Multidrug-resistant Plasmodium vivax associated with severe and fatal malaria: a prospective study in Papua, Indonesia.
BACKGROUND: Multidrug-resistant Plasmodium vivax (Pv) is widespread in eastern Indonesia, and emerging elsewhere in Asia-Pacific and South America, but is generally regarded as a benign disease. The aim of the study was to review the spectrum of disease associated with malaria due to Pv and P. falc...
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Journal article |
| Language: | English |
| Published: |
Public Library of Science
2008
|
| _version_ | 1826273123069067264 |
|---|---|
| author | Tjitra, E Anstey, N Sugiarto, P Warikar, N Kenangalem, E Karyana, M Lampah, D Price, R |
| author_facet | Tjitra, E Anstey, N Sugiarto, P Warikar, N Kenangalem, E Karyana, M Lampah, D Price, R |
| author_sort | Tjitra, E |
| collection | OXFORD |
| description | BACKGROUND: Multidrug-resistant Plasmodium vivax (Pv) is widespread in eastern Indonesia, and emerging elsewhere in Asia-Pacific and South America, but is generally regarded as a benign disease. The aim of the study was to review the spectrum of disease associated with malaria due to Pv and P. falciparum (Pf) in patients presenting to a hospital in Timika, southern Papua, Indonesia. METHODS AND FINDINGS: Data were prospectively collected from all patients attending the outpatient and inpatient departments of the only hospital in the region using systematic data forms and hospital computerised records. Between January 2004 and December 2007, clinical malaria was present in 16% (60,226/373,450) of hospital outpatients and 32% (12,171/37,800) of inpatients. Among patients admitted with slide-confirmed malaria, 64% of patients had Pf, 24% Pv, and 10.5% mixed infections. The proportion of malarial admissions attributable to Pv rose to 47% (415/887) in children under 1 y of age. Severe disease was present in 2,634 (22%) inpatients with malaria, with the risk greater among Pv (23% [675/2,937]) infections compared to Pf (20% [1,570/7,817]; odds ratio [OR] = 1.19 [95% confidence interval (CI) 1.08-1.32], p = 0.001), and greatest in patients with mixed infections (31% [389/1,273]); overall p < 0.0001. Severe anaemia (haemoglobin < 5 g/dl) was the major complication associated with Pv, accounting for 87% (589/675) of severe disease compared to 73% (1,144/1,570) of severe manifestations with Pf (p < 0.001). Pure Pv infection was also present in 78 patients with respiratory distress and 42 patients with coma. In total 242 (2.0%) patients with malaria died during admission: 2.2% (167/7,722) with Pf, 1.6% (46/2,916) with Pv, and 2.3% (29/1260) with mixed infections (p = 0.126). CONCLUSIONS: In this region with established high-grade chloroquine resistance to both Pv and Pf, Pv is associated with severe and fatal malaria particularly in young children. The epidemiology of P. vivax needs to be re-examined elsewhere where chloroquine resistance is increasing. |
| first_indexed | 2024-03-06T22:23:23Z |
| format | Journal article |
| id | oxford-uuid:55d10e6f-2ab8-4630-b624-3651c2f0c18f |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-06T22:23:23Z |
| publishDate | 2008 |
| publisher | Public Library of Science |
| record_format | dspace |
| spelling | oxford-uuid:55d10e6f-2ab8-4630-b624-3651c2f0c18f2022-03-26T16:46:36ZMultidrug-resistant Plasmodium vivax associated with severe and fatal malaria: a prospective study in Papua, Indonesia.Journal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:55d10e6f-2ab8-4630-b624-3651c2f0c18fEnglishSymplectic Elements at OxfordPublic Library of Science2008Tjitra, EAnstey, NSugiarto, PWarikar, NKenangalem, EKaryana, MLampah, DPrice, R BACKGROUND: Multidrug-resistant Plasmodium vivax (Pv) is widespread in eastern Indonesia, and emerging elsewhere in Asia-Pacific and South America, but is generally regarded as a benign disease. The aim of the study was to review the spectrum of disease associated with malaria due to Pv and P. falciparum (Pf) in patients presenting to a hospital in Timika, southern Papua, Indonesia. METHODS AND FINDINGS: Data were prospectively collected from all patients attending the outpatient and inpatient departments of the only hospital in the region using systematic data forms and hospital computerised records. Between January 2004 and December 2007, clinical malaria was present in 16% (60,226/373,450) of hospital outpatients and 32% (12,171/37,800) of inpatients. Among patients admitted with slide-confirmed malaria, 64% of patients had Pf, 24% Pv, and 10.5% mixed infections. The proportion of malarial admissions attributable to Pv rose to 47% (415/887) in children under 1 y of age. Severe disease was present in 2,634 (22%) inpatients with malaria, with the risk greater among Pv (23% [675/2,937]) infections compared to Pf (20% [1,570/7,817]; odds ratio [OR] = 1.19 [95% confidence interval (CI) 1.08-1.32], p = 0.001), and greatest in patients with mixed infections (31% [389/1,273]); overall p < 0.0001. Severe anaemia (haemoglobin < 5 g/dl) was the major complication associated with Pv, accounting for 87% (589/675) of severe disease compared to 73% (1,144/1,570) of severe manifestations with Pf (p < 0.001). Pure Pv infection was also present in 78 patients with respiratory distress and 42 patients with coma. In total 242 (2.0%) patients with malaria died during admission: 2.2% (167/7,722) with Pf, 1.6% (46/2,916) with Pv, and 2.3% (29/1260) with mixed infections (p = 0.126). CONCLUSIONS: In this region with established high-grade chloroquine resistance to both Pv and Pf, Pv is associated with severe and fatal malaria particularly in young children. The epidemiology of P. vivax needs to be re-examined elsewhere where chloroquine resistance is increasing. |
| spellingShingle | Tjitra, E Anstey, N Sugiarto, P Warikar, N Kenangalem, E Karyana, M Lampah, D Price, R Multidrug-resistant Plasmodium vivax associated with severe and fatal malaria: a prospective study in Papua, Indonesia. |
| title | Multidrug-resistant Plasmodium vivax associated with severe and fatal malaria: a prospective study in Papua, Indonesia. |
| title_full | Multidrug-resistant Plasmodium vivax associated with severe and fatal malaria: a prospective study in Papua, Indonesia. |
| title_fullStr | Multidrug-resistant Plasmodium vivax associated with severe and fatal malaria: a prospective study in Papua, Indonesia. |
| title_full_unstemmed | Multidrug-resistant Plasmodium vivax associated with severe and fatal malaria: a prospective study in Papua, Indonesia. |
| title_short | Multidrug-resistant Plasmodium vivax associated with severe and fatal malaria: a prospective study in Papua, Indonesia. |
| title_sort | multidrug resistant plasmodium vivax associated with severe and fatal malaria a prospective study in papua indonesia |
| work_keys_str_mv | AT tjitrae multidrugresistantplasmodiumvivaxassociatedwithsevereandfatalmalariaaprospectivestudyinpapuaindonesia AT ansteyn multidrugresistantplasmodiumvivaxassociatedwithsevereandfatalmalariaaprospectivestudyinpapuaindonesia AT sugiartop multidrugresistantplasmodiumvivaxassociatedwithsevereandfatalmalariaaprospectivestudyinpapuaindonesia AT warikarn multidrugresistantplasmodiumvivaxassociatedwithsevereandfatalmalariaaprospectivestudyinpapuaindonesia AT kenangaleme multidrugresistantplasmodiumvivaxassociatedwithsevereandfatalmalariaaprospectivestudyinpapuaindonesia AT karyanam multidrugresistantplasmodiumvivaxassociatedwithsevereandfatalmalariaaprospectivestudyinpapuaindonesia AT lampahd multidrugresistantplasmodiumvivaxassociatedwithsevereandfatalmalariaaprospectivestudyinpapuaindonesia AT pricer multidrugresistantplasmodiumvivaxassociatedwithsevereandfatalmalariaaprospectivestudyinpapuaindonesia |