Age-related clinical spectrum of Plasmodium knowlesi malaria and predictors of severity
Background Plasmodium knowlesi is increasingly reported in Southeast Asia, but prospective studies of its clinical spectrum in children and comparison with autochthonous human-only Plasmodium species are lacking. Methods Over 3.5 years, we prospectively assessed patients of any age with molecul...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Journal Article |
| Language: | English |
| Published: |
2020
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| Online Access: | https://hdl.handle.net/10356/144212 |
| _version_ | 1811691578157170688 |
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| author | Grigg, Matthew J. William, Timothy Barber, Bridget E. Rajahram, Giri S. Menon, Jayaram Schimann, Emma Piera, Kim Wilkes, Christopher S. Patel, Kaajal Chandna, Arjun Drakeley, Christopher J. Yeo, Tsin W. Anstey, Nicholas M. |
| author2 | Lee Kong Chian School of Medicine (LKCMedicine) |
| author_facet | Lee Kong Chian School of Medicine (LKCMedicine) Grigg, Matthew J. William, Timothy Barber, Bridget E. Rajahram, Giri S. Menon, Jayaram Schimann, Emma Piera, Kim Wilkes, Christopher S. Patel, Kaajal Chandna, Arjun Drakeley, Christopher J. Yeo, Tsin W. Anstey, Nicholas M. |
| author_sort | Grigg, Matthew J. |
| collection | NTU |
| description | Background
Plasmodium knowlesi is increasingly reported in Southeast Asia, but prospective studies of its clinical spectrum in children and comparison with autochthonous human-only Plasmodium species are lacking.
Methods
Over 3.5 years, we prospectively assessed patients of any age with molecularly–confirmed Plasmodium monoinfection presenting to 3 district hospitals in Sabah, Malaysia.
Results
Of 481 knowlesi, 172 vivax, and 96 falciparum malaria cases enrolled, 44 (9%), 71 (41%), and 31 (32%) children aged ≤12 years. Median parasitemia was lower in knowlesi malaria (2480/μL [interquartile range, 538–8481/μL]) than in falciparum (9600/μL; P < .001) and vivax malaria. In P. knowlesi, World Health Organization–defined anemia was present in 82% (95% confidence interval [CI], 67%–92%) of children vs 36% (95% CI, 31%–41%) of adults. Severe knowlesi malaria occurred in 6.4% (95% CI, 3.9%–8.3%) of adults but not in children; the commenst severity criterion was acute kideny injury. No patient had coma. Age, parasitemia, schizont proportion, abdominal pain, and dyspnea were independently associated with severe knowlesi malaria, with parasitemia >15000/μL the best predictor (adjusted odds ratio, 16.1; negative predictive value, 98.5%; P < .001). Two knowlesi-related adult deaths occurred (fatality rate: 4.2/1000 adults).
Conclusions
Age distribution and parasitemia differed markedly in knowlesi malaria compared to human-only species, with both uncomplicated and severe disease occurring at low parasitemia. Severe knowlesi malaria occurred only in adults; however, anemia was more common in children despite lower parasitemia. Parasitemia independently predicted knowlesi disease severity: Intravenous artesunate is warranted initially for those with parasitemia >15000/μL. |
| first_indexed | 2024-10-01T06:22:07Z |
| format | Journal Article |
| id | ntu-10356/144212 |
| institution | Nanyang Technological University |
| language | English |
| last_indexed | 2024-10-01T06:22:07Z |
| publishDate | 2020 |
| record_format | dspace |
| spelling | ntu-10356/1442122020-11-01T05:23:32Z Age-related clinical spectrum of Plasmodium knowlesi malaria and predictors of severity Grigg, Matthew J. William, Timothy Barber, Bridget E. Rajahram, Giri S. Menon, Jayaram Schimann, Emma Piera, Kim Wilkes, Christopher S. Patel, Kaajal Chandna, Arjun Drakeley, Christopher J. Yeo, Tsin W. Anstey, Nicholas M. Lee Kong Chian School of Medicine (LKCMedicine) Science::Medicine Plasmodium Knowlesi Malaria Background Plasmodium knowlesi is increasingly reported in Southeast Asia, but prospective studies of its clinical spectrum in children and comparison with autochthonous human-only Plasmodium species are lacking. Methods Over 3.5 years, we prospectively assessed patients of any age with molecularly–confirmed Plasmodium monoinfection presenting to 3 district hospitals in Sabah, Malaysia. Results Of 481 knowlesi, 172 vivax, and 96 falciparum malaria cases enrolled, 44 (9%), 71 (41%), and 31 (32%) children aged ≤12 years. Median parasitemia was lower in knowlesi malaria (2480/μL [interquartile range, 538–8481/μL]) than in falciparum (9600/μL; P < .001) and vivax malaria. In P. knowlesi, World Health Organization–defined anemia was present in 82% (95% confidence interval [CI], 67%–92%) of children vs 36% (95% CI, 31%–41%) of adults. Severe knowlesi malaria occurred in 6.4% (95% CI, 3.9%–8.3%) of adults but not in children; the commenst severity criterion was acute kideny injury. No patient had coma. Age, parasitemia, schizont proportion, abdominal pain, and dyspnea were independently associated with severe knowlesi malaria, with parasitemia >15000/μL the best predictor (adjusted odds ratio, 16.1; negative predictive value, 98.5%; P < .001). Two knowlesi-related adult deaths occurred (fatality rate: 4.2/1000 adults). Conclusions Age distribution and parasitemia differed markedly in knowlesi malaria compared to human-only species, with both uncomplicated and severe disease occurring at low parasitemia. Severe knowlesi malaria occurred only in adults; however, anemia was more common in children despite lower parasitemia. Parasitemia independently predicted knowlesi disease severity: Intravenous artesunate is warranted initially for those with parasitemia >15000/μL. National Medical Research Council (NMRC) Published version This study was funded by the Malaysian Ministry of Health(grant number BP00500420); Asia Pacific Malaria Elimination Network (grant number 108-07); Australian National Health and Medical Research Council (grant numbers 1037304 and 1045156; fellowships [numbers 1042072 to N. M. A., 605831 to T W.Y., 1088738 to B. E. B., and 1138860 to M. J. G.]; “Improving Health Outcomes in the Tropical North: a multidisciplinary collaboration ‘Hot North” (grant number 1131932; fellowship to M. J. G.); the UK Medical Research Council, Natural Environment Research Council, Economic and Social Research Council, and Biotechnology and Biosciences Research Council (Environmental and Social Ecology of Human Infectious Diseases Initiative; grant number G1100796); and the National Institutes of Health (USA) grant number R01AI116472-01. T. W. Y. is funded by a Singapore National Medical Research Council Clinician Scientist Award (CSA INV 15nov007). 2020-10-21T02:36:41Z 2020-10-21T02:36:41Z 2018 Journal Article Grigg, M. J., William, T., Barber, B. E., Rajahram, G. S., Menon, J., Schimann, E., ... Anstey, N. M. (2018). Age-related clinical spectrum of Plasmodium knowlesi malaria and predictors of severity. Clinical Infectious Diseases 67(3), 350-359. doi:10.1093/cid/ciy065 1537-6591 https://hdl.handle.net/10356/144212 10.1093/cid/ciy065 29873683 3 67 350 359 en Clinical Infectious Diseases © 2018 The Author(s). Published by Oxford University Press for the Infectious Diseases Society of America. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited. application/pdf |
| spellingShingle | Science::Medicine Plasmodium Knowlesi Malaria Grigg, Matthew J. William, Timothy Barber, Bridget E. Rajahram, Giri S. Menon, Jayaram Schimann, Emma Piera, Kim Wilkes, Christopher S. Patel, Kaajal Chandna, Arjun Drakeley, Christopher J. Yeo, Tsin W. Anstey, Nicholas M. Age-related clinical spectrum of Plasmodium knowlesi malaria and predictors of severity |
| title | Age-related clinical spectrum of Plasmodium knowlesi malaria and predictors of severity |
| title_full | Age-related clinical spectrum of Plasmodium knowlesi malaria and predictors of severity |
| title_fullStr | Age-related clinical spectrum of Plasmodium knowlesi malaria and predictors of severity |
| title_full_unstemmed | Age-related clinical spectrum of Plasmodium knowlesi malaria and predictors of severity |
| title_short | Age-related clinical spectrum of Plasmodium knowlesi malaria and predictors of severity |
| title_sort | age related clinical spectrum of plasmodium knowlesi malaria and predictors of severity |
| topic | Science::Medicine Plasmodium Knowlesi Malaria |
| url | https://hdl.handle.net/10356/144212 |
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