Limits...
Mortality attributable to Plasmodium vivax malaria: a clinical audit from Papua, Indonesia.

Douglas NM, Pontororing GJ, Lampah DA, Yeo TW, Kenangalem E, Poespoprodjo JR, Ralph AP, Bangs MJ, Sugiarto P, Anstey NM, Price RN - BMC Med (2014)

Bottom Line: In recent years it has been associated with severe and fatal disease.There were an estimated 293,763 cases of pure P. vivax infection in the community during the study period giving an overall minimum case fatality of 0.12 per 1,000 infections.The corresponding case fatality in hospitalised patients was 10.3 per 1,000 infections.

View Article: PubMed Central - PubMed

Affiliation: Global Health Division, Menzies School of Health Research and Charles Darwin University, PO Box 41096, Casuarina, Darwin, NT 0811, Australia. nicholas.douglas@gmail.com.

ABSTRACT

Background: Plasmodium vivax causes almost half of all malaria cases in Asia and is recognised as a significant cause of morbidity. In recent years it has been associated with severe and fatal disease. The extent to which P. vivax contributes to death is not known.

Methods: To define the epidemiology of mortality attributable to vivax malaria in southern Papua, Indonesia, a retrospective clinical records-based audit was conducted of all deaths in patients with vivax malaria at a tertiary referral hospital.

Results: Between January 2004 and September 2009, hospital surveillance identified 3,495 inpatients with P. vivax monoinfection and 65 (1.9%) patients who subsequently died. Charts for 54 of these 65 patients could be reviewed, 40 (74%) of whom had pure P. vivax infections on cross-checking. Using pre-defined conservative criteria, vivax malaria was the primary cause of death in 6 cases, a major contributor in 17 cases and a minor contributor in a further 13 cases. Extreme anaemia was the most common primary cause of death. Malnutrition, sepsis with respiratory and gastrointestinal manifestations, and chronic diseases were the commonest attributed causes of death for patients in the latter two categories. There were an estimated 293,763 cases of pure P. vivax infection in the community during the study period giving an overall minimum case fatality of 0.12 per 1,000 infections. The corresponding case fatality in hospitalised patients was 10.3 per 1,000 infections.

Conclusions: Although uncommonly directly fatal, vivax malaria is an important indirect cause of death in southern Papua in patients with malnutrition, sepsis syndrome and chronic diseases, including HIV infection.

Show MeSH

Related in: MedlinePlus

Relationship between anaemia and acidosis in vivax-associated deaths. Diamond = Category 1, Squares = Category 2 and Triangles = Category 3. rs = 0.45, P = 0.09.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
getmorefigures.php?uid=PMC4264333&req=5

Fig4: Relationship between anaemia and acidosis in vivax-associated deaths. Diamond = Category 1, Squares = Category 2 and Triangles = Category 3. rs = 0.45, P = 0.09.

Mentions: Haematology testing was available in 97% (35/36) of patients in the death audit. There was a non-statistically significant association between anaemia and acidosis (rs = 0.45, P = 0.09; Figure 4). Severe anaemia was present in 29% (10/35) and acidosis in 64% (9/15) of patients who had blood gas analyses (three of the acidotic patients also had severe anaemia and eight had respiratory distress). Severe thrombocytopaenia was relatively common with 19% (7/35) of patients having a platelet concentration of less than 50 × 109 per litre and 14% (5/35) less than 20 × 109 per litre. Three of the 13 patients tested (23%) fulfilled the WHO criterion for hyperbilirubinaemia (>42.75 mmol/L), two of whom succumbed to vivax malaria as a direct cause of death. Two of the 28 patients assessed (7%) had hypoglycaemia (glucose <2.2 mmol/L). Six of nineteen patients assessed (32%) had a creatinine concentration above 230 μmol/L (the WHO criterion for severe malaria).Figure 4


Mortality attributable to Plasmodium vivax malaria: a clinical audit from Papua, Indonesia.

Douglas NM, Pontororing GJ, Lampah DA, Yeo TW, Kenangalem E, Poespoprodjo JR, Ralph AP, Bangs MJ, Sugiarto P, Anstey NM, Price RN - BMC Med (2014)

Relationship between anaemia and acidosis in vivax-associated deaths. Diamond = Category 1, Squares = Category 2 and Triangles = Category 3. rs = 0.45, P = 0.09.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4264333&req=5

Fig4: Relationship between anaemia and acidosis in vivax-associated deaths. Diamond = Category 1, Squares = Category 2 and Triangles = Category 3. rs = 0.45, P = 0.09.
Mentions: Haematology testing was available in 97% (35/36) of patients in the death audit. There was a non-statistically significant association between anaemia and acidosis (rs = 0.45, P = 0.09; Figure 4). Severe anaemia was present in 29% (10/35) and acidosis in 64% (9/15) of patients who had blood gas analyses (three of the acidotic patients also had severe anaemia and eight had respiratory distress). Severe thrombocytopaenia was relatively common with 19% (7/35) of patients having a platelet concentration of less than 50 × 109 per litre and 14% (5/35) less than 20 × 109 per litre. Three of the 13 patients tested (23%) fulfilled the WHO criterion for hyperbilirubinaemia (>42.75 mmol/L), two of whom succumbed to vivax malaria as a direct cause of death. Two of the 28 patients assessed (7%) had hypoglycaemia (glucose <2.2 mmol/L). Six of nineteen patients assessed (32%) had a creatinine concentration above 230 μmol/L (the WHO criterion for severe malaria).Figure 4

Bottom Line: In recent years it has been associated with severe and fatal disease.There were an estimated 293,763 cases of pure P. vivax infection in the community during the study period giving an overall minimum case fatality of 0.12 per 1,000 infections.The corresponding case fatality in hospitalised patients was 10.3 per 1,000 infections.

View Article: PubMed Central - PubMed

Affiliation: Global Health Division, Menzies School of Health Research and Charles Darwin University, PO Box 41096, Casuarina, Darwin, NT 0811, Australia. nicholas.douglas@gmail.com.

ABSTRACT

Background: Plasmodium vivax causes almost half of all malaria cases in Asia and is recognised as a significant cause of morbidity. In recent years it has been associated with severe and fatal disease. The extent to which P. vivax contributes to death is not known.

Methods: To define the epidemiology of mortality attributable to vivax malaria in southern Papua, Indonesia, a retrospective clinical records-based audit was conducted of all deaths in patients with vivax malaria at a tertiary referral hospital.

Results: Between January 2004 and September 2009, hospital surveillance identified 3,495 inpatients with P. vivax monoinfection and 65 (1.9%) patients who subsequently died. Charts for 54 of these 65 patients could be reviewed, 40 (74%) of whom had pure P. vivax infections on cross-checking. Using pre-defined conservative criteria, vivax malaria was the primary cause of death in 6 cases, a major contributor in 17 cases and a minor contributor in a further 13 cases. Extreme anaemia was the most common primary cause of death. Malnutrition, sepsis with respiratory and gastrointestinal manifestations, and chronic diseases were the commonest attributed causes of death for patients in the latter two categories. There were an estimated 293,763 cases of pure P. vivax infection in the community during the study period giving an overall minimum case fatality of 0.12 per 1,000 infections. The corresponding case fatality in hospitalised patients was 10.3 per 1,000 infections.

Conclusions: Although uncommonly directly fatal, vivax malaria is an important indirect cause of death in southern Papua in patients with malnutrition, sepsis syndrome and chronic diseases, including HIV infection.

Show MeSH
Related in: MedlinePlus