Arévalo-Herrera Myriam, Rengifo Lina, Lopez-Perez Mary, Arce-Plata Maria I, García Jhon, Herrera Sócrates
Caucaseco Scientific Research Center, Cali, Colombia.
Faculty of Health, Universidad del Valle, Cali, Colombia.
PLoS One. 2017 Sep 25;12(9):e0185435. doi: 10.1371/journal.pone.0185435. eCollection 2017.
Complicated malaria remains an important public health problem, particularly in endemic settings where access to health services is limited and consequently malaria fatal outcomes occur. Few publications describing the clinical course and outcomes of complicated malaria in Latin America are found in the literature. This prospective study approached the clinical and laboratory characteristics of hospitalized patients with complicated malaria in different endemic areas of the Colombian Pacific Coast with the aim to provide epidemiological knowledge and guide to further reducing malaria severity and mortality.
A prospective, descriptive hospital-based study was conducted in 323 complicated malaria patients (median age 20 years) enrolled in Quibdó, Tumaco and Cali between 2014 and 2016. Clinical evaluation was performed and laboratory parameters were assessed during hospitalization. Plasmodium falciparum was the most common parasite species (70%), followed by P. vivax (28%), and mixed malaria (Pf/Pv; 1.9%). Overall, predominant laboratory complications were severe thrombocytopenia (43%), hepatic dysfunction (40%), and severe anaemia (34%). Severe thrombocytopenia was more common in adults (52%) regardless of parasite species. Severe anaemia was the most frequent complication in children ≤10 years (72%) and was most commonly related to P. vivax infection (p < 0.001); whereas liver dysfunction was more frequent in older patients (54%) with P. falciparum (p < 0.001). Two deaths due to P. vivax and P. falciparum each were registered. Treatment provision before recruitment hindered qPCR confirmation of parasite species in some cases.
The study identified a high prevalence of complicated malaria in the Pacific Coast, together with more frequent severe anaemia in children infected by P. vivax and hepatic dysfunction in adults with P. falciparum. Results indicated the need for earlier diagnosis and treatment to prevent complications development as well as more effective attention at hospital level, in order to rapidly identify and appropriately treat these severe clinical conditions. The study describes epidemiological profiles of the study region and identified the most common complications on which clinicians must focus on to prevent mortality.
复杂型疟疾仍然是一个重要的公共卫生问题，尤其是在卫生服务可及性有限、因而出现疟疾致死情况的流行地区。文献中很少有描述拉丁美洲复杂型疟疾临床病程及转归的出版物。这项前瞻性研究探讨了哥伦比亚太平洋沿岸不同流行地区住院的复杂型疟疾患者的临床和实验室特征，旨在提供流行病学知识并指导进一步降低疟疾的严重程度和死亡率。
2014年至2016年期间，在基布多、图马科和卡利对323例复杂型疟疾患者（中位年龄20岁）进行了一项基于医院的前瞻性描述性研究。住院期间进行了临床评估并评估了实验室参数。恶性疟原虫是最常见的寄生虫种类（70%），其次是间日疟原虫（28%）和混合感染（Pf/Pv；1.9%）。总体而言，主要的实验室并发症为严重血小板减少（43%）、肝功能障碍（40%）和严重贫血（34%）。无论寄生虫种类如何，严重血小板减少在成人中更为常见（52%）。严重贫血是10岁及以下儿童中最常见的并发症（72%），且最常与间日疟原虫感染相关（p<0.001）；而肝功能障碍在感染恶性疟原虫的老年患者中更为常见（54%）（p<0.001）。各有2例因间日疟原虫和恶性疟原虫导致的死亡病例被记录。招募前的治疗措施在某些情况下妨碍了通过定量聚合酶链反应确认寄生虫种类。
该研究发现太平洋沿岸复杂型疟疾的患病率很高，同时感染间日疟原虫的儿童中严重贫血更为常见，感染恶性疟原虫的成人中肝功能障碍更为常见。结果表明需要早期诊断和治疗以预防并发症的发生，以及在医院层面提供更有效的医疗服务，以便快速识别并适当治疗这些严重的临床病症。该研究描述了研究区域的流行病学概况，并确定了临床医生必须关注以预防死亡的最常见并发症。
