no excess mortality based on treatment referral times, distance travelled or residence in artemisinin-resistance containment (ARC) Zone 1 compared to Zone 2.ConclusionsDespite limitations in diagnosis and treatment, and multiple confounding co-morbidities, mortality rates at BRH were similar to reports from other countries in the region. Interventions to improve access to early diagnosis and effective treatment, combined with modest improvements in intensive care, are likely to reduce mortality further. Patients referred from Zone 1 did not have excess mortality compared to Zone 2 ARC areas. A steep decrease in SM cases and deaths observed in the first half of 2009 has since continued, indicating some success from containment efforts despite the emergence of artemisinin resistance in this area.

Severe vivax malaria: a prospective exploration at a tertiary healthcare centre in Southwestern India

“…Higher propensity to contract malaria infection in men has been a consistent observation from this study region [9,20,34,35,38,39]. Male preponderance in malaria population has also been reported from other places in India [44−46] and elsewhere [47,48]. In contrast, female predominance was found in vivax malaria in Papua, Indonesia [36].…”

Clinical profile and outcome of cerebral malaria in pediatric cases at a tertiary Care Hospital

“…Wasnik et al noted that the cause of death were ARF, metabolic acidosis, aspiration pneumonia and circulatory failure. Case fatality rates in the other studies from Africa have shown a high mortality rate of 13-21% [14,15]. Artesunin components as combination therapy are the drug of choice as per WHO recommendations and can be easily administered with hardly any side effects [11].…”

Intravenous Artesunate for the Treatment of Severe and Complicated Malaria in the United States: Clinical Use Under an Investigational New Drug Protocol

“…These cases are not endemic to the US, but occur in individuals with a history of recent travel or residence in malaria endemic areas. Roughly 10% of US malaria cases are considered severe by the World Health Organization (WHO) criteria (2, 3), with the vast majority of these being caused by Plasmodium falciparum (4-7). Patients with severe malaria are at risk for life-threatening complications including: renal failure, acute respiratory distress syndrome (ARDS), severe hemolytic anemia, and cerebral malaria.…”

“…Patients with severe malaria are at risk for life-threatening complications including: renal failure, acute respiratory distress syndrome (ARDS), severe hemolytic anemia, and cerebral malaria. Among these, cerebral malaria is arguably the most dire, since it can present rapidly, often with minimal warning signs, and has a mortality rate of 15-30% with treatment and 100% when untreated (2, 4, 8-10). The only FDA-approved treatment for severe malaria in the United States is quinidine, a stereoisomer of quinine that once saw routine hospital use as a cardiac anti-arrhythmic medication (11, 12).…”