BACKGROUND: Over a 16-year period, we conducted a clinical study of malaria acquired worldwide in adults from malaria-nonendemic countries, to determine risk factors for severe Plasmodium falciparum malaria. METHODS: All patients with confirmed malaria who were managed by our unit from 1991 to 2006 were prospectively evaluated. Factors predicting disease severity according to (1) strict World Health Organization (WHO) criteria, (2) a composite measure of unfavorable outcome, and (3) length of hospital stay were identified by logistic and linear regression analyses. RESULTS: We evaluated 676 episodes of malaria, 482 (71%) due to P. falciparum and 194 (29%) due to nonfalciparum parasites. Black patients had a significantly reduced risk of developing WHO-defined severe falciparum malaria, with Asian patients having odds of severe falciparum malaria that were 8.05-fold (95% confidence interval [CI], 2.93-22.1-fold) higher and white patients having odds that were 8.20-fold (95% CI, 2.94-22.9-fold) higher. Black patients also had a reduced risk of an unfavorable outcome and of a prolonged stay in the hospital, compared with the risks for white or Asian patients. Of 6 patients with falciparum malaria who died, none were black. In univariate analysis, patients with parasitemias of >or= 2% had odds of severe falciparum malaria 12-fold higher than those of patients with parasitemias of <2% (73% vs. 19%). Patients with a history of previous clinical malaria, regardless of ethnicity, had a significantly reduced risk of WHO-defined severe falciparum malaria (odds ratio, 0.35 [95% CI, 0.15-0.80]). CONCLUSIONS: The findings of this study demonstrate that ethnicity and parasitemia are important independent risk factors for severe falciparum malaria in adults from malaria-nonendemic countries and that a history of previous clinical malaria significantly reduces the risk of WHO-defined severe falciparum malaria.
BACKGROUND: Over a 16-year period, we conducted a clinical study of malaria acquired worldwide in adults from malaria-nonendemic countries, to determine risk factors for severe Plasmodium falciparum malaria. METHODS: All patients with confirmed malaria who were managed by our unit from 1991 to 2006 were prospectively evaluated. Factors predicting disease severity according to (1) strict World Health Organization (WHO) criteria, (2) a composite measure of unfavorable outcome, and (3) length of hospital stay were identified by logistic and linear regression analyses. RESULTS: We evaluated 676 episodes of malaria, 482 (71%) due to P. falciparum and 194 (29%) due to nonfalciparum parasites. Black patients had a significantly reduced risk of developing WHO-defined severe falciparum malaria, with Asian patients having odds of severe falciparum malaria that were 8.05-fold (95% confidence interval [CI], 2.93-22.1-fold) higher and white patients having odds that were 8.20-fold (95% CI, 2.94-22.9-fold) higher. Black patients also had a reduced risk of an unfavorable outcome and of a prolonged stay in the hospital, compared with the risks for white or Asian patients. Of 6 patients with falciparum malaria who died, none were black. In univariate analysis, patients with parasitemias of >or= 2% had odds of severe falciparum malaria 12-fold higher than those of patients with parasitemias of <2% (73% vs. 19%). Patients with a history of previous clinical malaria, regardless of ethnicity, had a significantly reduced risk of WHO-defined severe falciparum malaria (odds ratio, 0.35 [95% CI, 0.15-0.80]). CONCLUSIONS: The findings of this study demonstrate that ethnicity and parasitemia are important independent risk factors for severe falciparum malaria in adults from malaria-nonendemic countries and that a history of previous clinical malaria significantly reduces the risk of WHO-defined severe falciparum malaria.
Authors: Fabrice Bruneel; Florence Tubach; Jean-Paul Mira; Sandrine Houze; Sebastien Gibot; Marie-Genevieve Huisse; Bruno Megarbane; Christophe Choquet; Philippe Corne; Eric Peytel; Daniel Villers; Christophe Camus; Olivier Bouchaud; Eric Caumes; Pierre-Marie Girard; Fabrice Simon; Antoine Kalloumeh; Carine Roy; Remy Durand; Jacques Le Bras; Sophie Matheron; Michel Wolff Journal: Intensive Care Med Date: 2016-05-11 Impact factor: 17.440
Authors: Marlies E van Wolfswinkel; Dennis A Hesselink; Robert Zietse; Ewout J Hoorn; Perry J J van Genderen Journal: Malar J Date: 2010-05-25 Impact factor: 2.979
Authors: Patrick S Twomey; Bryan L Smith; Cathy McDermott; Anne Novitt-Moreno; William McCarthy; S Patrick Kachur; Paul M Arguin Journal: Ann Intern Med Date: 2015-10-06 Impact factor: 25.391
Authors: Luana Roberta Michels; Tamara Ramos Maciel; Kelly Ayumi Nakama; Flavia Elizabete Guerra Teixeira; Felipe Barbosa de Carvalho; André Gundel; Bibiana Verlindo de Araujo; Sandra Elisa Haas Journal: Int J Nanomedicine Date: 2019-12-31