RESUMEN
BACKGROUND: Severe Plasmodium falciparum malarial anemia is still the principal cause of death in children in underdeveloped countries. An imbalance between proinflammatory and anti-inflammatory cytokines is associated with malaria progression. This study evaluated circulating levels of selected inflammatory cytokines among malaria-infected children in Ghana. METHODS: This case-control study was conducted at Tamale Teaching Hospital, Ghana. One hundred and twenty children with malaria and 60 controls, aged 12-144 months were selected from April to July, 2023 for the study. Malaria was diagnosed through microscopy, full blood count was measured using hematology analyzer, and cytokines were measured using enzyme-linked immunosorbent assay. RESULTS: Malaria-infected children had higher tumor necrosis factor alpha (TNF-α) (p < .001), interferon-gamma (IFN-É£) (p < .001), interleukin (IL)-1ß (p < .001), IL-6 (p < .001), granulocyte macrophage-colony stimulating factor (GM-CSF) (p < .001), and IL-10 (p < .001) levels than controls. Participants with high parasitemia had raised TNF-α (p < .001), IFN-É£ (p < .001), IL-1ß (p < .001), IL-6 (p < .001), GM-CSF (p < .001), and IL-10 (p < .001), but reduced IL-3 (p < .001) and TGF-ß (p < .001) than those with low parasitemia. Severe malarial anemic children had elevated TNF-α (p < .001), IFN-É£ (p < .001), IL-1ß (p < .001), IL-6 (p < .001), GM-CSF (p < .001), and IL-10 (p < .001), but lower IL-3 (p < .001) and TGF-ß (p < .001) than those with uncomplicated malaria. CONCLUSION: Parasite density was the principal predictor of the cytokine levels, as parasitemia positively associated with IL-10, GM-CSF, IL-6, IL-1ß, IFN-É£, and TNF-α, but negatively associated with IL-3 and TGF-ß. Malaria is associated with enhanced secretion of pro- and anti-inflammatory cytokines in Ghanaian children. Inflammatory cytokines may be involved in the development of severe malarial anemia in children. However, IL-3 and TGF-ß may offer protection against severe malarial anemia.
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Anemia , Citocinas , Progresión de la Enfermedad , Malaria Falciparum , Humanos , Citocinas/sangre , Anemia/sangre , Anemia/inmunología , Anemia/parasitología , Masculino , Preescolar , Femenino , Estudios Prospectivos , Estudios de Casos y Controles , Lactante , Malaria Falciparum/sangre , Malaria Falciparum/inmunología , Malaria Falciparum/complicaciones , Malaria Falciparum/parasitología , Malaria Falciparum/epidemiología , Ghana/epidemiología , Niño , Parasitemia/sangre , Parasitemia/inmunología , Plasmodium falciparum/inmunología , Mediadores de Inflamación/sangreRESUMEN
BACKGROUND: Plasmodium falciparum infection is associated with the human ABO blood group. However, there is a paucity of data on the role that ABO and Rhesus blood groups play in malaria clinical presentations. Therefore, the objective of this study was to assess the association of human ABO blood groups and the Rhesus blood (Rh) types with the severity of malaria. METHODS: This cross-sectional study was carried out at the Suhum Government Hospital in the Eastern region of Ghana. Conveniently, study participants with malaria, diagnosed by microscopy, were selected into the study. Subsequently, their ABO and Rh blood groups were determined (Accucare ABO/Rh monoclonal antibodies, Chennai, India). Malaria severity was assessed using the criteria for assessing severe malarial anaemia published by the World Health Organization. According to the criteria, severe malarial anaemia was classified as having haemoglobin (Hb) < 5 g/dL for children < 12 years and in patients ≥ 12 years, Hb level < 7 g/dL, with parasitaemia > 10,000/µL in both cases. Severe malarial anaemia was also classified as having plasma bilirubin > 50 µmol/L with parasitaemia ≥ 100,000/µL, for all ages. Chi square statistical analysis was used to test the association between the blood groups and the clinical or laboratory findings, while multivariate analysis was performed to identify which blood groups were more vulnerable to develop severe malarial anaemia. RESULTS: Of the total number of the study participants (n = 328), most of the patients had blood group O Rh positive (35.7%) while few of them had blood group AB Rh negative (2.1%). The types of Rhesus did not associate with malaria. However, compared to blood group O, the odds of developing severe malarial anaemia, in children < 12 years and in patients ≥ 12 years, were 16 times and 17.8 times higher among patients with blood group A, respectively. Furthermore, the odds of having bilirubin level > 50 µmol/L with parasitaemia ≥ 100,000 /µL was 10 times higher among patients with blood groups A and 2.6 times higher in patients with blood group B, compared to blood group O. Finally, in patients with blood group A majority (71.6%) of them developed high temperature (> 37.5 °C) while 43.3% of them vomited and had diarrhoea. However, pallor (group B = 46.2% vs group A = 37.3%), fever (group B = 84.6% vs group A = 79.1%) and nausea (group B = 46.2% vs group A = 25.4%) were more frequent in patients with blood group B than A. CONCLUSIONS: This study found that people with blood groups A and B were severely affected by malaria, with group A being the most vulnerable. It is recommended that blood group assessment be performed for all patients with malaria. Patients found to have blood group A or B must be promptly and efficiently managed to avoid the development of severe malaria anaemia.
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Sistema del Grupo Sanguíneo ABO , Anemia , Malaria Falciparum , Sistema del Grupo Sanguíneo Rh-Hr , Humanos , Estudios Transversales , Masculino , Femenino , Preescolar , Niño , Ghana/epidemiología , Adulto , Malaria Falciparum/complicaciones , Malaria Falciparum/epidemiología , Malaria Falciparum/sangre , Anemia/etiología , Anemia/sangre , Anemia/epidemiología , Adolescente , Adulto Joven , Lactante , Persona de Mediana Edad , AncianoRESUMEN
MEDICAL HISTORY: A 25-year-old female outpatient presenting with fever and micro-hematuria was treated for urinary tract infection. Her condition worsened over 3 days at home. After experiencing multiple falls caused by leg weakness and mental confusion, she was admitted to a hospital with high fever. DIAGNOSTICS: Initial laboratory findings showed hemolytic anemia, pancytopenia, and acute kidney injury, suggesting hemolytic uremic syndrome. However, a detailed fever evaluation revealed her recent return from Afrika. This prompted a malaria test, which confirmed Plasmodium falciparum infection with 80â% parasitemia. THERAPY AND PROGRESS: Despite the quick reduction of parasitemia following treatment with intravenous administered artesunate and oral Artemether-Lumefantrine, her condition worsened, leading to a septic shock. This required renal replacement and kinetic ventilation therapy, as well as blood transfusions due to persistent hemolysis until the laboratory values normalized after 48 days post-admission. CONCLUSION: The evaluation of fever is often challenging, but most often a detailed patient history is key to early diagnosis and treatment preventing deathly outcomes in severe cases.
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Antimaláricos , Malaria Falciparum , Adulto , Femenino , Humanos , Antimaláricos/uso terapéutico , Combinación Arteméter y Lumefantrina/uso terapéutico , Artesunato/uso terapéutico , Malaria Falciparum/complicaciones , Malaria Falciparum/diagnóstico , Malaria Falciparum/terapia , Plasmodium falciparum/aislamiento & purificación , Choque Séptico/diagnóstico , Choque Séptico/parasitología , Choque Séptico/terapia , Tanzanía , Enfermedad Relacionada con los ViajesRESUMEN
BACKGROUND: Understanding the impact of malnutrition on innate immune response in Plasmodium falciparum (Pf)-infected subjects is critical for malaria control. AIMS AND OBJECTIVES: This study aims to investigate the nutritional status and innate immune response of Pf-infected subjects in Lagos, Nigeria. MATERIALS AND METHODS: A total of 1183 patients with a history of fever or axillary temperature ≥37°C were screened microscopically for Pf at Ijede General Hospital, Lagos, Nigeria. Malnutrition was determined according to the U.S National Center for Health Statistics (NCHS) as stunting, wasting, or underweight when the Z-score is <-2 in the participants aged <20 years. Serum levels of tumor necrosis factor-alpha (TNF-α), interleukin-1ß (IL-1ß), and IL-12 were determined by capture ELISA while hematological parameters were measured using an automated hematology system. RESULTS: A total of 384 volunteers were positive for Pf, of which 114 were <20 years with a median age of 10 years. Overall malaria prevalence was 20.89%. The malnutrition rate was 89.5%; 24 (21.05%) were stunted, 30 (26.32%) were underweight, and 48 (42.11%) were wasted. Pro-inflammatory cytokine responses were not affected by the type of malaria. TNF-α was higher in participants <5 years (P = 0.001) and in malnourished patients (P < 0.05). CONCLUSION: Together, it could be deduced that nutritional status influences Plasmodium falciparum malaria outcomes and progression pattern.
Résumé Contexte:Comprendre l'impact de la malnutrition sur la réponse immunitaire innée chez les sujets infectés par Plasmodium falciparum (Pf) est essentiel pour la lutte contre le paludisme.Buts et objectifs:Cette étude vise à étudier l'état nutritionnel et la réponse immunitaire innée des sujets infectés par Pf à Lagos, au Nigeria.Matériels et méthodes:Un total de 1183 patients ayant des antécédents de fièvre ou une température axillaire ≥37°C ont fait l'objet d'un dépistage microscopique de Pf à l'hôpital général Ijede, Lagos, Nigeria. La malnutrition a été déterminée selon le National Center for Health Statistics (NCHS) des États-Unis comme un retard de croissance, une émaciation ou une insuffisance pondérale lorsque le score Z est <-2 chez les participants âgés de moins de 20 ans. Les taux sériques de facteur de nécrose tumorale alpha (TNF-α), d'interleukine-1ß (IL-1ß) et d'IL-12 ont été déterminés par capture ELISA, tandis que les paramètres hématologiques ont été mesurés à l'aide d'un système d'hématologie automatisé.Résultats:Au total, 384 volontaires étaient positifs pour le Pf, dont 114 étaient âgés de moins de 20 ans avec un âge médian de 10 ans. La prévalence globale du paludisme était de 20,89 %. Le taux de malnutrition était de 89,5 %; 24 (21,05 %) souffraient d'un retard de croissance, 30 (26,32 %) d'une insuffisance pondérale et 48 (42,11 %) d'émaciation. Les réponses des cytokines pro-inflammatoires n'ont pas été affectées par le type de paludisme. Le TNF-α était plus élevé chez les participants de moins de 5 ans ( P = 0,001) et chez les patients souffrant de malnutrition ( P < 0,05).Conclusion:On peut en déduire que l'état nutritionnel peut influencer les résultats et le schéma de progression du paludisme.
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Citocinas , Malaria Falciparum , Desnutrición , Estado Nutricional , Plasmodium falciparum , Factor de Necrosis Tumoral alfa , Humanos , Malaria Falciparum/epidemiología , Malaria Falciparum/sangre , Malaria Falciparum/inmunología , Malaria Falciparum/complicaciones , Nigeria/epidemiología , Masculino , Femenino , Desnutrición/epidemiología , Desnutrición/sangre , Niño , Adolescente , Preescolar , Adulto , Adulto Joven , Factor de Necrosis Tumoral alfa/sangre , Citocinas/sangre , Prevalencia , Interleucina-1beta/sangre , Estudios Transversales , Lactante , Ensayo de Inmunoadsorción Enzimática , Persona de Mediana Edad , Interleucina-12/sangre , Inmunidad InnataRESUMEN
Plasmodium falciparum malaria, caused by Plasmodium falciparum infection, is an Anopheles mosquito-transmitted infectious diseases, which predominantly occurs in tropical areas of Africa. P. falciparum malaria is characterized by complex and atypical clinical manifestations, and high likelihood of misdiagnosis and missing diagnosis, and may be life-threatening if treated untimely. This case report presents the diagnosis and treatment of a P. falciparum malaria case with acute abdominal pain as the first symptom.
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Dolor Abdominal , Malaria Falciparum , Humanos , Malaria Falciparum/diagnóstico , Malaria Falciparum/complicaciones , Dolor Abdominal/etiología , Dolor Abdominal/parasitología , Masculino , Plasmodium falciparum/aislamiento & purificación , Plasmodium falciparum/fisiología , AdultoRESUMEN
Diagnostic routine and knowledge about the therapy regimes of infectious diseases like malaria gain in importance due to globalization, global warming, and increasing numbers of refugees. We report a case of a 66-year-old patient who presented with severe abdominal pain, most prominent in the left upper abdomen. He was recently hospitalized with severe falciparum malaria, diagnosed after returning from a trip around the world. Upon readmission, laboratory results showed post-artesunate delayed hemolysis. The ultrasound examination was highly suspicious of splenic rupture, confirmed by the immediately performed CT scan. In this case, the prompt diagnosis allowed the initiation of adequate conservative therapy including intensive care monitoring and hemodynamic stabilization.
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Rotura del Bazo , Humanos , Anciano , Rotura del Bazo/etiología , Rotura del Bazo/diagnóstico por imagen , Rotura del Bazo/terapia , Masculino , Malaria Falciparum/diagnóstico , Malaria Falciparum/complicaciones , Diagnóstico Diferencial , Artesunato/uso terapéutico , Tomografía Computarizada por Rayos X , Ultrasonografía , Viaje , Resultado del Tratamiento , Antimaláricos/uso terapéutico , Rotura EspontáneaRESUMEN
Background: COVID-19 and malaria cause significant morbidity and mortality globally. Co-infection of these diseases can worsen their impact on public health. This review aims to synthesize literature on the clinical outcomes of COVID-19 and malaria co-infection to develop effective prevention and treatment strategies. Methods: A comprehensive literature search was conducted using MeSH terms and keywords from the start of the COVID-19 pandemic to January 2023. The review included original articles on COVID-19 and malaria co-infection, evaluating their methodological quality and certainty of evidence. It was registered in PROSPERO (CRD42023393562). Results: Out of 1,596 screened articles, 19 met the inclusion criteria. These studies involved 2,810 patients, 618 of whom had COVID-19 and malaria co-infection. Plasmodium falciparum and vivax were identified as causative organisms in six studies. Hospital admission ranged from three to 18 days. Nine studies associated co-infection with severe disease, ICU admission, assisted ventilation, and related complications. One study reported 6% ICU admission, and mortality rates of 3%, 9.4%, and 40.4% were observed in four studies. Estimated crude mortality rates were 10.71 and 5.87 per 1,000 person-days for patients with and without concurrent malaria, respectively. Common co-morbidities included Diabetes mellitus, hypertension, cardiovascular diseases, and respiratory disorders. Conclusion: Most patients with COVID-19 and malaria co-infection experienced short-term hospitalization and mild to moderate disease severity. However, at presentation, co-morbidities and severe malaria were significantly associated with higher mortality or worse clinical outcomes. These findings emphasize the importance of early detection, prompt treatment, and close monitoring of patients with COVID-19 and malaria co-infection.
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COVID-19 , Coinfección , Malaria , SARS-CoV-2 , Humanos , COVID-19/epidemiología , COVID-19/complicaciones , COVID-19/mortalidad , Coinfección/epidemiología , Malaria/epidemiología , Hospitalización/estadística & datos numéricos , Comorbilidad , Malaria Falciparum/epidemiología , Malaria Falciparum/complicacionesRESUMEN
HISTORY: A 42-year-old female presented with a two-day history of vomiting, diarrhea, fever and chills. Two weeks before she had returned to Germany from a Safari in Tanzania. She had disregarded the recommendation to take antimalarial chemoprophylaxis. CLINICAL FINDINGS AND DIAGNOSIS: The thin blood film showed Plasmodium falciparum-parasitized erythrocytes, and Plasmodium falciparum malaria was diagnosed. The full blood count showed thrombocytopenia and ultrasound imaging revealed splenomegaly. Initially the criteria for complicated malaria were not fulfilled. THERAPY AND COURSE: We started oral therapy with atovaquone/proguanil. The patient vomited the tablets twice. Therefore therapy was switched to intravenous artesunate. Subsequently, parasitemia dropped from 2.8 to 1.0â% within 22 hours. After 3 days of artesunate i.âv., treatment could then be completed with oral atovaquone/proguanil, and the symptoms resolved. CONCLUSIONS: Patients with malaria and persistent vomiting should be treated intravenously and monitored closely, as severe gastrointestinal symptoms may reflect impending organ failure. We therefore propose including persistent vomiting in the list of criteria for complicated malaria.
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Antimaláricos , Malaria Falciparum , Malaria , Femenino , Humanos , Adulto , Proguanil/uso terapéutico , Atovacuona/uso terapéutico , Artesunato/uso terapéutico , Antimaláricos/uso terapéutico , Malaria/tratamiento farmacológico , Malaria Falciparum/complicaciones , Malaria Falciparum/diagnóstico , Malaria Falciparum/tratamiento farmacológico , Combinación de Medicamentos , Vómitos/etiologíaRESUMEN
Malaria in pregnancy has severe consequences for the mother and foetus. Antibody response to specific malaria vaccine candidates (MVC) has been associated with a decreased risk of clinical malaria and its outcomes. We studied Plasmodium falciparum (Pf) and Schistosoma haematobium (Sh) infections and factors that could influence antibody responses to MVC in pregnant women. A total of 337 pregnant women receiving antenatal care (ANC) and 139 for delivery participated in this study. Pf infection was detected by qPCR and Sh infection using urine filtration method. Antibody levels against CSP, AMA-1, GLURP-R0, VAR2CSA and Pfs48/45 MVC were quantified by ELISA. Multivariable linear regression models identified factors associated with the modulation of antibody responses. The prevalence of Pf and Sh infections was 27% and 4% at ANC and 7% and 4% at delivery. Pf infection, residing in Adidome and multigravidae were positively associated with specific IgG response to CSP, AMA-1, GLURP-R0 and VAR2CSA. ITN use and IPTp were negatively associated with specific IgG response to GLURP-R0 and Pfs48/45. There was no association between Sh infection and antibody response to MVC at ANC or delivery. Pf infections in pregnant women were positively associated with antibody response to CSP, GLURP-R0 and AMA-1. Antibody response to GLURP-R0 and Pfs48/45 was low for IPTp and ITN users. This could indicate a lower exposure to Pf infection and low malaria prevalence observed at delivery.
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Vacunas contra la Malaria , Malaria Falciparum , Esquistosomiasis Urinaria , Animales , Humanos , Femenino , Embarazo , Plasmodium falciparum , Schistosoma haematobium , Formación de Anticuerpos , Mujeres Embarazadas , Antígenos de Protozoos , Anticuerpos Antiprotozoarios , Malaria Falciparum/epidemiología , Malaria Falciparum/prevención & control , Malaria Falciparum/complicaciones , Esquistosomiasis Urinaria/epidemiología , Esquistosomiasis Urinaria/prevención & control , Esquistosomiasis Urinaria/complicaciones , Inmunoglobulina GRESUMEN
BACKGROUND: Subclinical inflammation and cognitive deficits have been separately associated with asymptomatic Plasmodium falciparum infections in schoolchildren. However, whether parasite-induced inflammation is associated with worse cognition has not been addressed. We conducted a cross-sectional pilot study to better assess the effect of asymptomatic P. falciparum parasitemia and inflammation on cognition in Kenyan schoolchildren. METHODS: We enrolled 240 children aged 7-14 years residing in high malaria transmission in Western Kenya. Children performed five fluid cognition tests from a culturally adapted NIH toolbox and provided blood samples for blood smears and laboratory testing. Parasite densities and plasma concentrations of 14 cytokines were determined by quantitative PCR and multiplex immunoassay, respectively. Linear regression models were used to determine the effects of parasitemia and plasma cytokine concentrations on each of the cognitive scores as well as a composite cognitive score while controlling for age, gender, maternal education, and an interaction between age and P. falciparum infection status. RESULTS: Plasma concentrations of TNF, IL-6, IL-8, and IL-10 negatively correlated with the composite score and at least one of the individual cognitive tests. Parasite density in parasitemic children negatively correlated with the composite score and measures of cognitive flexibility and attention. In the adjusted model, parasite density and TNF, but not P. falciparum infection status, independently predicted lower cognitive composite scores. By mediation analysis, TNF significantly mediated ~29% of the negative effect of parasitemia on cognition. CONCLUSIONS: Among schoolchildren with PCR-confirmed asymptomatic P. falciparum infections, the negative effect of parasitemia on cognition could be mediated, in part, by subclinical inflammation. Additional studies are needed to validate our findings in settings of lower malaria transmission and address potential confounders that could affect both inflammation and cognitive performance.
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Inflamación , Malaria Falciparum , Parasitemia , Plasmodium falciparum , Humanos , Niño , Malaria Falciparum/sangre , Malaria Falciparum/complicaciones , Masculino , Parasitemia/sangre , Femenino , Estudios Transversales , Adolescente , Inflamación/sangre , Kenia/epidemiología , Citocinas/sangre , Proyectos Piloto , Infecciones Asintomáticas , Disfunción Cognitiva/parasitología , Disfunción Cognitiva/sangre , Disfunción Cognitiva/etiologíaRESUMEN
Malaria is a parasitic disease transmitted by the bite of female Anopheles mosquitoes. Although domestic malaria case notification in our country is not seen in World Health Organization records, cases originating from abroad are detected. Travelers to countries where malaria is endemic can become infected with the parasite. In our country, an average of 200-250 cases of malaria originating from abroad are reported every year. Approximately 75% of malaria cases of foreign origin detected in our country are P. falciparum malaria. Malaria and salmonellosis are infections especially seen in developing countries. Although malaria-Salmonella coinfection is rare, early diagnosis and treatment are important in terms of its high mortality rate. Preliminary information and initiation of chemoprophylaxis in travels to regions where the disease is endemic remain important in transmission. In this presentation, a case was examined following a business trip to Africa without any chemoprophylaxis, who applied to a local hospital upon symptoms and was diagnosed with P. falciparum and Salmonella Typhi coinfection but given incomplete treatment. After returning to our country, the patient applying to us with complaints of high fever, chills, nausea, diarrhea and abdominal pain and was discharged with ful recovery.
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Anopheles , Coinfección , Malaria Falciparum , Animales , Femenino , Humanos , Plasmodium falciparum , Salmonella typhi , Malaria Falciparum/complicaciones , Malaria Falciparum/diagnóstico , Malaria Falciparum/tratamiento farmacológicoRESUMEN
BACKGROUND: Malaria is an infectious malady caused by Plasmodium parasites, cerebral malaria standing out as one of its most severe complications. Clinical manifestation include elevated body temperature, loss of consciousness, and seizures. However, reports of cerebral malaria presenting as nonconvulsive status epilepticus are extremely rare. The case presented involves psychiatric symptoms, with the electroencephalogram indicated nonconvulsive status epilepticus associated with cerebral malaria. CASE PRESENTATION: A 53-year-old male, was urgently admitted, due to confusion and abnormal behaviour for 10 h. The patient returned to China after developing a fever while working in Tanzania two months ago. The blood smear revealed Plasmodium vivax and Plasmodium falciparum, and he was diagnosed with malaria. He recovered following anti-malarial treatment. After admission, the patient was confused, unable to communicate normally, and unwilling to cooperate with the physical examination. Plasmodium was not found in the blood smear, but the DNA sequence of P. falciparum was discovered using metagenomic next-generation sequencing of cerebrospinal fluid. Brain MRI revealed no significant abnormalities. Continuous electroencephalogram monitoring revealed that the patient had non-convulsive status epilepticus, which was treated with diazepam and levetiracetam. The patient had normal consciousness and behaviour. He received anti-malarial treatment for two weeks and fully recovered. CONCLUSIONS: This case demonstrates that nonconvulsive status epilepticus can be a manifestation of cerebral malaria. It is imperative for attending physicians to heighten vigilance when encountering patients with a history of travel to malaria-endemic regions or a prior malaria infection, especially in the presence of unusual clinical presentations.
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Antimaláricos , Malaria Cerebral , Malaria Falciparum , Plasmodium , Estado Epiléptico , Masculino , Humanos , Persona de Mediana Edad , Malaria Cerebral/complicaciones , Malaria Cerebral/diagnóstico , Malaria Cerebral/tratamiento farmacológico , Antimaláricos/uso terapéutico , Malaria Falciparum/complicaciones , Malaria Falciparum/diagnóstico , Malaria Falciparum/tratamiento farmacológico , Estado Epiléptico/diagnóstico , Estado Epiléptico/tratamiento farmacológico , Estado Epiléptico/etiologíaRESUMEN
Reports indicate that Plasmodium infections influence methemoglobin levels. However, findings have been inconclusive or have varied across different geographic and demographic contexts. This systematic review and meta-analysis aimed to consolidate existing data regarding the association between Plasmodium infections and alterations in methemoglobin levels related to the severity of the infection. A comprehensive literature search of several databases, including Ovid, ProQuest, Embase, Scopus, MEDLINE, and PubMed, was conducted to identify relevant studies that examined methemoglobin levels in patients with malaria. Qualitative synthesis and meta-analysis of the pooled standardized mean difference were conducted to synthesize the differences in methemoglobin levels between: (1) patients with malaria and those without malaria and (2) patients with severe malaria and those with uncomplicated malaria based on various themes including publication year, study design, study area, Plasmodium species, age group, symptomatic status, severity status, and method of malaria detection. Of the 1846 studies that were initially identified from the main databases and additional searches on Google Scholar, 10 studies met the eligibility criteria and were selected for this review. The systematic review distinctly highlighted an association between malaria and elevated methemoglobin levels, an observation consistent across diverse geographical regions and various Plasmodium species. Furthermore, the meta-analysis confirmed this by demonstrating increased methemoglobin levels in patients with malaria compared to those without malaria (P < 0.001, Hedges' g 2.32, 95% CI 1.36-3.29, I2 97.27, 8 studies). Moreover, the meta-analysis found elevated methemoglobin levels in patients with severe malaria compared to those with uncomplicated malaria (P < 0.001, Hedges' g 2.20, 95% CI 0.82-3.58, I2 96.20, 5 studies). This systematic review and meta-analysis revealed increased methemoglobin levels in patients with P. falciparum and P. vivax infections, with a notable association between elevated methemoglobin levels and severe malaria. Future research should focus on elucidating the specific mechanisms by which changes in methemoglobin levels are related to infections by P. falciparum and P. vivax, particularly in terms of severity, and how these alterations could potentially impact patient management and treatment outcomes.
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Malaria Falciparum , Malaria Vivax , Malaria , Plasmodium , Humanos , Plasmodium falciparum , Plasmodium vivax , Metahemoglobina , Malaria/complicaciones , Malaria Vivax/complicaciones , Malaria Vivax/epidemiología , Malaria Vivax/diagnóstico , Malaria Falciparum/complicaciones , Gravedad del PacienteRESUMEN
Severe plasmodium falciparum infection can induce respiratory distress and clinical ARDS in children, requiring intensive care admission and respiratory support. We present 3 cases of imported malarial acute respiratory distress syndrome requiring noninvasive ventilation in the pediatric intensive care unit, in the absence of any cerebral involvement. Radiological features and their relationship with severe hematological complications are also illustrated.
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Malaria Falciparum , Malaria , Síndrome de Dificultad Respiratoria , Niño , Humanos , Malaria Falciparum/complicaciones , Cuidados Críticos , Síndrome de Dificultad Respiratoria/etiología , Síndrome de Dificultad Respiratoria/terapia , Unidades de Cuidado Intensivo PediátricoRESUMEN
PURPOSE: The study attempted to identify possible overlap between serum cell-reactive proteins (C-rp) and hematological indices as predictors of comorbidity of malaria and septicemia among children attending primary healthcare facilities in Ilorin, Nigeria. METHODS: One hundred and ninety-three children (aged: ≤ 1-15 years) presenting with symptoms suggestive of malaria were enrolled. Blood specimens were collected and screened for: Romanowsky, culture, serum C-RP and hematological indices. RESULTS: One hundred and fifteen (59.6%) children had Plasmodium falciparum infections (female 69.0% and male 34.1%). Septicemia was common among 52 (26.9%), but malaria and septicemia co-infection was 42 (36.5%). C-rp levels were low (< 10 mg/L) in 41 (35.7%, OR 4.594, CI 2.463-8.571) and high (> 10 mg/L) in 74 (64.3%, OR 2.519, CI 1.681-3.775) among the malaria positives (p < 0.05). Children with low C-rp, 8 (15.4%, OR 9.413, CI 4.116-21.531) were positive for septicemia and high C-RP 44 (84.6%, OR 1.694, CI 1.396-2.055), but without malaria, respectively. Similarly, increased C-rp levels were significantly associated with clinical malaria; > 10,000 parasites/µL (OR 1.486, CI 1.076-2.054, P < 0.001). Malaria-positive versus negative showed that PCV, C-rp, hemoglobin, platelet, WBC, and neutrophil were statistically significant (P < 0.05). Two bacteria species were identified, viz; Staphylococcus aureus 39 (54.9%) and Escherichia coli 32 (45.1%). The trade-off between sensitivity and specificity occurred at 16.475 cut-off using C-rp and degree of malaria severity as the standard for AUROC. CONCLUSION: C-rp are inflammatory markers, though non-specificity may be associated with malaria prognosis and severity during malaria-septicemia co-infection.
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Coinfección , Comorbilidad , Malaria Falciparum , Sepsis , Humanos , Nigeria/epidemiología , Masculino , Femenino , Sepsis/epidemiología , Preescolar , Lactante , Niño , Adolescente , Malaria Falciparum/epidemiología , Malaria Falciparum/complicaciones , Malaria Falciparum/parasitología , Coinfección/epidemiología , Coinfección/parasitología , Proteína C-Reactiva/análisis , Plasmodium falciparum/aislamiento & purificaciónRESUMEN
Malaria is considered an important cause of morbidity and mortality among people living with sickle cell disease (SCD). This has partly been attributed to the loss of splenic function that occurs early in the disease process. We conducted a cross-sectional study and determined the frequency of malaria infection among SCD patients and explored the association with spleen's presence on ultrasonography and spleen function assessed using the frequency of Howell-Jolly bodies (HJBs). A total of 395 participants consisting of 119 acutely-ill SCD patients, 168 steady-state SCD controls, and 108 healthy non-SCD controls were studied. The prevalence of Plasmodium falciparum parasitemia was 51.3% in acutely-ill SCD patients, 31.7% in steady-state SCD controls, and 11.0% in the healthy non-SCD controls; however, the mean parasite density was significantly higher in the non-SCD controls compared to both SCD groups (p = 0.0001). Among the acutely-ill SCD patients, the prevalence of clinical malaria and severe malaria anemia were highest in children <5 years of age. The prevalence of parasitemia (p = 0.540) and parasite density (p = 0.975) showed no association with spleen presence or absence on ultrasonography. Similarly, the frequency of HJB red cells was not associated with the presence of parasitemia (p = 0.183). Our study highlights the frequency and role of malaria infection in acutely-ill SCD patients, especially in those younger than five years. Although we have found no evidence of an increased risk of malaria parasitemia or parasite density with markers of hyposplenism, the role played by an underlying immunity to malaria among SCD patients in malaria-endemic region is not clear and needs further studies.
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Anemia de Células Falciformes , Malaria Falciparum , Malaria , Niño , Humanos , Nigeria/epidemiología , Parasitemia/epidemiología , Parasitemia/complicaciones , Parasitemia/parasitología , Estudios Transversales , Malaria/complicaciones , Malaria/epidemiología , Malaria/parasitología , Anemia de Células Falciformes/complicaciones , Malaria Falciparum/complicaciones , Malaria Falciparum/epidemiologíaRESUMEN
BACKGROUND: Imported cerebral malaria (CM) cases in non-endemic areas are often misdiagnosed, which delays treatment. Post-malaria neurological syndrome (PMNS) after recovery from severe malaria can also complicate diagnosis. CASE: We report an imported malaria case from West Africa with two sequential episodes with neurological syndromes within about a month. The first episode was diagnosed as CM with microscopy-positive Plasmodium falciparum infection. The second episode, occurring a month after the recovery from the first CM episode, was consistent with PMNS, since malaria parasites were not detected by microscopy in peripheral blood smears. However, this diagnosis was complicated by the detection of Plasmodium vivax in peripheral blood by PCR, suggesting a potential cause of the second episode by P. vivax. CONCLUSION: This study suggests that PMNS often occurs after severe falciparum malaria. Concurrent P. vivax infection with pathogenic biomass being predominantly extravascular further complicates accurate diagnosis.
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Malaria Cerebral , Malaria Falciparum , Malaria Vivax , Plasmodium , Humanos , Plasmodium falciparum , Malaria Falciparum/complicaciones , Malaria Falciparum/diagnóstico , Malaria Falciparum/parasitología , Malaria Vivax/complicaciones , Malaria Vivax/diagnóstico , Malaria Vivax/parasitología , Plasmodium vivax/genética , Malaria Cerebral/complicaciones , Malaria Cerebral/diagnósticoRESUMEN
BACKGROUND: Blackwater fever (BWF) is a severe syndrome occurring in patients with malaria upon antimalarial treatment, characterized by massive intravascular haemolysis and haemoglobinuria. BWF is a neglected condition and management recommendations are unavailable. OBJECTIVES: We performed a scoping review to appraise available data on clinical picture, treatment and physiopathology of BWF, which could guide rationally its clinical management. METHODS: MEDLINE, EMBASE, LILACS, Web of Science, and Scopus databases, and the reference list of relevant publications, were searched. Papers reporting original data on BWF cases or investigating the physiopathology of BWF were eligible. Data regarding case characteristics, trigger event, clinical management and outcome were extracted. For papers investigating the physiopathology of BWF, study design and principal findings were extracted. No quality assessment was performed. Data are presented as numbers and percentages, and summary of findings, grouped by paper focus (clinical description or physiopathology). RESULTS: 101 papers were included. The majority of BWF cases were observed in autochthonous children (75.7%) and adults (15.3%), in contrast with historical perception that BWF patients were typically expatriates. Clinical management was described for 794 cases; corticosteroids were used in 23. Outcome was reported for 535 patients, with 18.1% mortality. The trigger was reported for 552 (47.5%) cases; in 70.4% identified as quinine. However, two RCT comparing artesunate and quinine for falciparum malaria treatment did not find significant difference in BWF occurrence after their administration. Two case-control studies did not find significant difference in G6PDH deficiency between malaria patients with and without BWF. CONCLUSIONS: The physiopathology and optimal treatment of BWF remain similarly unknown as they were over a century ago. Empirical supporting treatment approach seems reasonable, while change of antimalarial drug and use of corticosteroids remain object of debate.
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Antimaláricos , Fiebre Hemoglobinúrica , Malaria Falciparum , Malaria , Niño , Adulto , Humanos , Fiebre Hemoglobinúrica/tratamiento farmacológico , Fiebre Hemoglobinúrica/epidemiología , Fiebre Hemoglobinúrica/patología , Quinina/efectos adversos , Malaria Falciparum/complicaciones , Malaria Falciparum/tratamiento farmacológico , Antimaláricos/uso terapéutico , Malaria/complicaciones , Malaria/tratamiento farmacológico , Corticoesteroides/uso terapéuticoRESUMEN
Splenomegaly frequently occurs in patients with Plasmodium falciparum (Pf) or P. vivax (Pv) malarial anemia, but mechanisms underlying this co-occurrence are unclear. In malaria-endemic Papua, Indonesia, we prospectively analyzed red blood cell (RBC) concentrations in the spleen and spleen-mimetic retention in 37 subjects splenectomized for trauma or hyperreactive splenomegaly, most of whom were infected with Plasmodium. Splenomegaly (median 357 g [range: 80-1918 g]) was correlated positively with the proportion of red-pulp on histological sections (median 88.1% [range: 74%-99.4%]; r = .59, p = .0003) and correlated negatively with the proportion of white-pulp (median 8.3% [range: 0.4%-22.9%]; r = -.50, p = .002). The number of RBC per microscopic field (>95% uninfected) was correlated positively with spleen weight in both Pf-infected (r = .73; p = .017) and Pv-infected spleens (r = .94; p = .006). The median estimated proportion of total-body RBCs retained in Pf-infected spleens was 8.2% (range: 1.0%-33.6%), significantly higher than in Pv-infected (2.6% [range: 0.6%-23.8%]; p = .015) and PCR-negative subjects (2.5% [range: 1.0%-3.3%]; p = .006). Retained RBCs accounted for over half of circulating RBC loss seen in Pf infections. The proportion of total-body RBC retained in Pf- and Pv-infected spleens correlated negatively with hemoglobin concentrations (r = -.56, p = .0003), hematocrit (r = -.58, p = .0002), and circulating RBC counts (r = -.56, p = .0003). Splenic CD71-positive reticulocyte concentrations correlated with spleen weight in Pf (r = 1.0; p = .003). Retention rates of peripheral and splenic RBCs were correlated negatively with circulating RBC counts (r = -.69, p = .07 and r = -.83, p = .008, respectively). In conclusion, retention of mostly uninfected RBC in the spleen, leading to marked congestion of the red-pulp, was associated with splenomegaly and is the major mechanism of anemia in subjects infected with Plasmodium, particularly Pf.
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Anemia , Malaria Falciparum , Malaria Vivax , Malaria , Humanos , Esplenomegalia/etiología , Eritrocitos , Anemia/complicaciones , Malaria/complicaciones , Malaria Falciparum/complicaciones , Plasmodium falciparum , Malaria Vivax/complicacionesRESUMEN
Burkitt lymphoma (BL) is an aggressive B-cell lymphoma that significantly contributes to childhood cancer burden in sub-Saharan Africa. Plasmodium falciparum, which causes malaria, is geographically associated with BL, but the evidence remains insufficient for causal inference. Inference could be strengthened by demonstrating that mendelian genes known to protect against malaria-such as the sickle cell trait variant, HBB-rs334(T)-also protect against BL. We investigated this hypothesis among 800 BL cases and 3845 controls in four East African countries using genome-scan data to detect polymorphisms in 22 genes known to affect malaria risk. We fit generalized linear mixed models to estimate odds ratios (OR) and 95% confidence intervals (95% CI), controlling for age, sex, country, and ancestry. The ORs of the loci with BL and P. falciparum infection among controls were correlated (Spearman's ρ = 0.37, p = .039). HBB-rs334(T) was associated with lower P. falciparum infection risk among controls (OR = 0.752, 95% CI 0.628-0.9; p = .00189) and BL risk (OR = 0.687, 95% CI 0.533-0.885; p = .0037). ABO-rs8176703(T) was associated with decreased risk of BL (OR = 0.591, 95% CI 0.379-0.992; p = .00271), but not of P. falciparum infection. Our results increase support for the etiological correlation between P. falciparum and BL risk.