Risk Factors and Characterization of Plasmodium Vivax-Associated Admissions to Pediatric Intensive Care Units in the Brazilian Amazon

被引:53
作者
Caetano Lanca, Ellen Fatima [1 ,5 ]
Lopes Magalhaes, Belisa Maria [1 ,4 ]
Vitor-Silva, Sheila [1 ,4 ]
Siqueira, Andre Machado [1 ,2 ,4 ]
Benzecry, Silvana Gomes [1 ]
Araujo Alexandre, Marcia Almeida [1 ,2 ,3 ]
O'Brien, Connor [6 ]
Bassat, Quique [7 ]
Guimaraes Lacerda, Marcus Vinicius [1 ,2 ,3 ,4 ]
机构
[1] Univ Estado Amazonas, Manaus, Amazonas, Brazil
[2] Fundacao Med Trop Dr Heitor Vieira Dourado, Manaus, Amazonas, Brazil
[3] Univ Nilton Lins, Manaus, Amazonas, Brazil
[4] Natl Inst Sci & Technol Innovat Neglected Dis, Rio De Janeiro, Brazil
[5] Univ Fed Amazonas, Manaus, Amazonas, Brazil
[6] Columbia Univ, Med Ctr, New York, NY USA
[7] Univ Barcelona, Ctr Recerca Salut Int Barcelona CRESIB, Hosp Clin, Barcelona, Spain
关键词
MALARIA; CHILDREN; PAPUA; FALCIPARUM; MORTALITY; MANAUS;
D O I
10.1371/journal.pone.0035406
中图分类号
O [数理科学和化学]; P [天文学、地球科学]; Q [生物科学]; N [自然科学总论];
学科分类号
07 ; 0710 ; 09 ;
摘要
Background: Plasmodium vivax is responsible for a significant proportion of malaria cases worldwide and is increasingly reported as a cause of severe disease. The objective of this study was to characterize severe vivax disease among children hospitalized in intensive care units (ICUs) in the Western Brazilian Amazon, and to identify risk factors associated with disease severity. Methods and Findings: In this retrospective study, clinical records of 34 children, 0-14 years of age hospitalized in the 11 public pediatric and neonatal ICUs of the Manaus area, were reviewed. P. falciparum monoinfection or P. falciparum/P. vivax mixed infection was diagnosed by microscopy in 10 cases, while P. vivax monoinfection was confirmed in the remaining 24 cases. Two of the 24 patients with P. vivax monoinfection died. Respiratory distress, shock and severe anemia were the most frequent complications associated with P. vivax infection. Ninety-one children hospitalized with P. vivax monoinfections but not requiring ICU were consecutively recruited in a tertiary care hospital for infectious diseases to serve as a reference population (comparators). Male sex (p = 0.039), age less than five years (p = 0.028), parasitemia greater than 500/mm(3) (p = 0.018), and the presence of any acute (p = 0.023) or chronic (p = 0.017) co-morbidity were independently associated with ICU admission. At least one of the WHO severity criteria for malaria (formerly validated for P. falciparum) was present in 23/24 (95.8%) of the patients admitted to the ICU and in 17/91 (18.7%) of controls, making these criteria a good predictor of ICU admission (p = 0.001). The only investigated criterion not associated with ICU admission was hyperbilirubinemia (p = 0.513)]. Conclusions: Our study points to the importance of P. vivax-associated severe disease in children, causing 72.5% of the malaria admissions to pediatric ICUs. WHO severity criteria demonstrated good sensitivity in predicting severe P. vivax infection in this small case series.
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页数:10
相关论文
共 46 条
[1]  
Alecrim M das G, 1999, Rev Soc Bras Med Trop, V32, P67, DOI 10.1590/S0037-86821999000100013
[2]   Severe Plasmodium vivax Malaria, Brazilian Amazon [J].
Alexandre, Marcia A. ;
Ferreira, Cynthia O. ;
Siqueira, Andre M. ;
Magalhaes, Belisa L. ;
Mourao, Maria Paula G. ;
Lacerda, Marcus V. ;
Alecrim, Maria das Gracas C. .
EMERGING INFECTIOUS DISEASES, 2010, 16 (10) :1611-1614
[3]  
Alonso PL, 2011, PLOS MED, V8, DOI [10.1371/journal.pmed.1000406, 10.1371/journal.pmed.1000398]
[4]   Severe Plasmodium vivax malaria exhibits marked inflammatory imbalance [J].
Andrade, Bruno B. ;
Reis-Filho, Antonio ;
Souza-Neto, Sebastiao M. ;
Clarencio, Jorge ;
Camargo, Luis M. A. ;
Barral, Aldina ;
Barral-Netto, Manoel .
MALARIA JOURNAL, 2010, 9
[5]  
[Anonymous], 1986, Trans R Soc Trop Med Hyg, V80 Suppl, P3
[6]  
[Anonymous], 2008, WORLD MAL REP 2008
[7]  
[Anonymous], 2010, Guidelines for the treatment of Malaria, DOI DOI 10.1080/03630269.2023.2168201
[8]   Lung injury in vivax malaria: Pathophysiological evidence for pulmonary vascular sequestration and posttreatment alveolar-capillary inflammation [J].
Anstey, Nicholas M. ;
Handojo, Tjandra ;
Pain, Michael C. F. ;
Kenangalem, Enny ;
Tjitra, Emiliana ;
Price, Ric N. ;
Maguire, Graeme P. .
JOURNAL OF INFECTIOUS DISEASES, 2007, 195 (04) :589-596
[9]   Improving case definitions for severe malaria [J].
Anstey, Nicholas M. ;
Price, Ric N. .
PLOS MEDICINE, 2007, 4 (08) :1291-1292
[10]   Demographic risk factors for severe and fatal vivax and falciparum malaria among hospital admissions in northeastern Indonesian Papua [J].
Barcus, Mazie J. ;
Basri, Hasan ;
Picarima, Helena ;
Manyakori, C. ;
Sekartuti ;
Elyasar, Iqbal ;
Bangs, Michael J. ;
Maguire, Jason D. ;
Baird, J. Kevin .
AMERICAN JOURNAL OF TROPICAL MEDICINE AND HYGIENE, 2007, 77 (05) :984-991