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@#Abstract: To explore the clinical characteristics, diagnosis and treatment of imported severe malaria and COVID-19 co-infection cases, and to provide scientific basis for epidemic prevention and control measures. The epidemiological characteristics, clinical manifestations, laboratory tests, treatment process and prognosis of 4 cases of severe malaria and COVID-19 co-infection with confirmed diagnosis were analyzed retrospectively. Four cases of severe malaria were African returnees of the same batch, male, aged 40-54 years old, with the same journey track. They all had African work and life history and acute onset. The main clinical manifestations were fever (4/4), chills (3/4), chills (3/4), nausea and vomiting (3/4), diarrhea (4/4), fatigue and anorexia (4/4). Two cases had headache and dizziness, confusion, muscle aches, two cases had cough, one cases had sputum, sore throat and runny urine. All 4 cases were confirmed by positive nucleic acid detection of the new coronavirus (2019-nCOV) in throat swabs. Plasmodium falciparum was found by microscopic examination of peripheral blood smears of all patients, and all of them were consistent with high altitude helminthiasis. All cases were accompanied by abnormal liver function and severe hypoproteinemia, two cases were hyperbilirubinemia, three cases were dyslipidemia, three cases were involved in abnormal tertiary hemogram with different degrees of elevation of procalcitonin, two cases were lactic acid poisoning, and one case was hypoglycemia. One case showed viral pneumonia on chest CT. All cases were treated individually according to the different conditions and were discharged after improvement, and were rechecked for 2019-nCOV nucleic acid and microscopic examination of blood smear negative for Plasmodium.During the global COVID-19 epidemic, the emergence of coinfection cases of con-infection of imported malaria parasites and severe acuterespiratory syndrome coronavirus 2 (SARS-CoV-2) makes the clinical diagnosis and treatment more complicated. It is important to establish the awareness of simultaneous prevention and diagnosis of COVID-19 and malaria for local prevention and control and early warning of severe cases, and timely and effective formulation of treatment plan to improve the comprehensive treatment efficiency.
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This article presents a severe cerebral malaria patient in shock with a close contact of COVID-19 that was successfully cured in a negative pressure ward during the global pandemic of COVID-19. The patient experienced a sudden onset of high fever and coma in a designated isolation hotel after returning from Africa, and was transferred to a designated hospital. Following antimalarial therapy, blood pressure elevation, increase of blood volume, bedside hemodialysis, mechanical ventilation, plasma and platelet transfusions, the case gradual recovered.
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ABSTRACT The use of herbal tea with Artemisia annua by travelers and traditional communities in Africa has increased in recent years as a supposed form of malaria prophylaxis, although its use is not recommended due to lack of efficacy. The risk of severe malaria complications that can lead to death is real regarding said behavior, and awareness needs to be raised. We report a case of severe Plasmodium falciparum malaria imported in the Amazon rainforest by a traveler returning from Cameroon who treated himself with Artemisia annua herbal tea.
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Background Severe malaria is a key global public health issue, particularly in Sub-Saharan Africa, which accounts for over 80% of global malaria deaths. Rwanda has experienced about 11-fold annual increase in reported malaria cases since 2012 to 2016. Severe malaria accounted for 13,092 cases in 2015 to 17,248 cases in 2016. Objective To determine factors associated with severe malaria among patients under reference to Gihundwe and Mibilizi Hospitals. Methods A cross-sectional study that included 228 febrile patients diagnosed with malaria at Gihundwe and Mibilizi Hospitals was conducted. Data were collected from patients' files. Logistic regressions were computed to establish determinants of severe anemia. Odds ratio (OR), 95% confidence level (CI) and p-value were reported. Results The proportion of severe malaria was 64.03%. The multivariable logistic regression analysis showed that patients under five years (aOR = 8.169; 95%CI = 3.646- 18.304); being males (aOR = 2.539; 95%CI = 1.299-4.965); farmers (aOR = 2.757; 95%CI = 1.339-5.678) and limited access to health facilities (aOR = 2.740: 95%CI = 1.038-7.232) were the main factors associated with severe malaria. Conclusion Severe malaria was high with various associated factors. There is a need to strengthen malaria control and prevention interventions for young children, men and farmers. Furthermore, beside public health interventions, health facilities should be accessible to people residing in malaria endemic areas.
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La malaria representa un grave problema de salud pública en el país, por su morbilidad y mortalidad. Es importante conocer la patogenia y las manifestaciones clínicas de la malaria grave, en especial revisar el ciclo biológico del parásito, ya que la enfermedad comienza con la ruptura del esquizonte maduro, siendo las primeras manifestaciones clínicas: fiebre y anemia. La infección por Plasmodium falciparum es más severa y es mediada por el fenómeno de secuestro en la microvasculatura venosa profunda, mientras que Plasmodium vivax causa una enfermedad debilitante, rara vez mortal, pero en oportunidades se presentan manifestaciones graves que causan la muerte del paciente. Malaria grave se define por la presencia de signos clínicos y de laboratorio de disfunción de órganos vitales como sistema nervioso central, riñón, gastrointestinal, vías respiratorias y alteraciones hemodinámicas; la cual requiere el rápido reconocimiento de la enfermedad y del grado de severidad. Se debe hacer un manejo de índole general y prestar especial atención a la terapia antimalárica oportuna con Artesunato, primera línea en malaria grave, o Arthemeter o Quinina con Clindamicina según los protocolos nacionales e internacionales, para lograr una evolución satisfactoria. En consecuencia, es un reto enfrentar esta entidad y obliga a la constante actualización en las diferentes opciones cónsonas con las diferentes especies de Plasmodium patógeno.
Malaria represents a serious public health problem in the country, due to its morbidity and mortality. It is of most importance to know the pathogenesis and clinical manifestations of severe malaria, particularly to review the biological cycle of the parasite. The disease begins with the rupture of the mature schizont, with the first clinical manifestations being fever and anemia. Plasmodium falciparum infection is more severe and is mediated by the phenomenon of sequestration in the deep venous microvasculature, while Plasmodium vivax causes a debilitating disease, rarely fatal, but sometimes serious manifestations occur that cause the death of the patient. Severe malaria is defined by the presence of clinical and laboratory signs of dysfunction of vital organs such as the central nervous system, kidney, gastrointestinal, respiratory tract, and pathological hemodynamic changes that requires rapid disease recognition and degree of severity. General management and timely antimalarial therapy with Artesunate, first line in severe malaria, or Arthemeter, or Quinine with Clindamycin following national and international protocols, achieve a favorable outcome. Consequently, it is a challenge to face this entity and requires constant updating in the different options consistent with the different species of pathogenic Plasmodium.
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@#Abstract: Objective China was certified by World Health Organization as a malaria-free country in 2021. Malaria has become a rare infectious disease, and preventing the re-transmission of imported malaria and reducing deaths are the main challenges facing China after elimination of malaria. To analyze and clarify the characteristics of imported malaria deaths, and to provide prevention and treatment recommendations for overseas workers and health care workers. Methods The data of 17 imported malaria deaths in the analysis of malaria deaths from 2016 to 2020 by the National Severe Malaria Treatment Expert Group were collected, and the relevant clinical epidemiological data and disease course records were analyzed. Results The 17 malaria deaths were all imported from Africa with Plasmodium falciparum infection (malarial cerebral type), with no obvious regularity in the month of onset. Among them, 16 were male patients, 5 cases with underlying diseases such as diabetes mellitus, and 10 patients were first diagnosed in a second-level or lower hospital. Excluding patients who died of respiratory cardiac arrest in ambulances, the mean time difference between first onset and malaria diagnosis in 16 patients was 6.8 days (median 5.5 days), and the mean time between first onset and antimalarial treatment was 7.4 days (median 6 days), the mean time difference from initial onset to death was 10.3 days (median 8.5 days). Excluding cases with onset abroad and unknown time of return, all 14 patients developed the disease within 30 days after returning to China. Conclusion All the fatal cases were infected with Plasmodium falciparum imported from Africa. The patients' awareness of actively seeking medical treatment is weak, and the delay in seeking medical treatment caused by the insufficient diagnosis and treatment capacity of health institutions at the township level and below is the main reason for the deaths. It is recommended to strengthen the self-protection awareness of staff in malaria-endemic areas overseas and raise their awareness of malaria. For returnees from areas with high malaria risk, primary medical institutions should pay attention to the patient's travel history in Africa, improve the awareness of malaria diagnosis, malaria diagnosis and treatment capabilities.
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@#In Vietnam, severe malaria is currently rare but is a life-threatening disease. It may be misdiagnosed with other common diseases. This descriptive study aimed to characterize severe malaria and its clinical aspects, as well as outcomes of infected pediatric patients to improve case management. The case-series study was carried out based on medical records of children aged between one month and 15 years with malaria diagnosed by blood smear or rapid diagnostic test. Chi-squared test with the p values less than 0.05 were considered statistically significant. There were 47 cases enrolled in the study. The prevalence of severe malaria was 29.8% (57.1% in children under five). The morbidity was 71.4% in male and 28.6% in female. Common clinical signs of severe malaria were fever (100%), severe anemia (21.4%), hepatomegaly (85.7%), and splenomegaly (71.4%). Common biological abnormalities in severe malaria were anemia, thrombocytopenia, increased liver enzymes, and high CRP level. The severe malaria was mainly caused by P. falciparum (100%). The age range for those infected with P. falciparum was 6.5 ± 4.5 years (min 0.3; max 14.9). The successful rate of treatment was 92.9% with artesunate. Antimalarial treatment time was 9.0 (6 – 12) days for severe malaria, which was twice as many as that for non-severe malaria (p = 0.067). The current clinical and biological findings of severe malaria are different from those in previous times, which make it easy to be overlooked. Therefore, it’s important to perform malaria diagnostic tests when there’re clinical suggestions of severe malaria, including fever, hepatomegaly or splenomegaly.
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Background: Severe malaria is a life-threatening medical emergency and requires prompt and effective treatment to prevent death. The presentation of severe malaria varies depending on such factors as country, age, immunity, socioeconomic factors, drug resistance and type of intervention measures used. The aim of this study is to document the burden and forms of severe malaria in children in this region. Objective of this study was to determine the prevalence, clinical manifestation and outcome of children with severe malaria in Federal Teaching Hospital, GombeMethods: Case notes of patients admitted to the emergency Paediatric Unit and paediatric medical ward of Federal Teaching Hospital, Gombe with severe malaria from January 2014 to December 2018 (5years) were reviewed. Information sought included age, gender, use of ITN, parents’ education and occupation, criteria for diagnosis, treatment and outcome.Results: A total of 2,808 children were admitted during the period of study, out of these 237 (8.4%) had severe malaria. There were 140 (59.1%) male and 97 (40.9%) female with M: F of 1.4:1. Majority 129 (54.4%) of patients were aged more than 5 years. The most frequent modes of presentation were multiple convulsions 124 (52.3%), cerebral malaria 97 (40.9%) and severe anaemia 61 (25.7%). Some 45 (19.0%) of the subjects presented with multiple diagnostic criteria. Multiple convulsions, cerebral malaria and severe anaemia were significantly related to likelihood of mortality.Conclusions: The prevalence of severe malaria is high and multiple convulsions, cerebral malaria and severe anaemia are significantly associated with risk of mortality.
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@#Introduction: Malaria is the most common and widely prevalent life-threatening infectious disease in tropical and subtropical regions where it causes high rates of morbidity and mortality. Despite the successful elimination of malaria transmission in most of Saudi Arabia, the Jazan region is still considered to be a malaria-endemic area. Therefore, this study aimed at investigating the clinical profile of severe Plasmodium falciparum and P. vivax malaria in Jazan region, southwestern Saudi Arabia. Methods: A total of 25 febrile patients who presented at Sabya General Hospital and were suspected of having severe malaria were included in this study. Blood samples were collected and examined for malaria by rapid diagnostic test and by Giemsa-stained thin and thick blood films. Clinical and laboratory analyses to identify severe malaria complications were performed at the hospital. Results: In all, 76% (19/25) of the participants were infected with P. falciparum and 24% (6/25) had P. vivax. The most common complications in both groups were prostration (48%) followed by jaundice (44%) and liver dysfunction (36%). The prevalence of severe anaemia was significantly higher (P = 0.031) among P. vivax-infected patients (50%) compared with P. falciparum-infected patient (5.3%). In falciparum-infected patients, those with severe parasitaemia had a higher risk of developing prostration compared with those with low-to-moderate parasitaemia (P = 0.038). Conclusion: Most cases were caused by P. falciparum which required proper monitoring and treatment. However, those with P. vivax exhibited severe symptoms similar to those with P. falciparum.
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To isolate and characterize RNA aptamers that are specific to human CD36 protein using systematic evolution of ligands by exponential enrichment (SELEX) technology to identify candidates for adjunct therapy to reverse the binding of Plasmodiuminfected erythrocytes. Methods: RNA aptamers were isolated using nitrocellulose membrane-based SELEX and binding analysis was screened using an electrophoretic mobility shift assay and enzyme-linked oligonucleotide assay. Results: Thirteen cycles of nitrocellulose membrane-based SELEX yielded three aptamers (RC60, RC25, RC04) exhibiting high binding against CD36 protein as shown on electrophoretic mobility shift assay. The sequence analysis revealed a G-quadruplex sequence within all the isolated aptamers that might contribute to aptamer binding and thermodynamic stability. The specificity assay further showed that RC60 and RC25 were highly specific to CD36. The competitive inhibition assay demonstrated that RC60 and RC25 shared a similar binding epitope recognized by mAb FA6-152, a specific monoclonal antibody against CD36. Conclusions: RC60 and RC25 are promising candidates as anticytoadherence for severe malaria adjunct therapy.
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@#Malaria is a parasitic disease that is caused by the Plasmodium parasite. Worldwide, it remains a significant public health problem especially in the Africa region where it contributes to more than 90% of cases and malaria death. However, zoonotic (simian) Plasmodium knowlesi parasite is a widely prevalent cause of malaria in the South East Asian countries. It is known to cause severe human disease due to its 24hour erythrocytic cycles. Thus far, cases of severe falciparum malaria have been reported in asplenic patients. Here, we report a case of severe P.knowlesi malaria in a 51-year-old man who is a postsplenectomy patient.
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Objective: To isolate and characterize RNA aptamers that are specific to human CD36 protein using systematic evolution of ligands by exponential enrichment (SELEX) technology to identify candidates for adjunct therapy to reverse the binding of Plasmodium-infected erythrocytes. Methods: RNA aptamers were isolated using nitrocellulose membrane-based SELEX and binding analysis was screened using an electrophoretic mobility shift assay and enzyme-linked oligonucleotide assay. Results: Thirteen cycles of nitrocellulose membrane-based SELEX yielded three aptamers (RC60, RC25, RC04) exhibiting high binding against CD36 protein as shown on electrophoretic mobility shift assay. The sequence analysis revealed a G-quadruplex sequence within all the isolated aptamers that might contribute to aptamer binding and thermodynamic stability. The specificity assay further showed that RC60 and RC25 were highly specific to CD36. The competitive inhibition assay demonstrated that RC60 and RC25 shared a similar binding epitope recognized by mAb FA6-152, a specific monoclonal antibody against CD36. Conclusions: RC60 and RC25 are promising candidates as anti-cytoadherence for severe malaria adjunct therapy.
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Background: Malaria is a global health problem leading to huge morbidity and mortality. India accounts for 4% of global malaria cases and 52% of malaria deaths outside the African region. A disease that was relatively unknown in Mangaluru till 1990, has shown consistent rise till 2015 killing nearly 300 people. Though, declining trends are being observed since 2015, yet its incidence continues to be high. Present study was undertaken to study clinical as well as epidemiological factors associated with malaria transmission in Mangaluru.Methods: A record based retrospective study was conducted in A J Institute of Medical Sciences and Research Centre Mangaluru tertiary care hospital. The data was retrieved from the Medical Record Department of the hospital for three years i.e. 2015 to 2017 and analysed.Results: A total of 1779 confirmed cases of malaria were admitted during the study period. Out of these 1309 (73.58%) cases were due P. vivax, 73 (04.10%) cases due to P. falciparum 306 (17.20%) cases had mixed infections while species of remaining 91 (05.11%) cases remained unspecified. A peak in the number of inpatients was seen in June while mean duration of hospital stay was 5.17±3.31 days. A total of 252 (14.16%) patients had one or more severe manifestations of malaria as per WHO guidelines.Conclusions: The present study reveals that majority of admitted malaria cases were young adult males belonged to urban area. Majority of the cases were infected by Plasmodium vivax or had mixed infections.
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BACKGROUND Despite treatment with effective antimalarial drugs, the mortality rate is still high in severe cases of the disease, highlighting the need to find adjunct therapies that can inhibit the adhesion of Plasmodium falciparum-infected erythrocytes (Pf-iEs). OBJECTIVES In this context, we evaluated a new heparan sulfate (HS) from Nodipecten nodosus for antimalarial activity and inhibition of P. falciparum cytoadhesion and rosetting. METHODS Parasite inhibition was measured by SYBR green using a cytometer. HS was assessed in rosetting and cytoadhesion assays under static and flow conditions using Chinese hamster ovary (CHO) and human lymphatic endothelial cell (HLEC) cells expressing intercellular adhesion molecule-1 (ICAM1) and chondroitin sulfate A (CSA), respectively. FINDINGS This HS inhibited merozoite invasion similar to heparin. Moreover, mollusk HS decreased cytoadherence of P. falciparum to CSA and ICAM-1 on the surface of endothelial cells under static and flow conditions. In addition, this glycan efficiently disrupted rosettes. CONCLUSIONS These findings support a potential use for mollusk HS as adjunct therapy for severe malaria.
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Plasmodium falciparum , Malaria, Falciparum , Receptors, Cytoadhesin , Heparitin Sulfate , MolluscaABSTRACT
Background: Malaria is fast emerging as a number one infectious disease with high morbidity and mortality across the globe. It’s being transmitted across 108 countries containing 3 billion populations (40% of world’s populations) with more than 3 million deaths per year. India is an endemic country for malaria with an estimated 70-100 million1 cases per year. 45-50% of them are due to Plasmodium falciparum (Pf). Pf is responsible for majority of severe and fatal malaria though death due to Plasmodium vivax mono infection have also been reported. Symptoms and sign are highly non-specific in malaria making it more of a clinical diagnosis more than a laboratory diagnosis. Presentation may vary at times and can be quite confusing as malaria is a multisystem disease. Authors’ idea was to study the variable manifestations in confirmed cases of malaria patients at our hospitalMethods: A hospital based cross sectional study was conducted for a period of one year-from 01-08-2015 to 31-07-2016 based on authors’ hospitals records (case sheets with demography profile, clinical features, investigations and treatment outcome).Results: A total of 369 patients positive for malaria parasite were included in the study. 369 were smear positive-219 positive for Plasmodium vivax, 127 were P. falciparum type and 23 were for both. Majority were males (64.50%) and belonged to the age group of 21-50 years (58.84%). They were admitted in post monsoon months (60.43%). Of them 46.44% had classical symptoms of malaria. All the patients had received mainly artemisinin combination therapy (ACT) and 91.87% patients recovered in 7-28 days. The mortality rate was nearly 5.69%.Conclusions: The present study was useful to know the varied manifestations of malaria and hence will be useful in making a clinical diagnosis of malaria.
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Objective To retrospectively analyze the epidemic situation and diagnosis and treatment of severe falciparum malaria in Nantong City, summarize the causes of severe falciparum malaria, and evaluate the effect of diagnosis and treatment, so as to provide the evidence for formulating the practical treatment measures for this disease. Methods All the data of falciparum malaria cases in Nantong City from 2009 to 2016 were collected and analyzed for the onset time, diagnosis process and treatment of the disease. Results A total of 359 malaria cases, including 289 falciparum malaria cases, were reported in Nantong City from 2009 to 2016, including 26 severe falciparum malaria cases. All the severe falciparum malaria cases were imported from Africa, including 57.70% of cases (15/26) from Angola. All of them were male labor exporting personnel. The incidence of malaria was not obviously seasonal. The average time from onset to definite diagnosis was 5.2 days, and 11 cases were diagnosed 5 days after the onset. All the 26 cases were cured by anti-malaria treatment and symptomatic treatment, and there was no death. Conclusions Severe falciparum malaria seriously harm the people’s health and its clinical manifestations are complicated. Therefore, the training of medical staff and health education in residents, especially in labor exporting personnel, should be further strengthened.
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Objective To retrospectively analyze the epidemic situation and diagnosis and treatment of severe falciparum malaria in Nantong City, summarize the causes of severe falciparum malaria, and evaluate the effect of diagnosis and treatment, so as to provide the evidence for formulating the practical treatment measures for this disease. Methods All the data of falciparum malaria cases in Nantong City from 2009 to 2016 were collected and analyzed for the onset time, diagnosis process and treatment of the disease. Results A total of 359 malaria cases, including 289 falciparum malaria cases, were reported in Nantong City from 2009 to 2016, including 26 severe falciparum malaria cases. All the severe falciparum malaria cases were imported from Africa, including 57.70% of cases (15/26) from Angola. All of them were male labor exporting personnel. The incidence of malaria was not obviously seasonal. The average time from onset to definite diagnosis was 5.2 days, and 11 cases were diagnosed 5 days after the onset. All the 26 cases were cured by anti-malaria treatment and symptomatic treatment, and there was no death. Conclusions Severe falciparum malaria seriously harm the people’s health and its clinical manifestations are complicated. Therefore, the training of medical staff and health education in residents, especially in labor exporting personnel, should be further strengthened.
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Abstract INTRODUCTION Renal damage is a consequence of severe malaria, and is generally caused by sequestration of Plasmodium falciparum -infected erythrocytes in the renal microcirculation, which leads to obstruction, hypoxia, and ischemia. This triggers high mobility group box 1 (HMGB1) to send a danger signal through toll-like receptors 2 and 4. This signal up-regulates inducible nitric oxide (iNOS) and nitrotyrosine to re-perfuse the tissue, and also increases heat shock protein 70 (HSP70) expression. As no study has examined the involvement of intracellular secondary molecules in this setting, the present study compared the renal expressions of HSP70, HMGB1, iNOS, and nitrotyrosine between mice suffered from severe malaria and normal mice. METHODS C57BL/6 mice were divided into an infected group (intraperitoneal injection of 10 6 P. berghei ANKA) and a non-infected group. Renal damage was evaluated using hematoxylin eosin staining, and immunohistochemistry was used to evaluate the expressions of HSP70, HMGB1, iNOS, and nitrotyrosine. RESULTS Significant inter-group differences were observed in the renal expressions of HSP70, HMGB1, and iNOS (p=0.000, Mann-Whitney test), as well as nitrotyrosine (p=0.000, independent t test). The expressions of HSP70 and HMGB1 were strongly correlated (p=0.000, R=1.000). No correlations were observed between iNOS and HMGB, HMGB1 and nitrotyrosine, HSP70 and nitrotyrosine, or iNOS and nitrotyrosine. CONCLUSIONS It appears that HMGB1, HSP70, iNOS, and nitrotyrosine play roles in the renal damage that is observed in mice with severe malaria. Only HSP70 expression is strongly correlated with the expression of HMGB1.
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Animals , Female , Tyrosine/antagonists & inhibitors , HSP70 Heat-Shock Proteins/metabolism , HMGB1 Protein/metabolism , Nitric Oxide Synthase Type II/metabolism , Acute Kidney Injury/parasitology , Malaria/complications , Malaria/metabolism , Tyrosine/metabolism , Severity of Illness Index , Disease Models, Animal , Mice , Mice, Inbred C57BLABSTRACT
Objective: To investigate clinically severe malaria patients with Plasmodium falciparum (P. falciparum), Plasmodium vivax (P. vivax) and mixed species infections. Methods: This study was conducted at Dr. Saiful Anwar General Hospital, Malang, Indonesia, from December 2011 to May 2013. Twenty nine patients (mean age of 41 years, 22% female), who suffered from severe malaria according to World Health Or-ganization criteria (major and minor) and other criteria based on previous studies, were selected by consecutive sampling. Blood samples were obtained at admission from pe-ripheral blood for microscopic diagnostic, nested PCR and laboratory examination of blood chemistry. Laboratory results were compared between the groups and correlated to each other. Results: From 29 samples, eight (28%) were diagnosed as P. falciparum mono-infection, 12 (41%) as P. vivax mono-infection and nine (31%) as mixed infections, confirmed by PCR. Cerebral malaria occurred in P. falciparum or mixed species infection only. Para-sitaemia was highest in P. falciparum mono-infection. Mean haemoglobin was signifi-cantly lower in P. falciparum than P. vivax infection (P=0.01). Mean thrombocyte count (77 138/mL) was low in all groups. Mean urea, creatinine, total and direct bilirubin were significantly higher in P. falciparum mono-infection compared to other groups, whereas aspartate aminotransferase and alanine aminotransferase showed no significant differ-ences. Parasitaemia was positively correlated with an increase in urea, creatinine, bilirubin and leucocytosis in all species. Conclusions: Both Plasmodium species can solely or in combination cause severe ma-laria. Mixed infection was generally more benign than P. falciparum mono-infection and seemed to have some protective effects.
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Objective To investigate clinically severe malaria patients with Plasmodium falciparum (P. falciparum), Plasmodium vivax (P. vivax) and mixed species infections. Methods This study was conducted at Dr. Saiful Anwar General Hospital, Malang, Indonesia, from December 2011 to May 2013. Twenty nine patients (mean age of 41 years, 22% female), who suffered from severe malaria according to World Health Organization criteria (major and minor) and other criteria based on previous studies, were selected by consecutive sampling. Blood samples were obtained at admission from peripheral blood for microscopic diagnostic, nested PCR and laboratory examination of blood chemistry. Laboratory results were compared between the groups and correlated to each other. Results From 29 samples, eight (28%) were diagnosed as P. falciparum mono-infection, 12 (41%) as P. vivax mono-infection and nine (31%) as mixed infections, confirmed by PCR. Cerebral malaria occurred in P. falciparum or mixed species infection only. Parasitaemia was highest in P. falciparum mono-infection. Mean haemoglobin was significantly lower in P. falciparum than P. vivax infection (P = 0.01). Mean thrombocyte count (77 138/μL) was low in all groups. Mean urea, creatinine, total and direct bilirubin were significantly higher in P. falciparum mono-infection compared to other groups, whereas aspartate aminotransferase and alanine aminotransferase showed no significant differences. Parasitaemia was positively correlated with an increase in urea, creatinine, bilirubin and leucocytosis in all species. Conclusions Both Plasmodium species can solely or in combination cause severe malaria. Mixed infection was generally more benign than P. falciparum mono-infection and seemed to have some protective effects.