Early diagnosis and treatment of falciparum malaria in Cambodian trauma patients.

Asymptomatically infected patients with falciparum malaria may develop symptomatic malaria infection secondary to injury or surgery. This complication increases the risk for postoperative wound infection and adds to the burden of trauma. The aims of the present study were to investigate the preventive effect of early antimalaria treatment of Plasmodium falciparum infected trauma patients, and to study the validity and accuracy of a rapid test to identify those infected. An open, non-randomized, interventional multi-center, cohort study was carried out at six district hospitals in northwestern Cambodia. Two hundred twenty-two trauma patients was examined for P. falciparum by dipstick test soon after injury. The patients testing positive were immediately treated with artesunate-mefloquine. A subset of 108 patients from Pailin, an area considered highly endemic for falciparum malaria, was used for the main analysis. Of 28 P. falciparum rapid test-positives, 21 developed symptomatic postinjury malaria despite early antimalarial treatment. The agreement between the dipstick test and blood smear examination was good (kappa 92.5; 95% CI 84.5-100). Early pre-operative treatment of parasite carriers does not seem to prevent symptomatic malaria after injury and surgery. The rapid test for falciparum malaria was reliable in early identification of asymptomatic P. falciparum infected patients.

Postinjury malaria: experiences of doctors in Battambang Province, Cambodia.

Quantitative studies indicate that one-third of trauma victims in malaria endemic areas of Cambodia develop postinjury malaria. The main aim of this study was to assess the medical significance of the complication. All local doctors with trauma care surgical experience in the Battambang Province of Cambodia were interviewed regarding their experiences with postinjury malaria (n = 18). The qualitative data were processed according to the Editing Style Analysis method. In the study area, postinjury malaria has been a well-known complication to trauma doctors for years. Local doctors claim that the complication is more common in severe as compared to moderate trauma. The complication is reported to adversely affect the general condition of trauma patients, increasing the risk of wound infections, and delaying postoperative recovery. It was found that the informants draw exclusively on personal clinical experience regarding this clinical knowledge, asserting that postinjury malaria is not taught at local medical schools. The study indicated that post-injury malaria is a significant complication to trauma where falciparum malaria is endemic. The knowledge of postinjury malaria in the study area seemed to be non-institutional; the informants' assessments were exclusively based on their personal clinical experience.

Post-injury malaria: a risk factor for wound infection and protracted recovery.

OBJECTIVE: To assess the impact of post-injury falciparum malaria on morbidity parameters in Cambodia. METHOD: Retrospective study of 227 trauma patients managed at a surgical centre in Battambang, Cambodia. RESULTS: Within 10 days of the injury, 42.7% of the study population developed symptomatic malaria. In patients with post-injury malaria, the rate of wound infection was 36.1% compared with 10.0% in patients without symptomatic malaria (95% confidence interval for difference 15.2-36.9%). The average hospital stay in the post-injury malaria group was 31.2 days compared with 19.4 days in the patients without the complication (95% confidence interval for difference 7.2-16.4 days). CONCLUSION: Symptomatic malaria after trauma is common in Cambodia. Post-injury malaria seems to increase the risk of wound infection, delays postoperative recovery, and thus adds to the burden of trauma.

Postinjury malaria: a study of trauma victims in cambodia.

BACKGROUND: The pattern of host defense against plasmodium is comparable to the immune response to bacterial infection. Posttraumatic immunosuppression may therefore cause relapses of malaria secondary to trauma and trauma surgery in asymptomatic carriers of the parasites in endemic areas. To our knowledge this has not been validated in epidemiologic studies. METHODS: Postinjury malaria was registered retrospectively in 342 land mine and war victims from malaria-endemic areas in Cambodia. The incidence rate was analyzed in terms of age, gender, preinjury endemicity, evacuation times, anatomic injury severity, systolic blood pressure at admission, blood transfusion, and duration of the first surgical intervention as independent variables. RESULTS: The rate of postinjury malaria in the study patients was 33.3% (95% CI, 28.3-38.3%). Injury Severity Score (ISS) and surgical operation time were risk factors (area under the curve in receiver operating characteristic plots were 0.73 and 0.79, respectively). The impact of the other risk factors was nonsignificant. CONCLUSION: Despite difficulties in diagnosing postoperative malaria in endemic areas, the study demonstrates that the rate of postinjury malaria is high. The results legitimate controlled trials of immediate postinjury chemoprophylaxis to severely injured in endemic areas. The authors recommend staged surgical operations with brief primary interventions in victims with severe injuries.