Diarrhea in Children with Plasmodium falciparum Malaria: A Case–Control Study on the Prevalence and Response to Antimalarial Treatment

Abstract

The role of Plasmodium in the etiology of acute diarrhea in developing countries remains controversial, and gastrointestinal (GI) symptoms are inconsistently reported in malaria. In this observational case–control study, we investigated the prevalence and risk factors for GI symptoms in hospitalized malarious children aged 1 month to 5 years in northern Uganda. Children with a diagnosis of Plasmodium falciparum malaria were enrolled as cases, and feverish children in whom malaria was excluded were enrolled as controls. Among 451 malarious children, 46.1% had GI symptoms at admission. Compared with controls, the frequency of diarrhea (24.8% versus 11.2%, P < 0.001) and vomiting (35.5% versus 17.5%, P < 0.001) was significantly higher in children with malaria, who had a higher chance of showing either vomiting (odds ratio [OR]: 3.22; 95% CI: 2.14–4.91) or diarrhea (OR: 3.14; 95% CI: 1.99–5.07) at hospital admission. A subgroup analysis performed in children with severe malaria, severe anemia, or high-grade fever confirmed these results. Diarrhea was more frequent in infants and children younger than 3 years than in older children. The analysis of 71 malarious children with diarrhea who received intravenous artesunate showed that the symptom resolved within the first 24 hours since the beginning of the treatment in 85.9% of cases. The 3-fold higher prevalence of diarrhea and vomiting in malarious children compared with febrile controls may provide rationale for incorporating malaria testing in the symptom-guided diagnostic approach of the young child with diarrhea and vomiting in malaria-endemic settings.

Biomarkers of Intestinal Injury and Dysfunction: Adding New Possibilities to Current Methods for Risk Stratification of Children with Malaria Disease

“…Gastrointestinal symptoms can be frequent in malaria ( 3 , 4 ), yet there has been little interest in exploring intestinal injury and its role in SM pathogenesis. Histopathological studies of fatal cases have demonstrated intense sequestration of infected erythrocytes in the intestinal microvasculature and small bowel intussusceptions ( 5 , 6 ).…”

Detection and Epidemiological Features of Human Coronaviruses in Patients with Acute Gastroenteritis in Northern Jordan

“…Acute gastroenteritis (AGE) is a diarrheal illness that could be associated with many clinical manifestations and death worldwide and the most AGEcases in developing countries were in young children (Kotloff , 2017, Bányai et al, 2018, Lo Vecchio, 2020. Viruses are the leading cause of acute gastroenteritis globally, accounting for the majority of diagnosed acute episodes of community-acquired diarrhea.…”

Intestinal inflammation and increased intestinal permeability in Plasmodium chabaudi AS infected mice

“…Gastrointestinal symptoms are commonly noted in malaria patients, with diarrhoea reported in both travelers and those residing in malaria-endemic areas (systematically reviewed, (Sey et al, 2020)). For example, diarrhoea was reported in 25% of 451 Ugandan children hospitalised with malaria, significantly more frequently than among malaria-uninfected hospitalised children (11%) (Lo Vecchio et al, 2021) and treatment with antimalarial drugs can resolve diarrhoeal symptoms within 48 hours (Lo Vecchio et al, 2021;Sowunmi et al, 2000), suggesting, but not proving, a causal association.…”