Respiratory Complications of Plasmodium vivax Malaria: Systematic Review and Meta-Analysis

Val, Fernando; Machado, Kim Vinícius Amaral; Barbosa, L. S. Guedes; Salinas, Jorge; Siqueira, André Machado; Alecrim, Maria G. C.; Portillo, Hernando del; Bassat, Quique; Monteiro, Wuelton Marcelo; Lacerda, Marcus Vinícius Guimarães

doi:10.4269/ajtmh.17-0131

Cited by 29 publications

(37 citation statements)

References 131 publications

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“…vivax patients were treated with Chloroquine, including the 138 who had initiated treatment at the POC, before enrolment at the hospital. In our series, Chloroquine pre-treatment appear to associate with any particular malaria complication, as previously suggested [ 48 ].…”

Section: Discussionsupporting

confidence: 85%

Complicated malaria in children and adults from three settings of the Colombian Pacific Coast: A prospective study

et al. 2017

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BackgroundComplicated malaria remains an important public health problem, particularly in endemic settings where access to health services is limited and consequently malaria fatal outcomes occur. Few publications describing the clinical course and outcomes of complicated malaria in Latin America are found in the literature. This prospective study approached the clinical and laboratory characteristics of hospitalized patients with complicated malaria in different endemic areas of the Colombian Pacific Coast with the aim to provide epidemiological knowledge and guide to further reducing malaria severity and mortality.Methods and findingsA prospective, descriptive hospital-based study was conducted in 323 complicated malaria patients (median age 20 years) enrolled in Quibdó, Tumaco and Cali between 2014 and 2016. Clinical evaluation was performed and laboratory parameters were assessed during hospitalization. Plasmodium falciparum was the most common parasite species (70%), followed by P. vivax (28%), and mixed malaria (Pf/Pv; 1.9%). Overall, predominant laboratory complications were severe thrombocytopenia (43%), hepatic dysfunction (40%), and severe anaemia (34%). Severe thrombocytopenia was more common in adults (52%) regardless of parasite species. Severe anaemia was the most frequent complication in children ≤10 years (72%) and was most commonly related to P. vivax infection (p < 0.001); whereas liver dysfunction was more frequent in older patients (54%) with P. falciparum (p < 0.001). Two deaths due to P. vivax and P. falciparum each were registered. Treatment provision before recruitment hindered qPCR confirmation of parasite species in some cases.ConclusionsThe study identified a high prevalence of complicated malaria in the Pacific Coast, together with more frequent severe anaemia in children infected by P. vivax and hepatic dysfunction in adults with P. falciparum. Results indicated the need for earlier diagnosis and treatment to prevent complications development as well as more effective attention at hospital level, in order to rapidly identify and appropriately treat these severe clinical conditions. The study describes epidemiological profiles of the study region and identified the most common complications on which clinicians must focus on to prevent mortality.

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Section: Discussionsupporting

confidence: 85%

Complicated malaria in children and adults from three settings of the Colombian Pacific Coast: A prospective study

et al. 2017

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“…A pooled analysis of clinical studies since the year 1900 describing complications in vivax patients showed a 0.27% prevalence of respiratory dysfunction in reports with and without severity signs [ 10 ]. Geographical stratification has shown that prevalence estimates of respiratory complications vary according to endemic regions [ 11 ], mostly due to a complex interplay of host and vector characteristics [ 9 ]. Nonetheless, part of the variation is because of definitions used to describe these respiratory complications.…”

Section: Discussionmentioning

confidence: 99%

“…Several studies have reported cases of respiratory complications in vivax malaria after treatment [ 11 ], with a tenfold increase in the risk for developing respiratory distress [ 8 ]. It is suggested that a post-treatment inflammatory phenomenon occurs within lung microvasculature in these cases leading to respiratory impairment [ 30 , 31 ].…”

Section: Discussionmentioning

confidence: 99%

“…A recent meta-analysis showed that the prevalence of acute respiratory distress syndrome (ARDS) among vivax malaria cases ranged between 2.2% (adults) and 2.8% (children), with nearly 50% mortality, confirming the significance and associated poor prognosis of this type of complication among P. vivax malaria patients [ 11 ]. Moreover, female sex, having any comorbidity, lower body temperature, lower haemoglobin, and low oxygen saturation values (hypoxaemia) were significantly associated with mortality.…”

Section: Introductionmentioning

confidence: 99%

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Are respiratory complications of Plasmodium vivax malaria an underestimated problem?

Val

Ávalos

Gomes

et al. 2017

Malar J

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BackgroundRespiratory complications are uncommon, but often life-threatening features of Plasmodium vivax malaria. This study aimed to estimate the prevalence and lethality associated with such complications among P. vivax malaria patients in a tertiary hospital in the Western Brazilian Amazon, and to identify variables associated with severe respiratory complications, intensive care need and death. Medical records from 2009 to 2016 were reviewed aiming to identify all patients diagnosed with P. vivax malaria and respiratory complications. Prevalence, lethality and risk factors associated with WHO defined respiratory complications, intensive care need and death were assessed.ResultsA total of 587 vivax malaria patients were hospitalized during the study period. Thirty (5.1%) developed respiratory complications. Thirteen (43.3%) developed severe respiratory complications, intensive care was required for 12 (40%) patients and 5 (16.6%) died. On admission, anaemia and thrombocytopaenia were common findings, whereas fever was unusual. Patients presented different classes of parasitaemia and six were aparasitaemic on admission. Time to respiratory complications occurred after anti-malarials administration in 18 (60%) patients and progressed very rapidly. Seventeen patients (56.7%) had comorbidities and/or concomitant conditions, which were significantly associated to higher odds of developing severe respiratory complications, need for intensive care and death (p < 0.05).ConclusionRespiratory complications were shown to be associated with significant mortality in this population. Patients with comorbidities and/or concomitant conditions require special attention to avoid this potential life-threatening complication.Electronic supplementary materialThe online version of this article (10.1186/s12936-017-2143-y) contains supplementary material, which is available to authorized users.

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“…In Brazil, the great majority of malaria cases occur in the Amazon region, with Plasmodium vivax beingresponsible for nine out of every ten cases [1]. Although severe malaria has been historically associated to P. falciparum infection,an increasing number of reports has demonstrated the association between vivax malaria mono-infections and adverse outcomes [2][3][4][5].…”

Section: Introductionmentioning

confidence: 99%

Acute kidney injury in Plasmodium vivax malaria hospitalized patients in Manaus, Brazilian Amazon: are we underestimating the real burden?

Santos

Brito-Sousa

Val

et al. 2019

Preprint

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Background Acute kidney injury (AKI) is a common complication of Plasmodium falciparum malaria and can also occur secondary to P. malariae infections. Its association with P. vivax malaria is not well estimated neither understood.Methods Retrospective assessment of medical records was conducted among P. vivax malaria hospitalized patients in a reference hospital of Manaus, Brazilian Amazon, from 2009 to 2017. AKI was classified according to Acute Kidney Injury Network (AKIN) criteria and through the World Health Organization (WHO) criteria for severe malaria. Patients diagnosed with primaquine-induced hemolysis due to confirmed glucose 6-phosphate dehydrogenase deficiency (G6PDd) and chronic renal failure were excluded. Prevalence of AKI and factors associated to this complication were assessed.Results Out of 28,095 P. vivax malaria diagnoses during the study period in the reference center, 638 cases (2.3%) required hospitalization; with 433 (67.8%) of those patients having at least one creatinine measure. Twenty-two patients (5.1%) were diagnosed with AKI as per WHO criteria; 241 patients presented more than two creatinine measures, of which 117 (49.2%) patients had AKI per AKIN criteria. These were stratified in stage I (n=88; 75.2%), stage II (n=6; 5.1%), and stage III (n=23; 19.6%). Major risk factor for AKI was older age. Renal replacement therapy (dialysis) was necessary in 6 cases (1.4%).Conclusions AKI secondary to vivax malaria was not unfrequent amongst hospitalized patients and may be a potentially severe complication. WHO diagnostic criteria for malaria AKI was shown to underestimate the real burden of AKI. Renal impairment should be closely monitored especially in older patients.

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Respiratory Complications of Plasmodium vivax Malaria: Systematic Review and Meta-Analysis

Cited by 29 publications

References 131 publications

Complicated malaria in children and adults from three settings of the Colombian Pacific Coast: A prospective study

Complicated malaria in children and adults from three settings of the Colombian Pacific Coast: A prospective study

Are respiratory complications of Plasmodium vivax malaria an underestimated problem?

Acute kidney injury in Plasmodium vivax malaria hospitalized patients in Manaus, Brazilian Amazon: are we underestimating the real burden?

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