Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.766
Filtrar
1.
Lancet Haematol ; 7(11): e789-e797, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33091354

RESUMO

BACKGROUND: Infection with Plasmodium falciparum leads to severe malaria and death in approximately 400 000 children each year in sub-Saharan Africa. Blood transfusion might benefit some patients with malaria but could potentially harm others. The aim of this study was to estimate the association between transfusion and death among children admitted to hospital with P falciparum malaria. METHODS: In this prospective, multicentre observational study, we analysed admissions to six tertiary care hospitals in The Gambia, Malawi, Gabon, Kenya, and Ghana that participated in the Severe Malaria in African Children network. Patients were enrolled if they were younger than 180 months and had a Giemsa-stained thick blood smear that was positive for P falciparum. Blood transfusion (whole blood at a target volume of 20 mL per kg) was administered at the discretion of the responsible physicians who were aware of local and international transfusion guidelines. The primary endpoint was death associated with transfusion, which was estimated using models adjusted for site and disease severity. We also aimed to identify factors associated with the decision to transfuse. The exploratory objective was to estimate optimal haemoglobin transfusion thresholds using generalised additive models. FINDINGS: Between Dec 19, 2000, and March 8, 2005, 26 106 patients were enrolled in the study, 25 893 of whom had their transfusion status recorded and were included in the primary analysis. 8513 (32·8%) patients received a blood transfusion. Patients were followed-up until discharge from hospital for a median of 2 days (IQR 1-4). 405 (4·8%) of 8513 patients who received a transfusion died compared with 689 (4·0%) of 17 380 patients who did not receive a transfusion. Transfusion was associated with decreased odds of death in site-adjusted analysis (odds ratio [OR] 0·82 [95% CI 0·71-0·94]) and after adjusting for the increased disease severity of patients who received a transfusion (0·50 [0·42-0·60]). Severe anaemia, elevated lactate concentration, respiratory distress, and parasite density were associated with greater odds of receiving a transfusion. Among all study participants, transfusion was associated with improved survival when the admission haemoglobin concentration was up to 77 g/L (95% CI 65-110). Among those with impaired consciousness (Blantyre Coma Score ≤4), transfusion was associated with improved survival at haemoglobin concentrations up to 105 g/L (95% CI 71-115). Among those with hyperlactataemia (blood lactate ≥5·0 mmol/L), transfusion was not significantly associated with harm at any haemoglobin concentration-ie, the OR of death comparing transfused versus not transfused was less than 1 at all haemoglobin concentrations (lower bound of the 95% CI for the haemoglobin concentration at which the OR of death equals 1: 90 g/L; no upper bound). INTERPRETATION: Our findings suggest that whole blood transfusion was associated with improved survival among children hospitalised with P falciparum malaria. Among those with impaired consciousness or hyperlactataemia, transfusion was associated with improved survival at haemoglobin concentrations above the currently recommended transfusion threshold. These findings highlight the need to do randomised controlled trials to test higher transfusion thresholds among African children with severe malaria complicated by these factors. FUNDING: US National Institute of Allergy and Infectious Diseases.


Assuntos
Transfusão de Sangue , Malária Falciparum/mortalidade , Anemia/complicações , Antimaláricos/uso terapêutico , Pré-Escolar , Estado de Consciência , Hemoglobinas/análise , Hospitalização , Humanos , Hiperlactatemia/complicações , Lactente , Quênia , Malária Falciparum/complicações , Malária Falciparum/tratamento farmacológico , Malária Falciparum/patologia , Razão de Chances , Estudos Prospectivos , Quinina/uso terapêutico , Índice de Gravidade de Doença , Taxa de Sobrevida , Centros de Atenção Terciária , Resultado do Tratamento
2.
PLoS Negl Trop Dis ; 14(7): e0008466, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32687495

RESUMO

Malaria caused by Plasmodium vivax is a highly prevalent infection world-wide, that was previously considered mild, but complications such as anemia have been highly reported in the past years. In mice models of malaria, anti-phosphatidylserine (anti-PS) autoantibodies, produced by atypical B-cells, bind to uninfected erythrocytes and contribute to anemia. In human patients with P. falciparum malaria, the levels of anti-PS, atypical B-cells and anemia are strongly correlated to each other. In this study, we focused on assessing the relationship between autoantibodies, different B-cell populations and hemoglobin levels in two different cohorts of P. vivax patients from Colombia, South America. In a first longitudinal cohort, our results show a strong inverse correlation between different IgG autoantibodies tested (anti-PS, anti-DNA and anti-erythrocyte) and atypical memory B-cells (atMBCs) with hemoglobin in both P. vivax and P. falciparum patients over time. In a second cross-sectional cohort, we observed a stronger relation between hemoglobin levels, atMBCs and autoantibodies in complicated P. vivax patients compared to uncomplicated ones. Altogether, these data constitute the first evidence of autoimmunity associating with anemia and complicated P. vivax infections, suggesting a role for its etiology through the expansion of autoantibody-secreting atMBCs.


Assuntos
Anemia/complicações , Autoanticorpos/sangue , Linfócitos B/classificação , Malária Vivax/sangue , Malária Vivax/complicações , Anemia/sangue , Anemia/imunologia , Hemoglobinas/metabolismo , Humanos , Malária Falciparum/sangue , Malária Falciparum/complicações , Malária Falciparum/imunologia , Fosfatidilserinas/imunologia , Plasmodium falciparum , Plasmodium vivax
3.
PLoS One ; 15(7): e0235437, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32645025

RESUMO

BACKGROUND: Acute respiratory distress syndrome (ARDS) is a severe complication of malaria that remains largely unstudied. We aim to describe the development of ARDS associated with severe P. falciparum malaria, its management and impact on clinical outcome. METHODS: Retrospective observational study of adult patients admitted with severe P. falciparum malaria in an Intensive Care Unit (ICU) of a tertiary care hospital from Portugal from 2008 to 2018. A multivariate logistic regression analysis was used to identify factors associated with the development of ARDS, defined according to Berlin Criteria. Prognosis was assessed by case-fatality ratio, nosocomial infection and length of stay. RESULTS: 98 patients were enrolled, of which 32 (33%) developed ARDS, a median of 2 days after starting antimalarial medication (IQR 0-4, range 0-6). Length of stay in ICU and in hospital were significantly longer in patients who developed ARDS: 13 days (IQR 10-18) vs 3 days (IQR 2-5) and 21 days (IQR 15-30.5) vs 7 days (IQR 6-10), respectively. Overall case-fatality ratio in ICU was 4.1% and did not differ between groups. The risk of ARDS development is difficult to establish. CONCLUSION: ARDS is a hard to predict late complication of severe malaria. A low threshold for ICU admission and monitoring should be used. Ideally patients should be managed in a centre with experience and access to advanced techniques.


Assuntos
Malária Falciparum/complicações , Malária Falciparum/epidemiologia , /epidemiologia , Centros de Atenção Terciária , Adolescente , Adulto , Idoso , Feminino , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Portugal/epidemiologia , Resultado do Tratamento , Adulto Jovem
4.
BMC Infect Dis ; 20(1): 363, 2020 May 24.
Artigo em Inglês | MEDLINE | ID: mdl-32448216

RESUMO

BACKGROUND: 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. METHODS: 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. RESULTS: 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, I2 = 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). CONCLUSIONS: 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.


Assuntos
Malária Falciparum/epidemiologia , Malária Vivax/epidemiologia , Plasmodium falciparum , Plasmodium vivax , Índice de Gravidade de Doença , Adulto , Anemia/etiologia , Antimaláricos/uso terapêutico , Anuria/etiologia , Feminino , Febre , Frequência Cardíaca , Humanos , Icterícia/etiologia , Malária Falciparum/complicações , Malária Falciparum/tratamento farmacológico , Malária Falciparum/parasitologia , Malária Vivax/complicações , Malária Vivax/tratamento farmacológico , Malária Vivax/parasitologia , Masculino , Oligúria/etiologia , Prevalência , Insuficiência Renal/etiologia , Fatores de Risco , Trombocitopenia/etiologia , Resultado do Tratamento , Organização Mundial da Saúde , Adulto Jovem
5.
Trop Doct ; 50(3): 251-253, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32437296

RESUMO

We present a patient with severe Plasmodium falciparum malaria of seven days' duration who developed an altered sensorium of one day. During hospital admission, peripheral symmetrical gangrene of hands and feet followed, despite normal limb vasculature.


Assuntos
Gangrena/etiologia , Malária Falciparum/complicações , Idoso de 80 Anos ou mais , Feminino , Pé/patologia , Gangrena/parasitologia , Mãos/patologia , Humanos , Malária Falciparum/diagnóstico , Plasmodium falciparum/isolamento & purificação
6.
J Ayub Med Coll Abbottabad ; 32(1): 136-138, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32468773

RESUMO

Malaria is a common public health problem which may have high morbidity and mortality. Physicians should be aware of the unusual presentations of this disease so that it can be timely diagnosed and treated. Herein we are presenting a case of falciparum malaria who presented to the hospital with carpopedal spasm and tetany. We will subsequently discuss mineral homeostasis and the mechanisms of hypocalcaemia in falciparum malaria and the dysregulation of calcium, phosphorus and magnesium metabolism.


Assuntos
Malária Falciparum , Tetania , Cálcio/sangue , Humanos , Hipocalcemia/complicações , Hipocalcemia/diagnóstico , Malária Falciparum/complicações , Malária Falciparum/diagnóstico , Masculino , Pessoa de Meia-Idade , Tetania/diagnóstico , Tetania/etiologia
7.
Infez Med ; 28(1): 11-16, 2020 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-32172256

RESUMO

There is a massive burden of acute febrile diseases during the post-monsoon season in tropical countries. Despite this, there is a lack of clarity amongst the primary care physicians and travel medicine experts on how to approach such patients in a syndromic fashion. In this review, the authors summarize a case-based approach in the management of acute febrile diseases.


Assuntos
Tempestades Ciclônicas , Países em Desenvolvimento , Febre/etiologia , Doença Aguda , Adulto , Febre de Chikungunya/complicações , Febre de Chikungunya/diagnóstico , Dengue/complicações , Dengue/diagnóstico , Humanos , Leptospirose/complicações , Leptospirose/diagnóstico , Malária Falciparum/complicações , Malária Falciparum/diagnóstico , Masculino , Tifo por Ácaros/complicações , Tifo por Ácaros/diagnóstico , Avaliação de Sintomas/métodos , Febre Tifoide/complicações , Febre Tifoide/diagnóstico , Infecção por Zika virus/complicações , Infecção por Zika virus/diagnóstico
8.
APMIS ; 128(2): 129-135, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32133709

RESUMO

Burkitt lymphoma (BL) is an aggressive non-Hodgkin lymphoma. The prevalence of BL is ten-fold higher in areas with stable transmission of Plasmodium falciparum malaria, where it is the most common childhood cancer, and is referred to as endemic BL (eBL). In addition to its association with exposure to P. falciparum infection, eBL is strongly associated with Epstein-Barr virus (EBV) infection (>90%). This is in contrast to BL as it occurs outside P. falciparum-endemic areas (sporadic BL), where only a minority of the tumours are EBV-positive. Although the striking geographical overlap in the distribution of eBL and P. falciparum was noted shortly after the first detailed description of eBL in 1958, the molecular details of the interaction between malaria and eBL remain unresolved. It is furthermore unexplained why exposure to P. falciparum appears to be essentially a prerequisite to the development of eBL, whereas other types of malaria parasites that infect humans have no impact. In this brief review, we summarize how malaria exposure may precipitate the malignant transformation of a B-cell clone that leads to eBL, and propose an explanation for why P. falciparum uniquely has this capacity.


Assuntos
Linfoma de Burkitt/etiologia , Linfoma de Burkitt/parasitologia , Malária Falciparum/complicações , Parasitos/patogenicidade , Plasmodium falciparum/patogenicidade , Animais , Criança , Infecções por Vírus Epstein-Barr/complicações , Herpesvirus Humano 4/patogenicidade , Humanos , Malária Falciparum/parasitologia
9.
Am J Trop Med Hyg ; 102(5): 1030-1032, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32067632

RESUMO

The post-malaria neurological syndrome (PMNS) is an unusual and relatively underreported complication of malaria, which usually occurs after the resolution of acute febrile illness and the patient is free from parasitemia. The clinical spectrum of the PMNS varies from acute-onset cerebellar ataxia to significant encephalopathy with focal deficits resembling acute disseminated encephalomyelitis. Uncommon presentations of PMNS include Guillain-Barre syndrome, postural tremor, or even isolated neuropsychiatric features. Although in a significant proportion of PMNS cases clinical resolution occurs with conservative treatment only, corticosteroids have been used in an attempt to hasten recoveries. Here, we present a case of a 12-year-old girl with acute onset, isolated neuropsychiatric features, following Plasmodium falciparum malaria. Neuroimaging, clinical examination, and cerebrospinal fluid studies were within normal limits. The child recovered completely after treatment with methylprednisolone pulse therapy. This case report illustrates the need for creating awareness about this uncommon complication of malaria. In view of the uncommon complication, early diagnosis and prompt treatment might help in the early resolution of symptoms.


Assuntos
Encefalopatias/parasitologia , Malária Falciparum/complicações , Encefalopatias/diagnóstico por imagem , Encefalopatias/etiologia , Encefalopatias/terapia , Criança , Feminino , Humanos , Metilprednisolona/uso terapêutico , Neuroimagem , Olanzapina/uso terapêutico , Plasmodium falciparum
10.
Parasite Immunol ; 42(4): e12702, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32020650

RESUMO

AIMS: Schistosomiasis and malaria are endemic in sub-Saharan Africa where Schistosoma haematobium (Sh) and Plasmodium falciparum (Pf) coinfections are thus frequent. We explored the effect of Sh infection on antibody responses directed to Pf merozoite antigens and on malaria susceptibility in Beninese children. METHODS AND RESULTS: A total of 268 children were followed during a malaria transmission season. Detection of Pf infection was performed by microscopy and rapid diagnostic tests. Sh infection was determined in urine by microscopy. Antimalarial antibody, cytokine and HLA-G concentrations were quantified by ELISA. The expression of HLA-G receptors by immune cells was assessed by flow cytometry. Children infected by Sh had higher concentrations of IgG1 directed to MSP3 and GLURPR0 , IgG2 directed to GLURPR0 and IgG3 directed to MSP3, GLURPR0 and GLURPR2 and have lower Pf densities than those uninfected by Sh. No difference in cytokine and HLA-G concentrations was observed between Sh egg carriers and non-carriers. CONCLUSION: Schistosoma haematobium modulates host immune responses directed to Pf antigens. The absence of immune downregulation usually observed during helminth infections is surprising in our study. We hypothesize that the stage of Sh development could partly explain the immune pathways leading to increased antibody levels that favour better control of Pf parasitemia.


Assuntos
Anticorpos Antiprotozoários/sangue , Antimaláricos/imunologia , Malária Falciparum/imunologia , Plasmodium falciparum/imunologia , Schistosoma haematobium/imunologia , Esquistossomose Urinária/imunologia , Animais , Antígenos de Protozoários/imunologia , Antimaláricos/uso terapêutico , Benin , Criança , Pré-Escolar , Coinfecção/parasitologia , Citocinas/sangue , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Malária Falciparum/complicações , Masculino , Esquistossomose Urinária/complicações , Esquistossomose Urinária/tratamento farmacológico
11.
J Trop Pediatr ; 66(2): 218-225, 2020 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-31505001

RESUMO

BACKGROUND: The prevalence of acute kidney injury (AKI) in children with severe malaria in sub-Saharan African may have been underestimated. The study aimed to determine the prevalence of AKI in children with severe malaria and its association with adverse hospital outcomes. METHODS: At presentation, we measured complete blood count, serum bilirubin, and serum electrolytes, urea and creatinine in children with severe malaria. At 24 h after hospitalization, we repeated serum creatinine measurement. Urine passed in the first 24 h of hospitalization was also measured. We defined AKI and its severity using the Kidney Disease: Improving Global Outcome AKI guidelines. RESULTS: The study involved 244 children (53.3% males) with a median age of 3.5 (1.9-7.0) years. One hundred and forty-four (59%) children had AKI, and it reached maximum Stages 1, 2 and 3 in 56 (23%), 45 (18.4%) and 43 (17.6%) children, respectively. The majority (86.1%) with AKI had only elevated serum creatinine. Mortality increased with increasing severity of AKI on univariate analysis but weakened on multiple logistic regression. Mortality was also higher in those with both oliguria and elevated serum creatinine than in those with elevated serum creatinine only (50% vs. 4.8%, p < 0.001). Furthermore, children with AKI spent three days more in hospital than those without AKI (p < 0.001). CONCLUSIONS: Acute kidney injury complicates severe malaria in 6 out of every 10 children and is commonly identified using elevated serum creatinine. It is also associated with adverse hospital outcome.


Assuntos
Lesão Renal Aguda/mortalidade , Tempo de Internação/estatística & dados numéricos , Malária Falciparum/complicações , Lesão Renal Aguda/parasitologia , Criança , Pré-Escolar , Creatinina/sangue , Feminino , Mortalidade Hospitalar , Humanos , Lactente , Malária/complicações , Malária/diagnóstico , Malária/mortalidade , Malária Falciparum/diagnóstico , Malária Falciparum/mortalidade , Masculino , Oligúria/etiologia , Plasmodium falciparum/isolamento & purificação , Prevalência , Fatores de Risco , Índice de Gravidade de Doença
12.
Rev Peru Med Exp Salud Publica ; 36(3): 520-524, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-31800949

RESUMO

The clinical signs of malaria in HIV patients may vary depending on the immunological status of the patient. Nationally, evidence regarding co-infection is scarce. This research describes four cases from a hospital in Iquitos, Peru, of patients diagnosed with HIV infection and a positive blood test for malaria. Two of these patients had Plasmodium falciparum infection, and two had Plasmodium vivax infection. One of the patients was in the AIDS stage with poor adherence to combination antiretroviral therapy (cART), and the other three were in the early stages and not receiving cART.


Assuntos
Infecções por HIV/complicações , Malária Falciparum/complicações , Malária Vivax/complicações , Adulto , Feminino , Hospitais , Humanos , Masculino , Pessoa de Meia-Idade , Peru , Estudos Retrospectivos
13.
Elife ; 82019 11 12.
Artigo em Inglês | MEDLINE | ID: mdl-31713516

RESUMO

Anemia is a common complication of malaria that is characterized by the loss of infected and uninfected erythrocytes. In mouse malaria models, clearance of uninfected erythrocytes is promoted by autoimmune anti-phosphatidylserine (PS) antibodies produced by T-bet+B-cells, which bind to exposed PS in erythrocytes, but the mechanism in patients is still unclear. In Plasmodium falciparum patients with anemia, we show that atypical memory FcRL5+T-bet+ B-cells are expanded and associate both with higher levels of anti-PS antibodies in plasma and with the development of anemia in these patients. No association of anti-PS antibodies or anemia with other B-cell subsets and no association of other antibody specificities with FcRL5+T-bet+ B-cells is observed, revealing high specificity in this response. We also identify FcRL5+T-bet+ B-cells as producers of anti-PS antibodies in ex vivo cultures of naïve human peripheral blood mononuclear cells (PBMC) stimulated with P.-falciparum-infected erythrocyte lysates. These data define a crucial role for atypical memory B-cells and anti-PS autoantibodies in human malarial anemia.


Assuntos
Anemia/imunologia , Autoanticorpos/imunologia , Linfócitos B/imunologia , Memória Imunológica , Malária Falciparum/imunologia , Fosfatidilserinas/imunologia , Anemia/etiologia , Animais , Humanos , Malária Falciparum/complicações , Camundongos
14.
Sci Rep ; 9(1): 14940, 2019 10 17.
Artigo em Inglês | MEDLINE | ID: mdl-31624288

RESUMO

Autoantibodies targeting host antigens contribute to autoimmune disorders, frequently occur during and after infections and have been proposed to contribute to malaria-induced anemia. We measured anti-phosphatidylserine (PS) and anti-DNA antibody levels in 382 Ugandan children prospectively recruited in a study of severe malaria (SM). High antibody levels were defined as antibody levels greater than the mean plus 3 standard deviations of community children (CC). We observed increases in median levels of anti-PS and anti-DNA antibodies in children with SM compared to CC (p < 0.0001 for both). Children with severe malarial anemia were more likely to have high anti-PS antibodies than children with cerebral malaria (16.4% vs. 7.4%), p = 0.02. Increases in anti-PS and anti-DNA antibodies were associated with decreased hemoglobin (p < 0.05). A one-unit increase in anti-DNA antibodies was associated with a 2.99 (95% CI, 1.68, 5.31) increase odds of acute kidney injury (AKI) (p < 0.0001). Elevated anti-PS and anti-DNA antibodies were associated with post-discharge mortality (p = 0.031 and p = 0.042, respectively). Children with high anti-PS antibodies were more likely to have multiple hospital readmissions compared to children with normal anti-PS antibody levels (p < 0.05). SM is associated with increased autoantibodies against PS and DNA. Autoantibodies were associated with anemia, AKI, post-discharge mortality, and hospital readmission.


Assuntos
Lesão Renal Aguda/epidemiologia , Anemia/epidemiologia , Autoanticorpos/sangue , Autoantígenos/imunologia , Malária Falciparum/complicações , Lesão Renal Aguda/sangue , Lesão Renal Aguda/imunologia , Anemia/sangue , Anemia/imunologia , Autoanticorpos/imunologia , Criança , Pré-Escolar , DNA/imunologia , Feminino , Seguimentos , Humanos , Lactente , Malária Falciparum/imunologia , Malária Falciparum/mortalidade , Masculino , Alta do Paciente , Readmissão do Paciente/estatística & dados numéricos , Fosfatidilserinas/imunologia , Plasmodium falciparum/imunologia , Estudos Prospectivos , Medição de Risco/métodos , Medição de Risco/estatística & dados numéricos , Índice de Gravidade de Doença , Uganda/epidemiologia
15.
Am J Case Rep ; 20: 1576-1580, 2019 Oct 27.
Artigo em Inglês | MEDLINE | ID: mdl-31655844

RESUMO

BACKGROUND Malaria adversely affects the kidney in a variety of ways. The most common kidney injury is acute tubular necrosis, although various glomerular lesions are also described. Of these, collapsing focal segmental glomerulosclerosis (cFSGS) is the most rarely seen. Thus, the natural history of this lesion and response to treatment are not clear. Herein, we present a case of cFSGS complicated by acute interstitial nephritis caused by Plasmodium falciparum (P. falciparum) unresponsive to prednisone. CASE REPORT A 64-year-old Nigerian man with chronic kidney disease due to hypertensive nephropathy was admitted to the hospital, diagnosed with active P. falciparum malaria infection after returning from Nigeria. He developed acute kidney injury and nephrotic range proteinuria. Renal biopsy showed acute interstitial nephritis and cFSGS. Despite corticosteroid therapy, his kidney function worsened, requiring initiation of renal replacement therapy. This is the fifth case report of cFSGS due to malaria P. falciparum but the first to report the presence of acute interstitial nephritis in association with cFSGS due to malaria. CONCLUSIONS cFSGS is rarely seen as a manifestation of P. falciparum infection. When associated with acute interstitial nephritis, the prognosis seems to be worse. It appears that age and co-morbidities are the risk factors for unresponsiveness to corticosteroids, and treatment of the renal disease should focus on rapidly eradicating the parasitemia and providing supportive care. Our case report is the first to describe a combination of cFSGS and interstitial nephritis caused by P. falciparum unresponsive to corticosteroids.


Assuntos
Resistência a Medicamentos , Glomerulosclerose Segmentar e Focal/parasitologia , Malária Falciparum/complicações , Nefrite Intersticial/parasitologia , Glomerulosclerose Segmentar e Focal/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Nefrite Intersticial/terapia , Nigéria/epidemiologia , Plasmodium falciparum , Prednisona/administração & dosagem , Terapia de Substituição Renal
16.
PLoS Med ; 16(10): e1002914, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31574087

RESUMO

BACKGROUND: Malaria in pregnancy is associated with adverse birth outcomes. However, the underlying mechanisms remain poorly understood. Tight regulation of angiogenic, metabolic, and inflammatory pathways are essential for healthy pregnancies. We hypothesized that malaria disrupts these pathways leading to preterm birth (PTB). METHODS AND FINDINGS: We conducted a secondary analysis of a randomized trial of malaria prevention in pregnancy conducted in Malawi from July 21, 2011, to March 18, 2013. We longitudinally assessed circulating mediators of angiogenic, metabolic, and inflammatory pathways during pregnancy in a cohort of HIV-negative women (n = 1,628), with a median age of 21 years [18, 25], and 562 (35%) were primigravid. Pregnancies were ultrasound dated, and samples were analyzed at 13 to 23 weeks (Visit 1), 28 to 33 weeks (Visit 2), and/or 34 to 36 weeks (Visit 3). Malaria prevalence was high; 70% (n = 1,138) had PCR-positive Plasmodium falciparum infection at least once over the course of pregnancy and/or positive placental histology. The risk of delivering preterm in the entire cohort was 20% (n = 304/1506). Women with malaria before 24 weeks gestation had a higher risk of PTB (24% versus 18%, p = 0.005; adjusted relative risk [aRR] 1.30, 95% confidence interval [CI] 1.04-1.63, p = 0.021); and those who were malaria positive only before week 24 had an even greater risk of PTB (28% versus 17%, p = 0.02; with an aRR of 1.67, 95% CI 1.20-2.30, p = 0.002). Using linear mixed-effects modeling, malaria before 24 weeks gestation was associated with altered kinetics of inflammatory (C-Reactive Protein [CRP], Chitinase 3-like protein-1 [CHI3L1], Interleukin 18 Binding Protein [IL-18BP], soluble Tumor Necrosis Factor receptor II [sTNFRII], soluble Intercellular Adhesion Molecule-1 [sICAM-1]), angiogenic (soluble Endoglin [sEng]), and metabolic mediators (Leptin, Angiopoietin-like 3 [Angptl3]) over the course of pregnancy (χ2 > 13.0, p ≤ 0.001 for each). Limitations include being underpowered to assess the impact on nonviable births, being unable to assess women who had not received any antimalarials, and, because of the exposure to antimalarials in the second trimester, there were limited numbers of malaria infections late in pregnancy. CONCLUSIONS: Current interventions for the prevention of malaria in pregnancy are initiated at the first antenatal visit, usually in the second trimester. In this study, we found that many women are already malaria-infected by their first visit. Malaria infection before 24 weeks gestation was associated with dysregulation of essential regulators of angiogenesis, metabolism, and inflammation and an increased risk of PTB. Preventing malaria earlier in pregnancy may reduce placental dysfunction and thereby improve birth outcomes in malaria-endemic settings.


Assuntos
Malária Falciparum/complicações , Malária Falciparum/diagnóstico , Neovascularização Patológica , Complicações Infecciosas na Gravidez/diagnóstico , Nascimento Prematuro/prevenção & controle , Adulto , Estudos de Coortes , Feminino , Humanos , Recém-Nascido , Inflamação/complicações , Modelos Lineares , Malaui , Gravidez , Nascimento Prematuro/epidemiologia , Risco , Resultado do Tratamento , Ultrassonografia Pré-Natal , Adulto Jovem
17.
Am J Trop Med Hyg ; 101(6): 1424-1433, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31595873

RESUMO

Presently, it is difficult to accurately diagnose sepsis, a common cause of childhood death in sub-Saharan Africa, in malaria-endemic areas, given the clinical and pathophysiological overlap between malarial and non-malarial sepsis. Host biomarkers can distinguish sepsis from uncomplicated fever, but are often abnormal in malaria in the absence of sepsis. To identify biomarkers that predict sepsis in a malaria-endemic setting, we retrospectively analyzed data and sera from a case-control study of febrile Malawian children (aged 6-60 months) with and without malaria who presented to a community health center in Blantyre (January-August 2016). We characterized biomarkers for 29 children with uncomplicated malaria without sepsis, 25 without malaria or sepsis, 17 with malaria and sepsis, and 16 without malaria but with sepsis. Sepsis was defined using systemic inflammatory response criteria; biomarkers (interleukin-6 [IL-6], tumor necrosis factor receptor-1, interleukin-1 ß [IL-1ß], interleukin-10 [IL-10], von Willebrand factor antigen-2, intercellular adhesion molecule-1, and angiopoietin-2 [Ang-2]) were measured with multiplex magnetic bead assays. IL-6, IL-1ß, and IL-10 were elevated, and Ang-2 was decreased in children with malaria compared with non-malarial fever. Children with non-malarial sepsis had greatly increased IL-1ß compared with the other subgroups. IL-1ß best predicted sepsis, with an area under the receiver operating characteristic (AUROC) of 0.71 (95% CI: 0.57-0.85); a combined biomarker-clinical characteristics model improved prediction (AUROC of 0.77, 95% CI: 0.67-0.85). We identified a distinct biomarker profile for non-malarial sepsis and developed a sepsis prediction model. Additional clinical and biological data are necessary to further explore sepsis pathophysiology in malaria-endemic regions.


Assuntos
Malária Falciparum/complicações , Malária Falciparum/diagnóstico , Sepse/diagnóstico , Sepse/parasitologia , Biomarcadores/sangue , Estudos de Casos e Controles , Pré-Escolar , Citocinas/sangue , Feminino , Febre/parasitologia , Humanos , Lactente , Malaui , Masculino , Curva ROC , Estudos Retrospectivos
18.
Biomedica ; 39(2): 354-369, 2019 06 15.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31529822

RESUMO

Introduction: Malaria during pregnancy has a negative impact on maternal-neonatal health, with a high risk of clinic complications and mortality. High endemic areas are specially characterized by maternal anaemia and low birth weight. The clinical spectrum is little known in low endemic areas. Objective: To clinically and epidemiologically characterize malaria episodes in hospitalized pregnant women in the Department of Antioquia (Colombia) in the period 2010-2014. Materials and methods: Retrospective, cross-sectional, descriptive study with medical records of pregnant women with P. falciparum and P. vivax malaria. The WHO severe malaria diagnostic criteria and the Colombian Guía para la atención clínica integral del paciente con malaria (guidelines for comprehensive malaria treatment) were used. Results: We analyzed 111 cases, out of which 13.5% were classified as severe malaria according to the WHO criteria. Following the Colombian Guidelines, the proportion increased to 23.4%. Identified complications included hepatic dysfunction, anaemia, acidosis, and severe thrombocytopenia. No difference in the frequency of complications by Plasmodium species was observed; 39.4% of the cases presented general danger signs, pallor and jaundice being the most frequent; 40.5% showed danger signs for pregnancy, such as persistent headache, abdominal pain, and vaginal bleeding. Conclusions: Severe malaria is a highly frequent event in pregnant women, without differences by Plasmodium species. It shows early recognizable dangers signs. Hospital under-reporting was identified in 88% of severe cases as well as a lack of laboratory tests for a more comprehensive diagnosis. A protocol for the clinical diagnosis of pregnant women with malaria is required.


Assuntos
Malária Falciparum/epidemiologia , Malária Vivax/epidemiologia , Complicações Infecciosas na Gravidez/epidemiologia , Adolescente , Adulto , Anemia/etiologia , Colômbia/epidemiologia , Estudos Transversais , Feminino , Idade Gestacional , Cefaleia/etiologia , Hemorragia/etiologia , Humanos , Icterícia/etiologia , Malária Falciparum/complicações , Malária Vivax/complicações , Gravidez , Cuidado Pré-Natal , Estudos Retrospectivos , Centros de Cuidados de Saúde Secundários/estatística & dados numéricos , Fatores Socioeconômicos , Centros de Atenção Terciária/estatística & dados numéricos , Adulto Jovem
19.
Malar J ; 18(1): 302, 2019 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-31477117

RESUMO

BACKGROUND: Infection during pregnancy with Plasmodium falciparum is associated with maternal anaemia and adverse birth outcomes including low birth weight (LBW). Studies using polymerase chain reaction (PCR) techniques indicate that at least half of all infections in maternal venous blood are missed by light microscopy or rapid diagnostic tests. The impact of these subpatent infections on maternal and birth outcomes remains unclear. METHODS: In a cohort of women co-enrolled in a clinical trial of intermittent treatment with sulfadoxine-pyrimethamine (SP) plus azithromycin for the prevention of LBW (< 2500 g) in Papua New Guinea (PNG), P. falciparum infection status at antenatal enrolment and delivery was assessed by routine light microscopy and real-time quantitative PCR. The impact of infection status at enrolment and delivery on adverse birth outcomes and maternal haemoglobin at delivery was assessed using logistic and linear regression models adjusting for potential confounders. Together with insecticide-treated bed nets, women had received up to 3 monthly intermittent preventive treatments with SP plus azithromycin or a single clearance treatment with SP plus chloroquine. RESULTS: A total of 9.8% (214/2190) of women had P. falciparum (mono-infection or mixed infection with Plasmodium vivax) detected in venous blood at antenatal enrolment at 14-26 weeks' gestation. 4.7% of women had microscopic, and 5.1% submicroscopic P. falciparum infection. At delivery (n = 1936), 1.5% and 2.0% of women had submicroscopic and microscopic P. falciparum detected in peripheral blood, respectively. Submicroscopic P. falciparum infections at enrolment or at delivery in peripheral or placental blood were not associated with maternal anaemia or adverse birth outcomes such as LBW. Microscopic P. falciparum infection at antenatal enrolment was associated with anaemia at delivery (adjusted odds ratio [aOR] 2.00, 95% confidence interval [CI] 1.09, 3.67; P = 0.025). Peripheral microscopic P. falciparum infection at delivery was associated with LBW (aOR 2.75, 95% CI 1.27; 5.94, P = 0.010) and preterm birth (aOR 6.58, 95% CI 2.46, 17.62; P < 0.001). CONCLUSIONS: A substantial proportion of P. falciparum infections in pregnant women in PNG were submicroscopic. Microscopic, but not submicroscopic, infections were associated with adverse outcomes in women receiving malaria preventive treatment and insecticide-treated bed nets. Current malaria prevention policies that combine insecticide-treated bed nets, intermittent preventive treatment and prompt treatment of symptomatic infections appear to be appropriate for the management of malaria in pregnancy in settings like PNG.


Assuntos
Anemia/parasitologia , Recém-Nascido de Baixo Peso , Malária Falciparum/sangue , Malária Falciparum/complicações , Complicações Infecciosas na Gravidez/parasitologia , Adulto , Antibacterianos/administração & dosagem , Antimaláricos/administração & dosagem , Artemisininas/administração & dosagem , Infecções Assintomáticas , Azitromicina/administração & dosagem , Feminino , Hemoglobina A/análise , Humanos , Recém-Nascido , Malária Falciparum/prevenção & controle , Papua Nova Guiné , Plasmodium falciparum/genética , Gravidez , Resultado da Gravidez , Nascimento Prematuro , Estudos Prospectivos , Pirimetamina/administração & dosagem , Sulfadoxina/administração & dosagem , Adulto Jovem
20.
Malar J ; 18(1): 312, 2019 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-31533836

RESUMO

BACKGROUND: Anaemia is a major consequence of malaria, caused by the removal of both infected and uninfected red blood cells (RBCs) from the circulation. Complement activation and reduced expression of complement regulatory proteins (CRPs) on RBCs are an important pathogenic mechanism in severe malarial anaemia in both Plasmodium falciparum and Plasmodium vivax infection. However, little is known about loss of CRPs on RBCs during mild malarial anaemia and in low-density infection. METHODS: The expression of CRP CR1, CD55, CD59, and the phagocytic regulator CD47, on uninfected normocytes and reticulocytes were assessed in individuals from two study populations: (1) P. falciparum and P. vivax-infected patients from a low transmission setting in Sabah, Malaysia; and, (2) malaria-naïve volunteers undergoing P. falciparum induced blood-stage malaria (IBSM). For clinical infections, individuals were categorized into anaemia severity categories based on haemoglobin levels. For IBSM, associations between CRPs and haemoglobin level were investigated. RESULTS: CRP expression on RBC was lower in Malaysian individuals with P. falciparum and P. vivax mild malarial anaemia compared to healthy controls. CRP expression was also reduced on RBCs from volunteers during IBSM. Reduction occurred on normocytes and reticulocytes. However, there was no significant association between reduced CRPs and haemoglobin during IBSM. CONCLUSIONS: Removal of CRPs occurs on both RBCs and reticulocytes during Plasmodium infection even in mild malarial anaemia and at low levels of parasitaemia.


Assuntos
Anemia/parasitologia , Proteínas do Sistema Complemento/genética , Eritrócitos/metabolismo , Malária Falciparum/complicações , Malária Vivax/complicações , Adulto , Proteínas do Sistema Complemento/metabolismo , Eritrócitos/parasitologia , Feminino , Humanos , Malária Falciparum/parasitologia , Malária Vivax/parasitologia , Malásia , Masculino , Pessoa de Meia-Idade , Plasmodium falciparum/fisiologia , Plasmodium vivax/fisiologia , Adulto Jovem
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...