Prevalence and spectrum of illness among hospitalized adults with malaria in Blantyre, Malawi

Malaria Journal

Research

Miriam K Laufer¹  Theresa J Allain²  Don P Mathanga³  Jacek Skarbinski⁴  Dalitso Taulo⁵  Miguel SanJoaquin⁵  Dalitso Segula⁶  Malcolm Molyneux⁷  Robert S Heyderman⁸  Anne P Frosch⁹ 

[1] Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, MD, USA;Department of Medicine, University of Malawi College of Medicine, Blantyre, Malawi;Malaria Alert Center, University of Malawi, College of Medicine, Blantyre, Malawi;Malaria Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA;Malawi-Liverpool-Wellcome Trust Clinical Research Programme, University of Malawi College of Medicine, P.O. Box 30096, Blantyre, Malawi;Malawi-Liverpool-Wellcome Trust Clinical Research Programme, University of Malawi College of Medicine, P.O. Box 30096, Blantyre, Malawi;Department of Medicine, University of Malawi College of Medicine, Blantyre, Malawi;Malawi-Liverpool-Wellcome Trust Clinical Research Programme, University of Malawi College of Medicine, P.O. Box 30096, Blantyre, Malawi;Department of Medicine, University of Malawi College of Medicine, Blantyre, Malawi;Liverpool School of Tropical Medicine, Liverpool, UK;Malawi-Liverpool-Wellcome Trust Clinical Research Programme, University of Malawi College of Medicine, P.O. Box 30096, Blantyre, Malawi;Liverpool School of Tropical Medicine, Liverpool, UK;University of Minnesota School of Medicine, Minneapolis, MN, USA;

关键词: Malaria;    Severe malaria;    Prostration;    Malawi;    Rapid diagnostic tests;    Hyperparasitaemia;    Malaria epidemiology;    Adult;   

DOI  :  10.1186/1475-2875-13-391

 received in 2014-05-11, accepted in 2014-09-27,  发布年份 2014

来源: Springer

【 摘 要 】

BackgroundAs control interventions are rolled out, the burden of malaria may shift from young children to older children and adults as acquisition of immunity is slowed and persistence of immunity is short-lived. Data for malaria disease in adults are difficult to obtain because of co-morbid conditions and because parasitaemia may be asymptomatic. Regular surveys of adult admissions to a hospital in Malawi were conducted to characterize the clinical spectrum of malaria and to establish a baseline to monitor changes that occur in future.MethodsIn 2011–2012, at Queen Elizabeth Hospital, Blantyre, four separated one-week surveys in the peak malaria transmission period (wet season) and three one-week surveys in the low transmission period (dry season) were conducted using rapid diagnostic tests (RDT) with confirmation of parasitaemia by microscopy. All adults (aged ≥15) being admitted to the adult medical wards regardless of the suspected diagnosis, were enrolled. Participants with a positive malaria test underwent a standardized physical examination and laboratory tests. Malaria syndromes were characterized by reviewing charts and laboratory results on discharge.Results765 adult admissions were screened. 63 (8.2%) were RDT-positive with 61 (8.0%) positive by microscopy. Over the course of the seven study weeks, two patients were judged to have incidental parasitaemia, 31 (4.1%) had uncomplicated malaria and 28 (3.7%) had severe malaria. Both uncomplicated and severe malaria cases were more common in the rainy season than the dry season. Prostration (22/28 cases) and hyperparasitaemia (>250,000 parasites/μl) (9/28) were the most common features of severe malaria. Jaundice (4/28), severe anaemia (2/28), hyperlactataemia (2/28), shock (1/28) and haemoglobinuria (1/28) were less commonly seen, and no patient had severe metabolic derangement or organ failure. There were no deaths attributable to malaria.ConclusionIn this study of adults admitted to hospital in southern Malawi, an area with year-round transmission of Plasmodium falciparum, classical metabolic and organ complications of malaria were not encountered. Prostration and hyperparasitaemia were more common indicators of severity in patients admitted with malaria, none of whom died. These data will provide a baseline for monitoring trends in the frequency and clinical patterns of severe malaria in adults.

【 授权许可】

CC BY   
© Segula et al.; licensee BioMed Central Ltd. 2014