HIV Infection, Malnutrition, and Invasive Bacterial Infection among Children with Severe Malaria

Berkley, James A.; Bejon, Philip; Mwangi, Tabitha; Gwer, Samson; Maitland, Kathryn; Williams, Thomas N.; Mohammed, Shebe; Osier, Faith; Kinyanjui, Samson; Fegan, Greg; Lowe, Brett; English, Mike; Peshu, Norbert; Marsh, Kevin; Newton, Charles R.

doi:10.1086/600299

Cited by 139 publications

(142 citation statements)

References 40 publications

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“…falciparum [26]. While this relationship is likely bidirectional, our study supports previous literature suggesting that malnutrition significantly worsens the outcome of infectious disease and implicates vivax malaria as not only a potential cause of malnutrition, but also a subsequent precipitating cause of death in those with significant malnutrition [16].…”

Section: Discussionsupporting

confidence: 87%

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Mortality attributable to Plasmodium vivax malaria: a clinical audit from Papua, Indonesia

Douglas

Pontororing²,

Lampah³

et al. 2014

BMC Medicine

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Background: Plasmodium vivax causes almost half of all malaria cases in Asia and is recognised as a significant cause of morbidity. In recent years it has been associated with severe and fatal disease. The extent to which P. vivax contributes to death is not known. Methods: To define the epidemiology of mortality attributable to vivax malaria in southern Papua, Indonesia, a retrospective clinical records-based audit was conducted of all deaths in patients with vivax malaria at a tertiary referral hospital. Results: Between January 2004 and September 2009, hospital surveillance identified 3,495 inpatients with P. vivax monoinfection and 65 (1.9%) patients who subsequently died. Charts for 54 of these 65 patients could be reviewed, 40 (74%) of whom had pure P. vivax infections on cross-checking. Using pre-defined conservative criteria, vivax malaria was the primary cause of death in 6 cases, a major contributor in 17 cases and a minor contributor in a further 13 cases. Extreme anaemia was the most common primary cause of death. Malnutrition, sepsis with respiratory and gastrointestinal manifestations, and chronic diseases were the commonest attributed causes of death for patients in the latter two categories. There were an estimated 293,763 cases of pure P. vivax infection in the community during the study period giving an overall minimum case fatality of 0.12 per 1,000 infections. The corresponding case fatality in hospitalised patients was 10.3 per 1,000 infections. Conclusions: Although uncommonly directly fatal, vivax malaria is an important indirect cause of death in southern Papua in patients with malnutrition, sepsis syndrome and chronic diseases, including HIV infection.

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Section: Discussionsupporting

confidence: 87%

“…Overall, the most prominent manifestation of severity was respiratory distress which was present in 74% (26) of the 35 patients in whom this could be assessed. In total, 83% (19/23) of children (≤15 years) had respiratory distress compared with 58% (7/12) of adults; P = 0.36.…”

Section: The Death Auditmentioning

confidence: 99%

Mortality attributable to Plasmodium vivax malaria: a clinical audit from Papua, Indonesia

Douglas

Pontororing²,

Lampah³

et al. 2014

BMC Medicine

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“…A general impairment in monocyte phagocytosis may contribute to increased susceptibility to invasive bacterial infections, a known complication of malaria in children (67)(68)(69). Impairment in neutrophil killing of nontyphoidal Salmonella has been observed following uncomplicated falciparum malaria in African children (51), but this impairment is related to defects in oxidative killing due to malaria-induced changes in heme-oxygenase 1 expression during myeloid cell development and not to phagocytosis.…”

Section: Cd16mentioning

confidence: 99%

Monocyte dysregulation and systemic inflammation during pediatric falciparum malaria

Dobbs¹,

Embury²,

Vulule³

et al. 2017

JCI Insight

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“…nvasive bacterial infections have been associated with high mortality in children with severe malaria in sub-Saharan Africa (1)(2)(3)(4)(5). Recently, malaria has been shown to strongly predispose children in areas of malaria endemicity to bacteremia (6).…”

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confidence: 99%

Bacterial Coinfections in Travelers with Malaria: Rationale for Antibiotic Therapy

et al. 2013

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e Malaria predisposes children in areas where malaria is endemic to concurrent bacteremia, often with severe outcomes. The importance of bacterial coinfections in patients diagnosed with malaria in nonendemic settings has, however, not been reported. A retrospective analysis of microbiology data was performed in 755 travelers diagnosed with malaria in Sweden. Bacterial cultures from blood and other locations were correlated to clinical outcome and antibiotic treatment. Blood cultures were drawn from 417 (55%) patients (88% of whom were >15 years old), and bacterial isolates of clinical relevance (Salmonella enterica serovar Enteritidis and Escherichia coli) were detected in 2 patients (0.3%). Cultures from other locations (mainly urine, nasopharyngeal, and fecal samples) were obtained from 44% of the patients with 4.9% positivity. Of the 38 patients given antibiotics, 47% had neither severe malaria nor positive cultures and/or radiology signs indicative of treatment. C-reactive protein levels were associated with bacterial infections but had only a fair predictive value. Bacterial coinfections are uncommon among travelers with malaria. These data suggest a weaker association between malaria and bacteremia than previously described in endemic settings and might indicate different patient populations with different pathophysiological mechanisms and microbial environments. The study supports a restrictive antibiotic policy in returning travelers with malaria.

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HIV Infection, Malnutrition, and Invasive Bacterial Infection among Children with Severe Malaria

Abstract: HIV, malnutrition and IBI are biologically associated with severe disease due to falciparum malaria rather than being simply alternative diagnoses in co-incidentally parasitized children in an endemic area.

Cited by 139 publications

References 40 publications

Mortality attributable to Plasmodium vivax malaria: a clinical audit from Papua, Indonesia

Mortality attributable to Plasmodium vivax malaria: a clinical audit from Papua, Indonesia

Monocyte dysregulation and systemic inflammation during pediatric falciparum malaria

Bacterial Coinfections in Travelers with Malaria: Rationale for Antibiotic Therapy

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