Medical Technology, School of Allied Health Sciences, Walailak University, Thasala, Nakhon Si Thammarat, Thailand.
Department of Medical Technology, Far Eastern University, Manila, Philippines.
BMC Infect Dis. 2020 May 24;20(1):363. doi: 10.1186/s12879-020-05046-y.
Plasmodium vivax rarely develops severe complications when compared to severe falciparum malaria. However, severe vivax malaria also needs urgent, intensive care and treatment as severe falciparum malaria. This systematic review aimed to explore pooled prevalence of severe vivax malaria and to identify factors related to poor outcome of patients who developed severe manifestation.
The systematic review conducted by two reviewers independently through searching of research publications related to severe P. vivax malaria in three databases including MEDLINE, Web of Science (ISI), and Scopus until October, 22 2019. The pooled prevalence of severe vivax malaria was achieved using STATA and RevMan 5 Software. Factors related to poor outcome of patients with severe vivax malaria were analyzed using SPSS 11.5 Software.
Among 2615 research publications retrieved from three databases, 49 articles reporting on 42,325 severity cases were selected for calculating pooled prevalence. Seventy-six patients from case reports, case series, letter to editors, and research communications were collected to identify factors related to poor outcome of patients with severe vivax malaria. The results showed that severe anemia, jaundice, respiratory distress, impaired consciousness, and renal failure were the most common major manifestations of severe malaria guided by the World Health Organization (WHO) criterion. The meta-analysis indicated that severe malaria was less frequent in patient with P. vivax compared to those with P. falciparum (P -value < 0.00001, OR = 0.38, 95% CI = 0.25-0.56, I = 87%). In addition, thrombocytopenia, anemia, hepatitis, and severe thrombocytopenia were the most common minor complications. Analysis of cases indicated that convulsion, respiratory distress, renal failure, jaundice, anuria/oliguria, and complication during treatment impacted on longer hospital stays compared to other severe complications (P-value < 0.05). Respiratory distress was frequently found after first treatment with anti-malarial drugs (P-value = 0.002). Renal failure was frequently found before treatment with anti-malarial drugs (P-value = 0.016). Mean days of fever and higher pulse rates at presentation were predictors of poor outcome among patients with severe vivax malaria (P-value < 0.05).
Severe anemia was the most common major manifestation of P. vivax malaria guided by the WHO criterion. Severe anemia was found less frequently in patients with P. vivax than those with P. falciparum. Renal failure, jaundice, anuria/oliguria, and complication during treatment along with, mean days of fever and higher pulse rates at presentation might be predictors of poor outcome of patients with severe vivax malaria.
与严重恶性疟相比，间日疟原虫很少引起严重并发症。然而，严重间日疟也需要紧急、强化护理和治疗，就像严重恶性疟一样。本系统评价旨在探讨严重间日疟的总患病率，并确定与出现严重表现的患者预后不良相关的因素。
两名评审员通过在三个数据库（包括 MEDLINE、Web of Science（ISI）和 Scopus）中搜索与严重间日疟相关的研究出版物，独立进行了系统评价。使用 STATA 和 RevMan 5 软件计算严重间日疟的总患病率。使用 SPSS 11.5 软件分析与严重间日疟患者预后不良相关的因素。
从三个数据库中检索到的 2615 篇研究出版物中，选择了 49 篇报告 42325 例严重病例的文章，以计算总患病率。从病例报告、病例系列、给编辑的信和研究通讯中收集了 76 例患者，以确定与严重间日疟患者预后不良相关的因素。结果表明，严重贫血、黄疸、呼吸窘迫、意识障碍和肾功能衰竭是世卫组织（WHO）标准指导下严重疟疾最常见的主要表现。荟萃分析表明，与恶性疟原虫感染患者相比，间日疟原虫感染患者的严重疟疾发生率较低（P 值<0.00001，OR=0.38，95%CI=0.25-0.56，I=87%）。此外，血小板减少症、贫血、肝炎和严重血小板减少症是最常见的次要并发症。病例分析表明，与其他严重并发症相比，抽搐、呼吸窘迫、肾功能衰竭、黄疸、无尿/少尿和治疗期间的并发症会导致更长的住院时间（P 值<0.05）。在首次使用抗疟药物治疗后经常发现呼吸窘迫（P 值=0.002）。在使用抗疟药物治疗之前经常发现肾功能衰竭（P 值=0.016）。发热天数和就诊时更高的脉搏率是严重间日疟患者预后不良的预测因素（P 值<0.05）。
世卫组织标准指导下严重间日疟的最常见主要表现为严重贫血。与恶性疟原虫感染患者相比，间日疟原虫感染患者的严重贫血发生率较低。肾功能衰竭、黄疸、无尿/少尿和治疗期间的并发症以及发热天数和就诊时更高的脉搏率可能是严重间日疟患者预后不良的预测因素。
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