The prognostic value of schizontaemia in imported Plasmodium falciparum malaria

Malaria Journal

Research

Marlies E van Wolfswinkel¹  Klaske Vliegenthart-Jongbloed¹  Perry J van Genderen²  Mariana de Mendonça Melo²  Rob Koelewijn³  Jaap J van Hellemond⁴ 

[1] Department of Internal Medicine, Harbour Hospital, Rotterdam, The Netherlands;Department of Internal Medicine, Harbour Hospital, Rotterdam, The Netherlands;Institute for Tropical Diseases, Harbour Hospital, Haringvliet 72, 3011, Rotterdam, TG, The Netherlands;Laboratory of Parasitology, Harbour Hospital and Institute for Tropical Diseases, Rotterdam, The Netherlands;Laboratory of Parasitology, Harbour Hospital and Institute for Tropical Diseases, Rotterdam, The Netherlands;Department of Medical Microbiology and Infectious Diseases, Erasmus Medical Centre, Rotterdam, The Netherlands;

关键词: Schizont;    Prognosis;    Malaria;    Falciparum;    Import;    Severe;   

DOI  :  10.1186/1475-2875-11-301

 received in 2012-05-23, accepted in 2012-08-23,  发布年份 2012

来源: Springer

【 摘 要 】

BackgroundIn Plasmodium falciparum infection, peripheral parasite counts do not always correlate well with the sequestered parasite burden. As erythrocytes parasitized with mature trophozoites and schizonts have a high tendency to adhere to the microvascular endothelium, they are often absent in peripheral blood samples. The appearance of schizonts in peripheral blood smears is thought to be a marker of high sequestered parasite burden and severe disease. In the present study, the value of schizontaemia as an early marker for severe disease in non-immune individuals with imported malaria was evaluated.MethodsAll patients in the Rotterdam Malaria Cohort diagnosed with P. falciparum malaria between 1 January 1999 and 1 January 2012 were included. Thick and thin blood films were examined for the presence of schizontaemia. The occurrence of WHO defined severe malaria was the primary endpoint. The diagnostic performance of schizontaemia was compared with previously evaluated biomarkers C-reactive protein and lactate.ResultsSchizonts were present on admission in 49 of 401 (12.2%) patients. Patients with schizontaemia were more likely to present with severe malaria, a more complicated course and had longer duration of admission in hospital. Schizontaemia had a specificity of 0.95, a sensitivity of 0.53, a negative predictive value of 0.92 and a positive predictive value of 0.67 for severe malaria. The presence of schizonts was an independent predictor for severe malaria.ConclusionAbsence of schizonts was found to be a specific marker for exclusion of severe malaria. Presence of schizonts on admission was associated with a high positive predictive value for severe malaria. This may be of help to identify patients who are at risk of a more severe course than would be expected when considering peripheral parasitaemia alone.

【 授权许可】

Unknown   
© van Wolfswinkel et al.; licensee BioMed Central Ltd. 2012. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.