Diagnosis, Clinical Presentation, and In-Hospital Mortality of Severe Malaria in HIV-Coinfected Children and Adults in Mozambique

Hendriksen, Ilse C. E.; Ferro, Josefo; Montoya, Pablo; Chhaganlal, Kajal; Seni, Amir Hussein Abubacar; Gomes, Ermelinda; Silamut, Kamolrat; Lee, Sue J.; Lucas, Marcelino; Chotivanich, Kesinee; Fanello, Caterina; Day, Nicholas P. J.; White, Nicholas J.; Seidlein, Lorenz von; Dondorp, Arjen M.

doi:10.1093/cid/cis590

Cited by 34 publications

(46 citation statements)

References 42 publications

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“…In a previous study in Zambia, cases of severe malaria could not be confirmed in patients coinfected with HIV due to similarity of their clinical presentations with several opportunistic infections in AIDS patients (Chalwe et al, 2009). In another two prospective studies of severe malaria from Mozambique and Zambia both suggested that HIV-infected adults have a higher malaria case-fatality rate (Chalwe et al, 2009;Hendriksen et al, 2012). Hochman and Kim, 2009, claimed that HIV infection tends to increase episodes of symptomatic malaria and risk of severe or complicated malaria including death in both children and adults.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of malaria and HIV coinfection and influence of HIV infection on malaria disease severity in population residing in malaria endemic area along the Thai–Myanmar border

et al. 2015

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Section: Discussionmentioning

confidence: 99%

Prevalence of malaria and HIV coinfection and influence of HIV infection on malaria disease severity in population residing in malaria endemic area along the Thai–Myanmar border

et al. 2015

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“…Severe malaria in HIV co‐infected patients presents with higher parasite burden, more complications and more frequent comorbidity and carries a higher case‐fatality rate (Hendriksen et al . ). Caution is needed when attributing complications to P. falciparum infection, as HIV immunosuppression also increases susceptibility to many of the opportunistic infections that cause clinical illnesses that might be mistakenly attributed to malaria in populations with a high prevalence of incidental parasitaemia.…”

Section: Section 3: Clinical Features Of Severe Falciparum Malaria Inmentioning

confidence: 97%

“…; Hendriksen et al . ). Obtaining a parasitological diagnosis does not resolve the diagnostic problem, especially in high transmission areas, where asymptomatic parasitaemia is common and may be incidental in any severe illnesses (Gwer et al .…”

Section: Section 9: Clinical and Laboratory Diagnosis Of Severe Malariamentioning

confidence: 97%

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Severe Malaria

2014

Tropical Med Int Health

465

354

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Fever and diarrhea developed in a 34-year-old Swiss man two weeks after his return from Madagascar. Before his visit he had not taken any prophylactic antimalarial drugs. Despite self-treatment with ciprofloxacin and metronidazole, he remained febrile. He also reported hematuria and dark urine. On admission, his temperature was 39.2°C and his vital signs and mental status were normal. The abdomen was tender, and the spleen was palpable 15 cm below the costal margin. The hemoglobin level was 12.4 g per deciliter, the hematocrit was 35 percent, the white-cell count was 8500 per cubic millimeter, and the platelet count was 15,000 per cubic millimeter. The creatinine level was 2.6 mg per deciliter (234 µmol per liter), the lactate dehydrogenase level was 1920 U per liter (normal, 187 to 443), and the bilirubin level was 11.5 mg per deciliter (197 µmol per liter); the results of other liver-function tests were in the normal range. Examination of blood smears showed severe infestation with Plasmodium falciparum, with 70 to 80 percent of red cells containing up to five parasites (small ring forms) per cell (long arrow in Panel A). Other features of P. falciparum that were present included chromatin dots (arrowheads in Panel A) and appliqué forms (short arrow in Panels A and B; Wright's stain, ¬1000). About 70 percent of the neutrophils contained hemozoin (shown in a band form [long arrows] in Panel B). The patient was treated with intravenous quinine sulfate and exchange transfusions, with dramatic improvement. The degree of parasitemia fell to 65 percent after the first exchange transfusion and to 8 percent after the second. The patient's course was complicated by acute renal failure, the acute respiratory distress syndrome, and spontaneous rupture of the spleen, necessitating continuous hemofiltration, mechanical ventilation, and laparotomy with splenectomy. Despite these complications , the patient was able to return home within three months and was well at the last follow-up visit.

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“…While there is increased mortality in adults co-infected with malaria and HIV in areas with unstable malaria transmission, this phenomenon has not been established in areas with stable malaria transmission [13], [14], [15], [16].…”

Section: Introductionmentioning

confidence: 99%

Increased Severity and Mortality in Adults Co-Infected with Malaria and HIV in Maputo, Mozambique: A Prospective Cross-Sectional Study

et al. 2014

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BackgroundCo-infection with falciparum malaria and HIV-1 increases the severity and mortality of both infections in unstable malaria-transmission areas. In contrast, in stable transmission areas, HIV co-infection increases the severity of both infections but has not been found to influence malaria mortality.MethodsIn a prospective cross-sectional study, clinical and laboratory data were consecutively collected for all adults admitted with fever and/or suspected malaria to the medical department of the Central Hospital of Maputo, Mozambique, during two malaria seasons from January 2011. Malaria and HIV PCRs were performed, and risk factors for fatal outcomes were analysed. The impact of HIV on the clinical presentation and mortality of malaria was assessed.FindingsA total of 212 non-pregnant adults with fever and/or suspected malaria and 56 healthy controls were included in the study. Of the 131 patients with confirmed falciparum malaria, 70 were co-infected with HIV-1. The in-hospital mortality of the co-infected patients was 13.0% (9/69) compared with 1.7% (1/59) in the patients without HIV (p = 0.018). Malaria severity (p = 0.016) and co-infection with HIV (p = 0.064) were independent risk factors for death although the association with HIV did not reach statistical significance. The co-infected patients had significantly more frequent respiratory distress, bleeding disturbances, hypoglycaemia, liver and renal failure and high malaria parasitemia compared with the patients with malaria alone.InterpretationsHIV co-infection is associated with increased disease severity in and mortality from malaria in an area of stable malaria transmission. This finding was not observed earlier and should motivate doctors working in malaria-endemic areas to consider early HIV testing and a closer follow-up of patients with malaria and HIV co-infection.

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Diagnosis, Clinical Presentation, and In-Hospital Mortality of Severe Malaria in HIV-Coinfected Children and Adults in Mozambique

Cited by 34 publications

References 42 publications

Prevalence of malaria and HIV coinfection and influence of HIV infection on malaria disease severity in population residing in malaria endemic area along the Thai–Myanmar border

Prevalence of malaria and HIV coinfection and influence of HIV infection on malaria disease severity in population residing in malaria endemic area along the Thai–Myanmar border

Severe Malaria

Increased Severity and Mortality in Adults Co-Infected with Malaria and HIV in Maputo, Mozambique: A Prospective Cross-Sectional Study

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