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Plasmodium malariae Infection Associated with a High Burden of Anemia: A Hospital-Based Surveillance Study.

Langford S, Douglas NM, Lampah DA, Simpson JA, Kenangalem E, Sugiarto P, Anstey NM, Poespoprodjo JR, Price RN - PLoS Negl Trop Dis (2015)

Bottom Line: Morbidity associated with P. malariae infection has received relatively little attention, and the risk of P. malariae-associated nephrotic syndrome is unknown.Plasmodium malariae infection is relatively uncommon in Papua, Indonesia but is associated with significant morbidity from anemia and a similar risk of mortality to patients hospitalized with P. falciparum and P. vivax infection.In our large hospital database, one in 200 children under the age of 5 years with P. malariae infection were recorded as having nephrotic syndrome.

View Article: PubMed Central - PubMed

Affiliation: Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Casuarina, Darwin, Northern Territory, Australia.

ABSTRACT

Background: Plasmodium malariae is a slow-growing parasite with a wide geographic distribution. Although generally regarded as a benign cause of malaria, it has been associated with nephrotic syndrome, particularly in young children, and can persist in the host for years. Morbidity associated with P. malariae infection has received relatively little attention, and the risk of P. malariae-associated nephrotic syndrome is unknown.

Methodology/principal findings: We used data from a very large hospital-based surveillance system incorporating information on clinical diagnoses, blood cell parameters and treatment to describe the demographic distribution, morbidity and mortality associated with P. malariae infection in southern Papua, Indonesia. Between April 2004 and December 2013 there were 1,054,674 patient presentations to Mitra Masyarakat Hospital of which 196,380 (18.6%) were associated with malaria and 5,097 were with P. malariae infection (constituting 2.6% of all malaria cases). The proportion of malaria cases attributable to P. malariae increased with age from 0.9% for patients under one year old to 3.1% for patients older than 15 years. Overall, 8.5% of patients with P. malariae infection required admission to hospital and the median length of stay for these patients was 2.5 days (Interquartile Range: 2.0-4.0 days). Patients with P. malariae infection had a lower mean hemoglobin concentration (9.0 g/dL) than patients with P. falciparum (9.5 g/dL), P. vivax (9.6g/dL) and mixed species infections (9.3g/dL). There were four cases of nephrotic syndrome recorded in patients with P. malariae infection, three of which were in children younger than 5 years old, giving a risk in this age group of 0.47% (95% Confidence Interval; 0.10% to 1.4%). Overall, 2.4% (n = 16) of patients hospitalized with P. malariae infection subsequently died in hospital, similar to the proportions for the other endemic Plasmodium species (range: 0% for P. ovale to 1.6% for P. falciparum).

Conclusions/significance: Plasmodium malariae infection is relatively uncommon in Papua, Indonesia but is associated with significant morbidity from anemia and a similar risk of mortality to patients hospitalized with P. falciparum and P. vivax infection. In our large hospital database, one in 200 children under the age of 5 years with P. malariae infection were recorded as having nephrotic syndrome.

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Age distributions of patients presenting to RSMM by Plasmodium species.Vertical lines represent median age.
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pntd.0004195.g001: Age distributions of patients presenting to RSMM by Plasmodium species.Vertical lines represent median age.

Mentions: The age distribution of all patients presenting with P. malariae monoinfection was similar to P. falciparum (median 21.7 and 20.1 years respectively), but substantially older than for P. vivax (median 10.0 years) and mixed infections (15.1 years). For all species, there was a bimodal distribution of age at presentation with a peak in children under 5 years of age and another in early adulthood. The childhood peak for P. malariae was less pronounced than for the other species (P. ovale excepted) (see Fig 1). The proportion of malaria presentations attributable to P. malariae increased from 0.9% (80/8,669) for patients less than one year of age to 3.1% (3,367/107,066) for patients older than 15 years (Fig 2).


Plasmodium malariae Infection Associated with a High Burden of Anemia: A Hospital-Based Surveillance Study.

Langford S, Douglas NM, Lampah DA, Simpson JA, Kenangalem E, Sugiarto P, Anstey NM, Poespoprodjo JR, Price RN - PLoS Negl Trop Dis (2015)

Age distributions of patients presenting to RSMM by Plasmodium species.Vertical lines represent median age.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4697806&req=5

pntd.0004195.g001: Age distributions of patients presenting to RSMM by Plasmodium species.Vertical lines represent median age.
Mentions: The age distribution of all patients presenting with P. malariae monoinfection was similar to P. falciparum (median 21.7 and 20.1 years respectively), but substantially older than for P. vivax (median 10.0 years) and mixed infections (15.1 years). For all species, there was a bimodal distribution of age at presentation with a peak in children under 5 years of age and another in early adulthood. The childhood peak for P. malariae was less pronounced than for the other species (P. ovale excepted) (see Fig 1). The proportion of malaria presentations attributable to P. malariae increased from 0.9% (80/8,669) for patients less than one year of age to 3.1% (3,367/107,066) for patients older than 15 years (Fig 2).

Bottom Line: Morbidity associated with P. malariae infection has received relatively little attention, and the risk of P. malariae-associated nephrotic syndrome is unknown.Plasmodium malariae infection is relatively uncommon in Papua, Indonesia but is associated with significant morbidity from anemia and a similar risk of mortality to patients hospitalized with P. falciparum and P. vivax infection.In our large hospital database, one in 200 children under the age of 5 years with P. malariae infection were recorded as having nephrotic syndrome.

View Article: PubMed Central - PubMed

Affiliation: Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Casuarina, Darwin, Northern Territory, Australia.

ABSTRACT

Background: Plasmodium malariae is a slow-growing parasite with a wide geographic distribution. Although generally regarded as a benign cause of malaria, it has been associated with nephrotic syndrome, particularly in young children, and can persist in the host for years. Morbidity associated with P. malariae infection has received relatively little attention, and the risk of P. malariae-associated nephrotic syndrome is unknown.

Methodology/principal findings: We used data from a very large hospital-based surveillance system incorporating information on clinical diagnoses, blood cell parameters and treatment to describe the demographic distribution, morbidity and mortality associated with P. malariae infection in southern Papua, Indonesia. Between April 2004 and December 2013 there were 1,054,674 patient presentations to Mitra Masyarakat Hospital of which 196,380 (18.6%) were associated with malaria and 5,097 were with P. malariae infection (constituting 2.6% of all malaria cases). The proportion of malaria cases attributable to P. malariae increased with age from 0.9% for patients under one year old to 3.1% for patients older than 15 years. Overall, 8.5% of patients with P. malariae infection required admission to hospital and the median length of stay for these patients was 2.5 days (Interquartile Range: 2.0-4.0 days). Patients with P. malariae infection had a lower mean hemoglobin concentration (9.0 g/dL) than patients with P. falciparum (9.5 g/dL), P. vivax (9.6g/dL) and mixed species infections (9.3g/dL). There were four cases of nephrotic syndrome recorded in patients with P. malariae infection, three of which were in children younger than 5 years old, giving a risk in this age group of 0.47% (95% Confidence Interval; 0.10% to 1.4%). Overall, 2.4% (n = 16) of patients hospitalized with P. malariae infection subsequently died in hospital, similar to the proportions for the other endemic Plasmodium species (range: 0% for P. ovale to 1.6% for P. falciparum).

Conclusions/significance: Plasmodium malariae infection is relatively uncommon in Papua, Indonesia but is associated with significant morbidity from anemia and a similar risk of mortality to patients hospitalized with P. falciparum and P. vivax infection. In our large hospital database, one in 200 children under the age of 5 years with P. malariae infection were recorded as having nephrotic syndrome.

Show MeSH
Related in: MedlinePlus