Clinicopathological study of potential biomarkers of Plasmodium falciparum malaria severity and complications

Bhardwaj, Nitin; Ahmed, Zohaib; Sharma, Supriya; Srivastava, Bina; Pande, Veena; Anvikar, Anupkumar R.

doi:10.1016/j.meegid.2019.104046

Cited by 5 publications

(11 citation statements)

References 40 publications

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“…A total of 156 studies were assessed in full text, of which 43 fulfilled the inclusion criteria. The studies were divided in two major categories, the first involving 17 clinical studies [31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47] and the second 26 case reports and series of cases (Figure 1).…”

Section: Resultsmentioning

confidence: 99%

“…Fifteen studies assessed infection with P. falciparum, of which a majority examined severe malaria cases (n = 13). 31,32,[34][35][36]39,[41][42][43][44][45][46][47] Studies were conducted in Southeast Asia (n = 6), 31,32,34,37,38,41 Germany (n = 5), 35,36,39,40,42 Africa (n = 5), [43][44][45][46][47] and South America (n = 1). 33 The most commonly reported cardiovascular parameters are displayed in Table 2.…”

Section: Resultsmentioning

confidence: 99%

“…This is supported by Egger's tests, which indicated publication bias in studies reporting on ECG and cardiac biomarkers. Lack of systematic reporting, different objectives, and use of different control groups (healthy 31,33,35,36 versus uncomplicated malaria 32,39,41 ) may have affected our results. Malaria is not a uniform disease; it may therefore be controversial to include several species in the same study.…”

Section: Discussionmentioning

confidence: 98%

“…Those are the same parameters that we found affected in a majority of clinical studies of P. falciparum patients on admission. 31,32,[34][35][36][39][40][41][42][43][44][45][46][47]57 Although the definition of severe malaria includes cardiovascular collapse, this commonly refers to algid malaria, 79 a state of circulatory shock accompanied by bacteremia. As stated by the WHO, the presence of myocardial dysfunction and left ventricular impairment is considered very rare in severe malaria.…”

Section: Discussionmentioning

confidence: 99%

“…34,44 We found that studies included a wide range of biomarkers (Table 2), and that several studies lacked to provide cutoff values for categorizing biomarkers as elevated. 31,[33][34][35][36]38,43 Only four of seven studies with echocardiography reported on the LVEF, 33,34,42,43 which is a key ultrasonographic parameter. Also, studies failed to provide the diagnostic method for malaria 39 and parasite density.…”

Section: Discussionmentioning

confidence: 99%

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Prevalence of Cardiovascular Complications in Malaria: A Systematic Review and Meta-Analysis

Gomes

Marinho

Silvestre

et al. 2021

The American Journal of Tropical Medicine and Hygiene

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Recent studies have suggested that malaria may affect the cardiovascular system. The aim of this systematic review and meta-analysis was to determine the prevalence of cardiovascular complications in symptomatic malaria patients. We searched databases such as Pubmed, Embase, Cochrane, and Web of Science (January 1950–April 2020) for studies reporting on cardiovascular complications in adults and children with malaria. Cardiovascular complications were defined as abnormalities in electrocardiogram (ECG), cardiac biomarkers, and echocardiography on admission or during outpatient examination. Studies of patients with known heart disease or cardiovascular evaluation performed after the start of intravenous antimalarial medication were excluded. The study was registered in PROSPERO (No.: CRD42020167672). The literature search yielded 1,243 studies, and a total of 43 studies with symptomatic malaria patients were included. Clinical studies (n = 12 adults; n = 5 children) comprised 3,117 patients, of which a majority had Plasmodium falciparum (n = 15) and were diagnosed with severe malaria (n = 13). In random-effects models of adults, the pooled prevalence estimate for any cardiovascular complication was 7% (95% CI: 5–9). No meta-analysis was conducted in children, but the range of abnormal ECG was 0–8%, cardiac biomarkers 0–57%, and echocardiography 4–9%. We analyzed 33 cases (n = 10 postmortem), in which the most common cardiovascular pathologies were myocarditis and acute coronary syndrome. All histopathological studies found evidence of parasitized red blood cells in the myocardium. Cardiovascular complications are not uncommon in symptomatic adults and children with malaria. Additional studies investigating malaria and cardiovascular disease are encouraged.

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