Severe malaria in Burkina Faso: influence of age and transmission level on clinical presentation.

Abstract

Abstract. We analyzed the clinical presentation of 800 severe malaria cases six months to 15 years of age (mean Ϯ SD ϭ 4.3 Ϯ 3.0) recruited at the pediatric ward of the Ouagadougou University Hospital, and at the Sourou and Nayala District Hospitals in Burkina Faso. Inclusion criteria followed the World Health Organization (WHO) definition of severe and complicated malaria. The children were treated according to WHO guidelines with a complete regimen of drugs that were provided free of charge as part of the study. The case fatality rate of each sign and symptom of severe malaria was calculated on the 686 children whose outcomes were known. A total of 95 patients (13.8%) died while in the hospital; the mean Ϯ SD age of these children was 3.2 Ϯ 2.1 years. The age distribution and the clinical patterns of severe malaria was compared in patients from the urban areas of Ouagadougou characterized by relatively low transmission, and from rural areas where the mean inoculation rates are at least 20-fold higher. The mean Ϯ SD age of the urban and rural patients was 4.8 Ϯ 3.0 and 2.2 1.9 years, respectively (P Ͻ 0.001). The prevalence of coma was higher in the urban subsample (53.6% versus 28.9%; P K 0.001) while that of severe anemia (hemoglobin Ͻ 5 g/dL) was higher in rural patients (47.4% versus 14.8%; P Ͻ 0.001). Our data, in line with previous results obtained comparing rural areas characterized by different inoculation rates, show that the epidemiologic context influences the clinical presentation of severe malaria.

Characterization and Treatment of Severe Malaria in Hospitalized Children at a Ghanaian District Hospital

“…Contrary to earlier reports of neurological involvement being more common in low transmission zones and in older children [15], the symptoms, particularly convulsions, were common in younger children in our study. Here also, neurological symptoms were independent of sex of the patient.…”

Adult Javanese migrants to Indonesian Papua at high risk of severe disease caused by malaria

“…However, risk of severe disease among adults in populations with chronic exposure to relatively low risk of malaria, e.g. along the Thai-Burma border [39] or in urban areas of Sub-Saharan Africa [40], tends to be appreciably lower compared to young children. We believe the age-dependent exacerbation of risk of severe disease may appear only in adults and children who are not chronically exposed to infection by P. falciparum.…”

“…Severe, life-threatening malaria caused by P. falciparum has been linked to the release of pro-inflammatory cytokines, especially tumour necrosis factor (TNF) [40][41][42][43]. The basis of adult susceptibility to severe disease caused by primary infection with P. falciparum may lie in the production of inordinately high levels of pro-inflammatory cytokines like TNF.…”

Seasonal malaria attack rates in infants and young children in northern Ghana.

“…4 Risk of infection has been linked to patterns of morbidity and mortality caused by P. falciparum. [5][6][7][8][9] Severe anemia represents the primary cause of malaria-related death where the highest risk of infection prevails, while death due to cerebral malaria predominates in areas where infection risk is lower. Naturally acquired immunity in older children and adults in holoendemic Africa effectively prevents either outcome in those groups, but degree of exposure in infants and small children defines risk of specific disease outcomes.…”