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 molecularly-...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Journal article |
| Language: | English |
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Oxford University Press
2018
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| _version_ | 1797084194015281152 |
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| author | Grigg, M William, T Barber, B Rajahram, G Menon, J Schimann, E Piera, K Wilkes, C Patel, K Chandna, A Drakeley, C Yeo, T Anstey, N |
| author_facet | Grigg, M William, T Barber, B Rajahram, G Menon, J Schimann, E Piera, K Wilkes, C Patel, K Chandna, A Drakeley, C Yeo, T Anstey, N |
| author_sort | Grigg, M |
| collection | OXFORD |
| 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 | 2024-03-07T01:51:58Z |
| format | Journal article |
| id | oxford-uuid:9a698a63-e36f-4db1-b124-54266034ca26 |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-07T01:51:58Z |
| publishDate | 2018 |
| publisher | Oxford University Press |
| record_format | dspace |
| spelling | oxford-uuid:9a698a63-e36f-4db1-b124-54266034ca262022-03-27T00:21:13ZAge-related clinical spectrum of plasmodium knowlesi malaria and predictors of severityJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:9a698a63-e36f-4db1-b124-54266034ca26EnglishSymplectic Elements at OxfordOxford University Press2018Grigg, MWilliam, TBarber, BRajahram, GMenon, JSchimann, EPiera, KWilkes, CPatel, KChandna, ADrakeley, CYeo, TAnstey, NBackground: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. |
| spellingShingle | Grigg, M William, T Barber, B Rajahram, G Menon, J Schimann, E Piera, K Wilkes, C Patel, K Chandna, A Drakeley, C Yeo, T Anstey, N 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 |
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