Duong Minh Cuong, Pham Oanh Kieu Nguyet, Thai Thanh Truc, Lee Rogan, Nguyen Thanh Phong, Nguyen Van Vinh Chau, Nguyen Hoan Phu
School of Population Health, University of New South Wales, Sydney, NSW, Australia.
Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam.
Front Med (Lausanne). 2023 May 30;10:1128981. doi: 10.3389/fmed.2023.1128981. eCollection 2023.
Infection with is a recognized cause of severe malaria including deaths. The exact burden and patterns of severe monoinfections is however still not well quantified, especially in endemic regions. We examined the magnitude and patterns of severe malaria caused by monoinfections of and associated predictors among patients admitted to a tertiary care center for malaria in Vietnam.
A retrospective cohort study was conducted based on the patients' medical records at the Hospital for Tropical Diseases from January 2015 to December 2018. Extracted information included demographic, epidemiologic, clinical, laboratory and treatment characteristics.
Monoinfections with were found in 153 (34.5, 95% CI 30.3-39.1%) patients of whom, uncomplicated and severe malaria were documented in 89.5% (137/153, 95% CI 83.7-93.5%) and 10.5% (16/153, 95% CI 6.5-16.3%), respectively. Patterns of severe malaria included jaundice (8 cases), hypoglycemia (3 cases), shock (2 cases), anemia (2 cases), and cerebral malaria (1 case). Among 153 patients, 73 (47.7%) had classic malaria paroxysm, 57 (37.3%) had >7 days of illness at the time of admission, and 40 (26.1%) were referred from other hospitals. A misdiagnosis as having other diseases from malaria cases coming from other hospitals was up to 32.5% (13/40). Being admitted to hospital after day 7th of illness (AOR = 6.33, 95% CI 1.14-35.30, p = 0.035) was a predictor of severe malaria. Severe malaria was statistically associated with longer hospital length of stay (p = 0.035). Early and late treatment failures and recrudescence were not recorded. All patients recovered completely.
This study confirms the emergence of severe vivax malaria in Vietnam which is associated with delayed hospital admission and increased hospital length of stay. Clinical manifestations of infection can be misdiagnosed which results in delayed treatment. To meet the goal of malaria elimination by 2030, it is crucial that the non-tertiary hospitals have the capacity to quickly and correctly diagnose malaria and then provide treatment for malaria including infections. More robust studies need to be conducted to fully elucidate the magnitude of severe in Vietnam.
感染间日疟原虫是包括死亡在内的严重疟疾的公认病因。然而，严重间日疟原虫单一感染的确切负担和模式仍未得到充分量化，尤其是在疟疾流行地区。我们研究了越南一家三级疟疾治疗中心收治的间日疟原虫单一感染所致严重疟疾的程度、模式及相关预测因素。
基于2015年1月至2018年12月热带病医院患者的病历进行回顾性队列研究。提取的信息包括人口统计学、流行病学、临床、实验室及治疗特征。
153例（34.5%，95%可信区间30.3 - 39.1%）患者为间日疟原虫单一感染，其中89.5%（137/153，95%可信区间83.7 - 93.5%）为非重症疟疾，10.5%（16/153，95%可信区间6.5 - 16.3%）为重症疟疾。重症疟疾的模式包括黄疸（8例）、低血糖（3例）、休克（2例）、贫血（2例）和脑型疟疾（1例）。153例患者中，73例（47.7%）有典型疟疾发作，57例（37.3%）入院时病程>7天，40例（26.1%）从其他医院转诊而来。来自其他医院的疟疾病例被误诊为其他疾病的比例高达32.5%（13/40）。发病第7天后入院（比值比=6.33，95%可信区间1.14 - 35.30，p = 0.035）是重症疟疾的一个预测因素。重症疟疾与住院时间延长在统计学上相关（p = 0.035）。未记录早期和晚期治疗失败及复发情况。所有患者均完全康复。
本研究证实越南出现了严重间日疟，这与延迟入院和住院时间延长有关。间日疟原虫感染的临床表现可能被误诊，导致治疗延迟。为实现到2030年消除疟疾的目标，至关重要的是，非三级医院要有能力快速、正确地诊断疟疾，然后为包括间日疟原虫感染在内的疟疾提供治疗。需要开展更有力的研究以充分阐明越南严重间日疟的程度。
