Disease-associated QT-shortage versus quinine associated QT-prolongation: age dependent ECG-effects in Ghanaian children with severe malaria

Malaria Journal

Research

Jürgen Burhenne¹  Torsten Feldt²  Christian Thiel³  Samuel B Nguah⁴  Justice Sylverken⁵  Daniel Ansong⁵  Josephine N Hill⁶  Steffi Hoffmann⁶  Parisa Mehrfar⁶  Johanna Fischer-Herr⁶  Daniel Pelletier⁶  Louise Roggelin⁶  Gerd D Burchard⁷  Jakob P Cramer⁷ 

[1] Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital, Kumasi, Ghana;Department Clinical Research, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany;Clinic for Gastroenterology, Hepatology and Infectious Disease, University Hospital Düsseldorf, Hamburg, Germany;Paediatric Cardiology, University Center Hamburg-Eppendorf, Kumasi, Ghana;Pediatric Emergency Unit, Department of Child Health, Komfo Anokye Teaching Hospital, Kumasi, Ghana;Pediatric Emergency Unit, Department of Child Health, Komfo Anokye Teaching Hospital, Kumasi, Ghana;School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana;Section Tropical Medicine, Department of Internal Medicine, University Center Hamburg-Eppendorf, Hamburg, Germany;Section Tropical Medicine, Department of Internal Medicine, University Center Hamburg-Eppendorf, Hamburg, Germany;Department Clinical Research, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany;

关键词: Malaria;    Heart;    Children;    ECG;    QT interval;    Quinine;    Chloroquine;    Wernicke formula;   

DOI  :  10.1186/1475-2875-13-219

 received in 2013-12-03, accepted in 2014-05-20,  发布年份 2014

来源: Springer

【 摘 要 】

BackgroundWhile several anti-malarials are known to affect the electric conduction system of the heart, less is known on the direct effects of Plasmodium falciparum infection. Some earlier studies point to a direct impact of Plasmodium falciparum infection on the electric conduction system of the heart. The aim of this study was to analyse infection- and drug-induced effects on the electric conduction system.MethodsChildren aged 12 months to 108 months with severe malaria were included in Kumasi, Ghana. In addition to basic demographic, clinical, biochemical and parasitological, biochemical data were measured data upon hospitalization (day 0) and 12-lead electrocardiograms were recorded before (day 0) and after (day 1) initiation of quinine therapy as well as after 42 (±3) days.ResultsA total of 180 children were included. Most children were tachycardic on day 0 but heart rate declined on day 1 and during follow up. The corrected QT intervals were longest on day 1 and shortest on day 0. Comparison of QT intervals with day 42 (healthy status) after stratification for age demonstrated that in the youngest (<24 months) this was mainly due to a QT shortage on day 0 while a QT prolongation on day 1 was most pronounced in the oldest (≥48 months). Nearly one third of the participating children had measurable 4-aminoquinoline levels upon admission, but no direct effect on the corrected QT intervals could be shown.ConclusionSevere P. falciparum infection itself can provoke changes in the electrophysiology of the heart, independent of anti-malarial therapy. Especially in young - thus non immune - children the effect of acute disease associated pre-treatment QT-shortage is more pronounced than quinine associated QT-prolongation after therapy. Nevertheless, neither malaria nor anti-malarial induced effects on the electrophysiology of the heart were associated with clinically relevant arrhythmias in the present study population.

【 授权许可】

Unknown   
© Roggelin et al.; licensee BioMed Central Ltd. 2014. 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 credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.