Clinical Factors for Severity of Plasmodium falciparum Malaria in Hospitalized Adults in Thailand

Abstract

Plasmodium falciparum is a major cause of severe malaria in Southeast Asia, however, there is limited information regarding clinical factors associated with the severity of falciparum malaria from this region. We performed a retrospective case-control study to compare clinical factors and outcomes between patients with severe and non-severe malaria, and to identify clinical factors associated with the requirement for intensive care unit (ICU) admission of patients with severe falciparum malaria among hospitalized adults in Southeast Asia. A total of 255 patients with falciparum malaria in the Hospital for Tropical Diseases in Bangkok, Thailand between 2006 and 2012 were included. We identified 104 patients with severe malaria (cases) and 151 patients with non-severe malaria (controls). Patients with falciparum malaria with following clinical and laboratory characteristics on admission (1) referrals, (2) no prior history of malaria, (3) body temperature of >38.5°C, (4) white blood cell counts >10×109/µL, (5) presence of schizonts in peripheral blood smears, and (6) albumin concentrations of <3.5 g/dL, were more likely to develop severe malaria (P<0.05). Among patients with severe malaria, patients who met ≥3 of the 2010 WHO criteria had sensitivity of 79.2% and specificity of 81.8% for requiring ICU admission. Multivariate analysis identified the following as independent associated factors for severe malaria requiring ICU admission; (1) ethnicity of Thai [odds ratio (OR) = 3.601, 95% confidence interval (CI) = 1.011–12.822] or Myanmar [OR = 3.610, 95% CI = 1.138–11.445]; (2) referrals [OR = 3.571, 95% CI = 1.306–9.762]; (3) no prior history of malaria [OR = 5.887, 95% CI = 1.354–25.594]; and (4) albumin concentrations of <3.5 g/dL [OR = 7.200, 95% CI = 1.802–28.759]. Our findings are important for the clinical management of patients with malaria because it can help early identification of patients that could develop severe malaria and require ICU admission. Early identification and the timely initiation of appropriate treatments may well improve the outcomes and reduce the mortality of these patients.

Description of Plasmodium falciparum infections in central Gabon demonstrating high parasite densities among symptomatic adolescents and adults

“…Approximately one-third of the participants had anaemia, which may be related to the presence of a P. falciparum infection. The majority of anaemic individuals had haemoglobin values between 6 and 10 g/dl with only a few participants having severe anaemia, similar to reports in Cameroon and Thailand [30, 31]. No other infections were found in the participants, but nutritional deficiencies and malaria are recognized as the main causes of anaemia in African children [32].…”

FalciparumMalaria as an Emerging Cause of Fever in Adults Living in Gabon, Central Africa

“…The majority of anaemic individuals had low anaemia like that reported in other settings [34]. According to WHO, a severe public health problem is a disease with a prevalence greater than 40% in any group.…”

“…Nineteen percent of hospitalized patients had WHO-defined severe falciparum malaria. A higher frequency was reported in adults from Asia and non-malaria-endemic settings [ 33 , 34 ]. Studies performed the last 20 years confirm the lowest prevalence of SM in African population who already experienced malaria episodes [ 33 – 35 ].…”

Circulating microRNAs in malaria infection: bench to bedside

“…The 2000 World Health Organization (WHO) malaria case classification categorized the severity of malaria into severe ( P. falciparum) and uncomplicated malaria [ 6 , 7 ]. Diagnosis of severe malaria is evaluated if the condition is caused by P. falciparum infection with one or more of the followings: coma (cerebral malaria), metabolic acidosis, organ failure, and severe anaemia [ 8 , 9 ]. High-risk factors for severe malaria are non-immune patients, immune-compromised patients, and those with a high burden of malaria parasites.…”