Myocardial Dysfunction in Severe Falciparum Malaria

Kumar, Poddutoor Preetham; Kumar, Chirla Dinesh; Shaik, Farhan; Ghanta, Satish

doi:10.1093/tropej/fmp050

Cited by 8 publications

(7 citation statements)

References 7 publications

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“…48,49,66,69 Children. All cases were hospitalized, 54,61,63 of which three 61,63 had acute heart failure, as determined by the LVEF range 22-35%, and one had myocarditis. 54 In two cases, the LVEF was normal at follow-up.…”

Section: Resultsmentioning

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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Section: Resultsmentioning

confidence: 99%

“…54 In two cases, the LVEF was normal at follow-up. 54,61 Postmortem. Ten cases were analyzed (n = 9 P. falciparum, n = 1 P. knowlesi) 51,52,55,64,72 (Supplemental Table 6).…”

Section: Resultsmentioning

confidence: 99%

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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“…The aetiology of such cardiac depression is not clear, and may be related to cytokine release, acidosis, hypovolaemia or sequestration of red cells in myocardial vessels [41]. There are a few other reports of myocardial dysfunction caused primarily by malaria, all of them related to severe Plasmodium falciparum infection [42-44] and one caused by experimental malaria [45]. …”

Section: Discussionmentioning

confidence: 99%

Vivax malaria in an Amazonian child with dilated cardiomyopathy

Martins

Lins

Santos

et al. 2014

Malar J

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A child living in the Brazilian Amazon region who had had vivax malaria at the age of 11 months was admitted three months later with a history of progressive dyspnoea and fever, which culminated in respiratory distress and severe dilated cardiomyopathy at hospital admission in a malaria-free area. She received treatment for cardiac insufficiency and was tested for malaria with two thick blood smears, which were negative. There was general improvement of cardiorespiratory function in the next two weeks, but in the third week of hospital admission, there was re-appearance of fever, severe anaemia, severe plaquetopaenia, and respiratory distress. A third thick blood smear was positive for Plasmodium vivax mono-infection, which was confirmed by molecular methods. A serological panel with the most prevalent infectious agents known to cause myocarditis was performed, and specific anti-cytomegalovirus (CMV) IgM and elevated levels of anti-CMV IgG were also detected in the serum. After treatment for malaria, there was improvement of respiratory distress, although cardiac function did not recover. She was discharged home with drugs for cardiac insufficiency and is currently under follow-up with a paediatric cardiologist as an outpatient. This report presents a young child with several episodes of vivax malaria who suffers from cardiac insufficiency, probably related to CMV-induced myocarditis.

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“…While pro-inflammatory cytokines and immune mediators have been shown to exert a suppressive effect on myocardial function, cardiovascular biomarkers have been reported as good prognostic markers for outcome in septic and critically ill patients [6,26]. Recent publications support myocardial suppression in malaria [27,28] although other evidence is still contradictory [29]. In addition, anti-malarial treatment may add to cardiotoxic effects [30].…”

Section: Discussionmentioning

confidence: 99%

Reduced cardiac output in imported Plasmodium falciparum malaria

Herr

Mehrfar

Schmiedel

et al. 2011

Malar J

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BackgroundVolume substitution remains subject of controversy in the light of effusions and oedema potentially complicating this highly febrile disease. Understanding the role of myocardial and circulatory function appears to be essential for clinical management. In the present study, cardiac function and cardiac proteins have been assessed and correlated with parasitological and immunologic parameters in patients with imported Plasmodium falciparum malaria.MethodsIn a prospective case-control study, 28 patients with uncomplicated and complicated P. falciparum malaria were included and findings were compared with 26 healthy controls. Cardiac function parameters were assessed by an innovative non-invasive method based on the re-breathing technique. In addition, cardiac enzymes and pro- and anti-inflammatory cytokines were measured and assessed with respect to clinical symptoms and conditions of malaria.ResultsCardiac index (CI) as a measurement of cardiac output (CO) was 21% lower in malaria patients than in healthy controls (2.7 l/min/m2 versus 3.4 l/min/m2; P < 0.001). In contrast, systemic vascular resistance index (SVRI) was increased by 29% (32.6 mmHg⋅m2/(l/min) versus 23.2 mmHg⋅m2/(l/min); P < 0.001). This correlated with increased cardiac proteins in patients versus controls: pro-BNP 139.3 pg/ml versus 60.4 pg/ml (P = 0.03), myoglobin 43.6 μg/l versus 27.8 μg/l (P = < 0.001). All measured cytokines were significantly increased in patients with malaria. CI, SVRI as well as cytokine levels did not correlate with blood parasite density.ConclusionsThe results support previous reports suggesting impaired cardiac function contributing to clinical manifestations in P. falciparum malaria. Findings may be relevant for fluid management and should be further explored in endemic regions.

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Myocardial Dysfunction in Severe Falciparum Malaria

Cited by 8 publications

References 7 publications

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

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

Vivax malaria in an Amazonian child with dilated cardiomyopathy

Reduced cardiac output in imported Plasmodium falciparum malaria

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